Difficulty scores in laparoscopic liver surgery—getting closer to a powerful and necessary tool

摘要

Obtaining standardized difficulty scores for surgical techniques is mandatory. The more accurate the scores become, the better results may be achieved in terms of patients'' safety and surgical implementation. This need is especially useful when technically demanding and complex surgical procedures are performed. In this sense, liver resections are difficult procedures with high morbidity and mortality rates that should be performed by experienced surgeons. Hepatobiliary surgery has always been considered as a long-term project that needs patience, expertise and a progressive learning curve. Since the first reported laparoscopic liver resection in 1996, the adoption and implementation of minimally invasive liver surgery has been cautious. However, laparoscopic liver resections have experienced a wide expansion in recent years (1), mainly after the last Consensus Meeting held in Morioka in 2014 (2). One of the statements reported during this Consensus and in the latter European Guidelines Meeting held in Southampton in 2017 (3) is that a need for a safe expansion and control on technical procedures should be encouraged. In this context, liver surgical teams are trying to develop feasible tools that may standardize laparoscopic liver resections.