A simple difficulty scoring system for laparoscopic total mesorectal excision
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ORIGINAL ARTICLE
A simple difficulty scoring system for laparoscopic total mesorectal excision Dimitri Krizzuk1 · Shlomo Yellinek1 · Albert Parlade2 · Hong Liang3 · Giovanna Dasilva1 · Steven D. Wexner1 Received: 16 March 2020 / Accepted: 25 June 2020 © Springer Nature Switzerland AG 2020
Abstract Background The proposed difficulty scoring system (DSS) may aid in preoperative planning for laparoscopic total mesorectal excision (L-TME) for rectal cancer. Methods Fifty-three patients [28 males; 59.0 (31.0–88.0) years of age] treated for rectal cancer at our institution from 2/2011–5/2018 were identified. “Difficult operation” (DO) was defined as the presence of ≥3 factors: operative time ≥320 min, estimated blood loss >250 ml, intraoperative complications, conversion to laparotomy, >2 stapler applications, incomplete TME quality, and/or subjective perceived difficulty. Univariate analysis and multivariate logistic regression model with backward elimination method were used to obtain a DSS which consists of two factors: sex (male = 1 and female = 0) and body mass index (BMI) (≥30 kg/m2 = 1, 250 ml, presence of intraoperative complications, conversion to laparotomy, >2 stapler applications, incomplete TME quality, and/or a subjective judgment of the difficulty of the operation. The parameters were chosen based on clinical experience and data from the published literature [15–19]. All parameters were weighted equally and their cutoff value was derived from the highest Youden index. Only 30% patients had 3 or more of 7 difficulty parameters, and 30% percentile or cutoff value of 3 was used to define a DO in this study. Due to the retrospective nature of the study, there were no available
Techniques in Coloproctology Fig. 1 Pelvimetry measurements. a Interspinous distance (distance between the tips of the ischial spines) measured on axial sections. b Intertuberous distance (distance between the lowest points of the ischial tuberosities) measured on axial images. c Sagittal T2-weighted image showing the pelvic inlet (i) distance from the superior aspect of the pubic symphysis to the promontory, pelvic outlet (ii) distance from the inferior aspect of the pubic symphysis to the tip of the coccyx, and pelvic depth (iii) distance from the promontory to the tip of the coccyx). d Transverse diameter (distance between the outermost points of the iliopectineal lines) measured on reformatted oblique coronal T2-weighted image
data that would enable the authors to analyze a disbanded procedure; hence, the surgery was evaluated. Moreover, the absence of video data for all the cases hindered the possibility to create an objective clinical human reliability analysis (OCHRA) for evaluation of difficulty parameters. Univariate analysis was performed to assess the association between the preoperative factors and a DO. Chisquare test or Fisher’s exact test, when appropriate, was used for categorical factors, while Wilcoxon’s rank-sum test was applied for continuous factors. In addition, multivariate logistic regression model with
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