Journal of the American College of Surgeons · 2026
Validation of the Southampton Difficulty Scoring System in Robotic Liver Surgery and Development of the International RoboLiver Difficulty Scoring System.
СтатьяМногоцентровое исследованиеВалидационное исследованиеНазвание и аннотация: Перевод в очереди
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El Adel Soufyan, Pilz da Cunha Gabriela, Liu Rong, Sucandy Iswanto, Di Benedetto Fabrizio, D'Hondt Mathieu, Vrochides Dionisios, Croner Roland, Sparrelid Ernesto, Ratti Francesca, Geller David, Gallagher Tom K, Goh Brian Kp, Jovine Elio, Ahmad Jawad, Ruzzenente Andrea, Campos Ricardo Robles, White Steven, Efanov Mikhail, Memeo Ricardo, Cillo Umberto, Alzoubi Mohammed, Schmelzle Moritz, Alseidi Adnan, van Dieren Susan, Swijnenburg Rutger-Jan, Abu Hilal Mohammad
Аннотация
BACKGROUND: Robotic liver surgery (RLS) provides technical advantages over laparoscopic liver surgery, but no validated robotic-specific difficulty scoring system (DSS) exists. We evaluated the applicability of the Southampton DSS to RLS and developed a dedicated RLS difficulty model.
STUDY DESIGN: This multicenter retrospective cohort study included adults undergoing planned RLS across 24 international hepatobiliary centers. The Southampton DSS was assessed for calibration and discrimination in predicting intraoperative complications. Given limited performance, a robotic-specific model (International RoboLiver DSS) was developed using multivariable logistic regression with prolonged operative time (more than 280 minutes; 75th percentile) as a surrogate of technical difficulty. Model discrimination, calibration, and bootstrap internal validation were performed.
RESULTS: Among 1,497 RLS patients, higher Southampton DSS categories were associated with increased intraoperative complications (p = 0.003); however, discrimination was poor (area under the curve [AUC] 0.571, 95% CI 0.530 to 0.612) with miscalibration (slope 0.43; intercept 0.06). Independent predictors of prolonged operative time included neoadjuvant chemotherapy, earlier extrahepatic surgery, lesion greater than 50 mm, multiple lesions, bilobar disease, and technically or anatomically major resection. The International RoboLiver DSS demonstrated moderate discrimination (AUC 0.719, 95% CI 0.686 to 0.751) with excellent calibration (intercept 0.00; slope 1.14). Bootstrap validation confirmed model stability (corrected AUC 0.719).
CONCLUSIONS: Difficulty factors in RLS partially overlap with laparoscopic liver surgery but are not directly transferable. The International RoboLiver DSS provides a calibrated, robot-specific tool for preoperative complexity stratification and operative planning in RLS. External validation is required.
STUDY DESIGN: This multicenter retrospective cohort study included adults undergoing planned RLS across 24 international hepatobiliary centers. The Southampton DSS was assessed for calibration and discrimination in predicting intraoperative complications. Given limited performance, a robotic-specific model (International RoboLiver DSS) was developed using multivariable logistic regression with prolonged operative time (more than 280 minutes; 75th percentile) as a surrogate of technical difficulty. Model discrimination, calibration, and bootstrap internal validation were performed.
RESULTS: Among 1,497 RLS patients, higher Southampton DSS categories were associated with increased intraoperative complications (p = 0.003); however, discrimination was poor (area under the curve [AUC] 0.571, 95% CI 0.530 to 0.612) with miscalibration (slope 0.43; intercept 0.06). Independent predictors of prolonged operative time included neoadjuvant chemotherapy, earlier extrahepatic surgery, lesion greater than 50 mm, multiple lesions, bilobar disease, and technically or anatomically major resection. The International RoboLiver DSS demonstrated moderate discrimination (AUC 0.719, 95% CI 0.686 to 0.751) with excellent calibration (intercept 0.00; slope 1.14). Bootstrap validation confirmed model stability (corrected AUC 0.719).
CONCLUSIONS: Difficulty factors in RLS partially overlap with laparoscopic liver surgery but are not directly transferable. The International RoboLiver DSS provides a calibrated, robot-specific tool for preoperative complexity stratification and operative planning in RLS. External validation is required.