Tampa Difficulty Score

Robotic Hepatectomy Difficulty Scoring System

Our research team has developed the first tailored robotic hepatectomy difficulty scoring system, an innovative tool that quantifies case severity into a point-based system, effectively stratifying cases into distinct categories for optimized surgical planning and outcomes

Neoadjuvant Chemotherapy

No: 0
Yes: (+4)

Tumor Location

Segment 1: (+4)
Segment 2: (+2)
Segment 3: (+1)
Segment 4A: (+4)
Segment 4B: (+3)

Segment 5: (+3)
Segment 6: (+2)
Segment 7: (+5)
Segment 8: (+5)

Tumor Size

<3cm: 0
≥3cm: (+3)

Tumor Type

Benign: 0
Malignant: (+3)

Extent of Parenchymal Resection

Nonanatomical wedge resection: 0
Left lateral sectionectomy (segments 2&3): (+3)
Segmentectomy:(+6)
Left hepatic lobectomy: (+9)
Sectionectomy, right hepatic lobectomy, and extended hepatic lobectomy: (+12)
Lobectomy with complete caudate lobe resection: (+15)

Need for Portal Lymphadenectomy

No: 0
Yes: (+4)

Need for Extrahepatic Biliary Resection with Hepaticojejunal Reconstruction

No: 0
Yes: (+14)

Result:

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Team

Tampa Difficulty Score Research Team: Iswanto Sucandy MD, Michelle M. Dugan MD, Sharona B. Ross MD; Maria Christodoulou BS, Tara Menon Pattilachan BS, Cameron Syblis BS, Kaitlyn Crespo BS, Parisa Yazdankhah Kenary, Alexander Rosemurgy MD

Neoadjuvant chemotherapy

Neoadjuvant chemotherapy is considered in the scoring due to its potential impact on liver parenchyma and the complexity of the surgical procedure

Tumor Location and Size

Tumor characteristics, including location and size, are critical in planning the surgical approach and anticipating possible technical challenges

Tumor Type

Differentiating between benign and malignant tumors is crucial for surgical planning, as it may influence the extent of resection and operative strategy

Extent of Parenchymal Resection

The extent of resection is a significant factor in determining the complexity of the hepatectomy and in scoring robotic hepatectomies, which directly correlates with intraoperative challenges and postoperative outcomes.

Need for Portal Lymphadenectomy

Evaluating the need for portal lymphadenectomy is important for scoring robotic hepatectomies due to its association with operative complexity and potential implications for postoperative recovery.

Need for Extrahepatic Biliary Resection with Hepaticojejunostomy

Including this factor takes into account the additional surgical complexity and the increased risk of postoperative complications associated with biliary reconstructions; this is vital for scoring robotic hepatectomies.