AUTHOR=Sun Hongfa , Sun Chuandong , Zhang Bingyuan , Ma Kai , Wu Zehua , Visser Brendan C. , Han Bing 

TITLE=Establishment and Application of a Novel Difficulty Scoring System for da Vinci Robotic Pancreatoduodenectomy

JOURNAL=Frontiers in Surgery

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2022.916014

DOI=10.3389/fsurg.2022.916014

ISSN=2296-875X

ABSTRACT=Background: Robot-assisted pancreatoduodenectomy (RPD) technology is developing rapidly, but there is still a lack of a specific and objective difficulty evaluation system in the field of application and training of RPD surgery. 
Methods: The clinical data of patients who underwent RPD in our hospital from November 2014 to October 2020 were analyzed retrospectively. Univariate and multivariate logistic regression analysis were used to determine the predictors of operation difficulty, and converted into a scoring system.
Results: A total of 72 patients were enrolled in the group. According to the operation time (25%), intraoperative blood loss (25%), conversion to laparotomy and major complications, the difficulty of operation was divided into low difficulty (0~2point) and high difficulty (3~4point). The multivariate logistic regression model included the thickness of mesenteric tissue (P1)(P=0.035), the thickness of the abdominal wall (B1)(P=0.017) and the preoperative albumin (P=0.032), and nomogram was established. AUC=0.773 (0.645-0.901). 
Conclusions: The RPD difficulty evaluation system based on the specific anatomical relationship between Davinci's laparoscopic robotic arm and tissues/organs in the operation area can be used as a predictive tool to evaluate the surgical difficulty of patients before operation and guide clinical practice.