{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T18:29:45Z","timestamp":1791484185365,"version":"4.3.4"},"reference-count":29,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2018,9,17]],"date-time":"2018-09-17T00:00:00Z","timestamp":1537142400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["16H05417"],"award-info":[{"award-number":["16H05417"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Hepato Biliary Pancreat"],"published-print":{"date-parts":[[2018,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Several factors affect the level of difficulty of laparoscopic distal pancreatectomy (<jats:styled-content style=\"fixed-case\">LDP<\/jats:styled-content>). The purpose of this study was to develop a difficulty scoring (<jats:styled-content style=\"fixed-case\">DS<\/jats:styled-content>) system to quantify the degree of difficulty in <jats:styled-content style=\"fixed-case\">LDP<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We collected clinical data for 80 patients who underwent LDP. A 10\u2010level difficulty index was developed and subcategorized into a three\u2010level difficulty index; 1\u20133 as low, 4\u20136 as intermediate, and 7\u201310 as high index. The automatic linear modeling (LINEAR) statistical tool was used to identify factors that significantly increase level of difficulty in LDP.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The operator's 10\u2010level <jats:styled-content style=\"fixed-case\">DS<\/jats:styled-content> concordance between the 10\u2010level <jats:styled-content style=\"fixed-case\">DS<\/jats:styled-content> by the reviewers, LINEAR index <jats:styled-content style=\"fixed-case\">DS<\/jats:styled-content>, and clinical index <jats:styled-content style=\"fixed-case\">DS<\/jats:styled-content> systems were analyzed, and the weighted Cohen's kappa statistic were at 0.869, 0.729, and 0.648, respectively, showing good to excellent inter\u2010rater agreement. We identified five factors significantly affecting level of difficulty in LDP; type of operation, resection line, proximity of tumor to major vessel, tumor extension to peripancreatic tissue, and left\u2010sided portal hypertension\/splenomegaly.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This novel <jats:styled-content style=\"fixed-case\">DS<\/jats:styled-content> for LDP adequately quantified the degree of difficulty, and can be useful for selecting patients for LDP, in conjunction with fitness for surgery and prognosis.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jhbp.578","type":"journal-article","created":{"date-parts":[[2018,8,17]],"date-time":"2018-08-17T20:22:15Z","timestamp":1534537335000},"page":"489-497","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":55,"title":["Difficulty scoring system in laparoscopic distal pancreatectomy"],"prefix":"10.1002","volume":"25","author":[{"given":"Takao","family":"Ohtsuka","sequence":"first","affiliation":[{"name":"Department of Surgery and Oncology Graduate School of Medical Sciences Kyushu University Fukuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daisuke","family":"Ban","sequence":"additional","affiliation":[{"name":"Department of Hepatobiliary and Pancreatic Surgery Graduate School of Medicine Tokyo Medical and Dental University Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiharu","family":"Nakamura","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal and Hepato\u2010Biliary\u2010Pancreatic Surgery Nippon Medical School Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuichi","family":"Nagakawa","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal and Pediatric Surgery Tokyo Medical University Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minoru","family":"Tanabe","sequence":"additional","affiliation":[{"name":"Department of Hepatobiliary and Pancreatic Surgery Graduate School of Medicine Tokyo Medical and Dental University Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshitaka","family":"Gotoh","sequence":"additional","affiliation":[{"name":"Department of Surgery and Oncology Graduate School of Medical Sciences Kyushu University Fukuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vittoria Vanessa D. 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