{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T02:38:19Z","timestamp":1792550299795,"version":"4.5.0"},"reference-count":23,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T00:00:00Z","timestamp":1789257600000},"content-version":"vor","delay-in-days":255,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Asian J Endoscop Surgery"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>This study evaluated the association of the IWATE difficulty score with conversion to open surgery and perioperative outcomes after laparoscopic liver resection and explored the association between cirrhosis and conversion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single\u2010center retrospective cohort included 84 consecutive patients who underwent planned laparoscopic liver resection in Vietnam between January 2024 and March 2026. Patients were classified into low\/intermediate and advanced\/expert IWATE groups. The primary outcome was conversion to open surgery. Secondary outcomes included operative time, intraoperative blood loss, perioperative blood transfusion, 90\u2010day postoperative complications, and postoperative length of hospital stay. Discrimination for conversion was assessed using receiver operating characteristic analysis. Exploratory logistic regression analyses evaluated the associations of IWATE difficulty and cirrhosis with conversion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Fifty\u2010three patients had low\/intermediate and 31 had advanced\/expert difficulty. Conversion occurred in 4 of 53 patients (7.5%) and 12 of 31 patients (38.7%), respectively (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001). Advanced\/expert difficulty remained associated with conversion after adjustment for overall cirrhosis status (adjusted odds ratio, 6.30; 95% confidence interval, 1.54\u201325.79;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.010). Overall cirrhosis was also associated with conversion (adjusted odds ratio, 13.29; 95% confidence interval, 3.32\u201353.19;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). A sensitivity analysis restricted to cirrhosis documented before surgery showed similar exploratory associations, although confidence intervals were wide. The advanced\/expert group had longer operative time, greater intraoperative blood loss, more 90\u2010day postoperative complications, and longer postoperative hospital stay. The area under the receiver operating characteristic curve was 0.834 (95% confidence interval, 0.717\u20130.951); an exploratory cutoff of \u2265\u20098 provided 68.8% sensitivity and 85.3% specificity. Of the 16 conversions, 11 were bleeding\u2010related and five were non\u2010bleeding\u2010related.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Higher IWATE difficulty was associated with conversion to open surgery and worse perioperative outcomes. Cirrhosis showed an exploratory association with conversion after adjustment for IWATE difficulty, but these findings require confirmation in larger cohorts.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ases.70380","type":"journal-article","created":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T05:29:07Z","timestamp":1789363747000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association of the\n                    <scp>IWATE<\/scp>\n                    Difficulty Score With Conversion to Open Surgery and Perioperative Outcomes After Laparoscopic Liver Resection"],"prefix":"10.1111","volume":"19","author":[{"given":"Lai Thien","family":"Vo","sequence":"first","affiliation":[{"name":"Department of Liver Tumor Binh Dan Hospital  Ho Chi Minh City Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-5325-129X","authenticated-orcid":false,"given":"Kim Hoai","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Liver Tumor Binh Dan Hospital  Ho Chi Minh City Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ho","family":"Tran","sequence":"additional","affiliation":[{"name":"Department of General Surgery Binh Dan Hospital  Ho Chi Minh City Vietnam"},{"name":"Department of General Surgery University of Medicine and Pharmacy at Ho Chi Minh City  Ho Chi Minh City Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Binh Xuan","family":"Dau","sequence":"additional","affiliation":[{"name":"Department of Liver Tumor Binh Dan Hospital  Ho Chi Minh City Vietnam"},{"name":"Department of General Surgery Faculty of Medicine, University of Health Sciences\u2010Viet Nam National University ho Chi Minh City  Ho Chi Minh City Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thanh Phuoc Cong","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Liver Tumor Binh Dan Hospital  Ho Chi Minh City Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-8169-4994","authenticated-orcid":false,"given":"Phuoc Thanh","family":"Bui","sequence":"additional","affiliation":[{"name":"Department of Liver Tumor Binh Dan Hospital  Ho Chi Minh City Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phat Thuan","family":"Tran","sequence":"additional","affiliation":[{"name":"Department of Liver Tumor Binh Dan Hospital  Ho Chi Minh City Vietnam"},{"name":"Department of General Surgery Faculty of Medicine, University of Health Sciences\u2010Viet Nam National University ho Chi Minh City  Ho Chi Minh City Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,13]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.10252"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.21037\/hbsn.2016.03.03"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13304-015-0302-7"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1089\/lap.2025.0041"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000002332"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/hpb.12077"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/jhbp.166"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2018.10.012"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-021-08561-4"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2021.12.253"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/jhbp.731"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00423-025-03612-z"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/jhbp.576"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2025.109597"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-020-08018-0"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00423-022-02435-6"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-023-10431-0"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1089\/lap.2011.0334"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00423-018-1671-4"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/jhbp.12003"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.14701\/ahbps.26-001"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1089\/lap.2019.0701"},{"key":"e_1_2_12_24_1","first-page":"237","article-title":"Learning Curve of 150 Laparoscopic Liver Resections in a Single Center","volume":"7","author":"Ramiro A. 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