A new framework for tailoring laparoscopic cholecystectomy: Integrating preoperative clinical factors with surgical difficulty based on the Tokyo Guidelines 2018

Abstract

Purpose: The Tokyo Guidelines 2018 introduced the Surgical Difficulty Score (TGDS18) to assess laparoscopic cholecystectomy (LC) difficulty based on intraoperative findings. This study aimed to predict surgical difficulty preoperatively using clinical factors correlated with TGDS18. Methods: Of 369 LC cases for cholecystitis (Jan 2014–Jul 2024), 106 with operative video data were analyzed. Multivariate analysis of 69 with preoperative CT (≤14 days) evaluated the association between preoperative clinical findings and TGDS18 sub-scores (around the gallbladder, Calot's triangle, gallbladder bed, additional findings, unrelated to inflammation). Results: TGDS18 was positively correlated with operative time, blood loss, and hospital stay (all p