Background Liver resections have classically been distinguished as "minor" or "major" based on the number of segments removed. However, it is clear that the number of segments alone does not convey the complexity of a resection. To date, no study has formally assessed the complexity of various anatomic liver resections.
Study Design A 4-question survey was administered to 135 expert liver surgeons in 14 countries. The first 3 questions related to the country in which the surgeon was practicing and the surgeon's experience. In the fourth question, the experts were asked to rate the difficulty of various open, anatomic liver resections on a scale of 1 to 10.
Results Sixty-six of 135 (48.9%) surgeons responded to the survey. Twelve procedures were rated. The lowest mean score of 1.37 - indicating least difficulty - was given to peripheral wedge resection. Left trisectionectomy with caudate resection was deemed most difficult, with a score of 8.28. The mean scores for the 2 procedures perceived as least difficult - peripheral wedge resection and left lateral sectionectomy - were lower than the mean scores of all the rest of the procedures at a highly statistically significant level (p < 0.0001). The 4 procedures with the highest scores shared the common attribute that they involved the right intersectional plane.
Conclusions These data represent the first quantitative assessment of the perceived difficulty of a variety of liver resections. The complexity scores generated allow for separation of liver resections into 3 categories of complexity (low complexity, medium complexity, and high complexity) on a quantitative basis.