Hobeika C, Tribillon E, Marchese U, et al. - Researchers sought to validate the Institut Mutualiste Montsouris classification as a difficulty scoring system applicable to laparoscopic repeat liver resections. In addition, they investigated risk-factors of unexpected difficulty. They identified 205 laparoscopic repeat liver resections patients from a prospectively collected database between 2000 and 2019 and classified them according to the Institut Mutualiste Montsouris classification; 87, 25, and 93 procedures were classified as grade 1, 2, and 3 laparoscopic repeat liver resections, respectively. Following doubly robust adjustment, they identified association of the IMM classification with blood loss, operative time, and length of stay, as well as with the risk of both minor and severe complications and the chances of achieving textbook outcome. Independently from the Institut Mutualiste Montsouris classification, following were independent risk factors of unexpected difficulty: a first major hepatectomy and sinusoidal obstruction syndrome. Overall findings support the relevant utility of the Institut Mutualiste Montsouris classification as a difficulty scoring system for laparoscopic repeat liver resections procedures; previous major resection and presence of sinusoidal obstruction syndrome are likely to jeopardize the outcomes.