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Surgical Endoscopy
Published in: Surgical Endoscopy 6/2008

01-06-2008

Liver resection with intraoperative and laparoscopic ultrasound: report of 32 cases

Ultrasonic shears device for liver parenchymal transection

Authors: Domenico Piccolboni, Francesco Ciccone, Anna Settembre, Francesco Corcione

Published in: Surgical Endoscopy | Issue 6/2008

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Abstract

Background

Careful staging of hepatic tumors is mandatory for appropriate selection of patients for liver resection. Number and relationships of liver nodules are issues of utmost importance when evaluating resectability. Sensitivity of preoperative imaging for secondary lesions has been reported between 60–75% with spiral contrast-enhanced computed cosmography (CT), 80–85% with magnetic resonance imaging (MRI), and 90–96% with intraoperative ultrasound (IOUS). Also for primary lesions IOUS has been reported to allow detection of liver nodules in 17% and modify surgical strategy in 10%. The aim of this study was to point out the usefulness of open (IOUS) and laparoscopic (LIOUS) ultrasound in patients undergoing hepatic surgery for liver tumors.

Methods

In the years 2004–2006, 50 patients, mean age 66 years (range 44–76 years) were evaluated for resective surgery at the General Surgery Department of Monaldi Hospital, Naples, Italy. All of them were studied with biphasic CT and transabdominal ultrasound. Eighteen (36%) were judged unresectable. The others were scheduled for laparoscopy and LIOUS, by means of an ALOKA SSD–5500 (Aloka Co. Ltd. Tokyo, Japan), equipped with linear flexible tip laparoscopic probe.

Results

Six patients (18.7%) were excluded because of pathology diffusion; 26 (81.3%) were resected, using ultrasonic shears (Harmonic ACE, Ethicon Endo-Surgery, Cincinnati Oh., USA) for parenchymal transection, 3 (11.5%) laparoscopically and 23 (88.5%) after laparotomy. IOUS was repeated in the latter group. LIOUS spared useless laparotomies in six patients (18.7%) and, coupled with IOUS, found undetected nodes in five patients (19.2%), changing surgical strategy in three patients (11.5%).

Conclusion

In our experience LIUOS and IOUS proved to be of utmost importance both in the selection of patients for resective surgery and in planning surgical approach. Ultrasonic shears device and systematic pedicle clamping sped up resection time and reduced intraoperative bleeding.
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Metadata
Title
Liver resection with intraoperative and laparoscopic ultrasound: report of 32 cases
Ultrasonic shears device for liver parenchymal transection
Authors
Domenico Piccolboni
Francesco Ciccone
Anna Settembre
Francesco Corcione
Publication date
01-06-2008
Publisher
Springer-Verlag
Published in
Surgical Endoscopy / Issue 6/2008
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-008-9886-z

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