Ultrasound-guided laparoscopic liver resections
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Intraoperative liver ultrasound has an established role in liver surgery to complete staging and to guide resection. The same performances should be expected by laparoscopic ultrasound (LUS).
LUS is first performed to identify relationships between tumor and vasculo-biliary pedicles. The planes where the main vascular structures run are marked on the liver surface. Parenchymal transection is performed and each vessel recognized during LUS exploration is divided.
From 01/2009 to 10/2013, in 61 out of 742 liver resections (8.2 %), a laparoscopic approach was attempted. The conversion rate was 9.8 % (six patients). No conversion was related to bleeding or intraoperative complications. The remnant 55 patients were affected by benign lesions in 11 cases and malignant tumors in 44. The resections included 3 left hepatectomies, 14 bisegmentectomies Sg2–3, 5 segmentectomies, and 38 wedge resections. Associated procedures were performed in eight patients (14.5 %), including four colorectal resections. Median duration of surgery was 150 min (60–345 min). Median operative blood loss was 100 mL (0–500 mL). Median size of resected tumor was 2.5 cm (0.9–8 cm). Median surgical margin in oncological resections was 7 mm (0–50 mm). Postoperative complications occurred in four patients (7.2 %), all grade 2 according to Dindo classification. No liver-related morbidity occurred. Median length of hospital stay was 5 days (3–9 days).
Ultrasound-guided liver resections can be performed by laparoscopic approach with the same accuracy than open surgery.
KeywordsLaparoscopy Liver surgery Ultrasound
Drs. Alessandro Ferrero, Roberto Lo Tesoriere, Nadia Russolillo, Luca Viganò, Fabio Forchino, and Lorenzo Capussotti have no conflicts of interest or financial ties to disclose.
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