Surgical Endoscopy

, Volume 32, Issue 10, pp 4071–4077 | Cite as

Intraoperative ultrasonography of robot-assisted laparoscopic hepatectomy: initial experiences from 110 consecutive cases

  • Peng Zhu
  • Wei Liao
  • Ze-yang Ding
  • Hong-chang Luo
  • Bin-hao Zhang
  • Wan-guang Zhang
  • Wei Zhang
  • Zhan-guo Zhang
  • Bi-xiang ZhangEmail author
  • Xiao-ping ChenEmail author



To evaluate the safety and efficacy of IOUS in robotic liver surgery and propose a standard protocol of IOUS for safe robot-assisted hepatectomy.


Between February 2015 and December 2016, liver resection was performed in 110 patients with robotic approach in Tongji Hospital. In these patients, IOUS was routinely performed. All data about demographic, surgical procedure, postoperative course were collected prospectively and analyzed.


A four steps IOUS protocol in robotic liver surgery was proposed, including exploration, verification, guidance, and confirmation. A total of 11 additional lesions in 11 patients were detected and 7 patients accepted strategic surgical modification. No patient suffered from any single or multiple organ dysfunctions, and there were no mortalities observed.


IOUS is indispensable to understand lesions and vessels in robotic liver surgery. A four-step standard protocol of IOUS is essential for safe robot-assisted hepatectomy.


Robot Ultrasonography Hepatectomy Laparoscopic 



We are sincerely grateful to Dr. Satish Nadig (Department of Surgery, Medical University of South Carolina, USA) for language assistance and valuable suggestions.


Grants from the Chinese Ministry of Public Health for Key Clinical Projects (No. 2012ZX10002016). Grants from Hubei Province for Key Clinical Projects (No. 2018ACA137).

Author contributions

P.Z. perform the operation, analysis and interpretation of data, draft and revise the article. W.L., Z.-Y.D., B.-H.Z., W.-G.Z. acquisition and analysis of data. H.-C.L.: explanation of ultrasonic data. B.-X.Z., X.-P.C.: conception and design, perform the operation.

Compliance with ethical standards


Peng Zhu, Wei Liao, Ze-yang Ding, Hong-chang Luo, Bin-hao Zhang, Wan-guang Zhang, Wei Zhang, Zhan-guo Zhang, Bi-xiang Zhang, Xiao-ping Chen have no conflicts of interest or financial ties to disclose.


  1. 1.
    Tranchart H, Ceribelli C, Ferretti S, Dagher I, Patriti A (2014) Traditional versus robot-assisted full laparoscopic liver resection: a matched-pair comparative study. World J Surg 38:2904–2909CrossRefGoogle Scholar
  2. 2.
    Vigano L, Laurent A, Tayar C, Tomatis M, Ponti A, Cherqui D (2009) The learning curve in laparoscopic liver resection: improved feasibility and reproducibility. Ann Surg 250:772–782CrossRefGoogle Scholar
  3. 3.
    Ishizawa T, Gumbs AA, Kokudo N, Gayet B (2012) Laparoscopic segmentectomy of the liver: from segment I to VIII. Ann Surg 256:959–964CrossRefGoogle Scholar
  4. 4.
    Coelho FF (2016) Laparoscopic liver resection: experience based guidelines. World J Gastrointest Surg 8:5CrossRefGoogle Scholar
  5. 5.
    Mostaedi R, Milosevic Z, Han HS, Khatri VP (2012) Laparoscopic liver resection: current role and limitations. World J Gastrointest Oncol 4:187–192CrossRefGoogle Scholar
  6. 6.
    Han HS, Shehta A, Ahn S, Yoon YS, Cho JY, Choi Y (2015) Laparoscopic versus open liver resection for hepatocellular carcinoma: case-matched study with propensity score matching. J Hepatol 63:643–650CrossRefGoogle Scholar
  7. 7.
    Qiu J, Chen S, Chengyou D (2016) A systematic review of robotic-assisted liver resection and meta-analysis of robotic versus laparoscopic hepatectomy for hepatic neoplasms. Surg Endosc 30:862–875CrossRefGoogle Scholar
  8. 8.
    Pelletier JS, Gill RS, Shi X, Birch DW, Karmali S (2013) Robotic-assisted hepatic resection: a systematic review. Int J Med Robot Comput Assisted Surg 9:262–267CrossRefGoogle Scholar
  9. 9.
    Buell JF, Cherqui D, Geller DA, O’Rourke N, Iannitti D, Dagher I, Koffron AJ, Thomas M, Gayet B, Han HS, Wakabayashi G, Belli G, Kaneko H, Ker CG, Scatton O, Laurent A, Abdalla EK, Chaudhury P, Dutson E, Gamblin C, D’Angelica M, Nagorney D, Testa G, Labow D, Manas D, Poon RT, Nelson H, Martin R, Clary B, Pinson WC, Martinie J, Vauthey JN, Goldstein R, Roayaie S, Barlet D, Espat J, Abecassis M, Rees M, Fong Y, McMasters KM, Broelsch C, Busuttil R, Belghiti J, Strasberg S, Chari RS, World Consensus Conference on Laparoscopic S (2009) The international position on laparoscopic liver surgery: the Louisville Statement, 2008. Ann Surg 250:825–830CrossRefGoogle Scholar
  10. 10.
    Wakabayashi G, Cherqui D, Geller DA, Buell JF, Kaneko H, Han HS, Asbun H, O’Rourke N, Tanabe M, Koffron AJ, Tsung A, Soubrane O, Machado MA, Gayet B, Troisi RI, Pessaux P, Van Dam RM, Scatton O, Abu Hilal M, Belli G, Kwon CH, Edwin B, Choi GH, Aldrighetti LA, Cai X, Cleary S, Chen KH, Schon MR, Sugioka A, Tang CN, Herman P, Pekolj J, Chen XP, Dagher I, Jarnagin W, Yamamoto M, Strong R, Jagannath P, Lo CM, Clavien PA, Kokudo N, Barkun J, Strasberg SM (2015) Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka. Ann Surg 261:619–629PubMedGoogle Scholar
  11. 11.
    Lai EC, Yang GP, Tang CN (2013) Robot-assisted laparoscopic liver resection for hepatocellular carcinoma: short-term outcome. Am J Surg 205:697–702CrossRefGoogle Scholar
  12. 12.
    Makuuchi M, Hasegawa H, Yamazaki S (1985) Ultrasonically guided subsegmentectomy. Surg Gynecol Obstetric 161:346–350Google Scholar
  13. 13.
    Castaing D, Emond J, Kunstlinger F, Bismuth H (1986) Utility of operative ultrasound in the surgical management of liver tumors. Ann Surg 204:600–605CrossRefGoogle Scholar
  14. 14.
    Vigano L, Ferrero A, Amisano M, Russolillo N, Capussotti L (2013) Comparison of laparoscopic and open intraoperative ultrasonography for staging liver tumours. Br J Surg 100:535–542CrossRefGoogle Scholar
  15. 15.
    Schneider CM, Peng PD, Taylor RH, Dachs GW 2nd, Hasser CJ, DiMaio SP, Choti MA (2012) Robot-assisted laparoscopic ultrasonography for hepatic surgery. Surgery 151:756–762CrossRefGoogle Scholar
  16. 16.
    Ferrero A, Lo Tesoriere R, Russolillo N, Vigano L, Forchino F, Capussotti L (2015) Ultrasound-guided laparoscopic liver resections. Surg Endosc 29:1002–1005CrossRefGoogle Scholar
  17. 17.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefGoogle Scholar
  18. 18.
    Balzan S, Belghiti J, Farges O, Ogata S, Sauvanet A, Delefosse D, Durand F (2005) The “50-50 criteria” on postoperative day 5: an accurate predictor of liver failure and death after hepatectomy. Ann Surg 242:824–828 discussion 828-829 CrossRefGoogle Scholar
  19. 19.
    Araki K, Conrad C, Ogiso S, Kuwano H, Gayet B (2014) Intraoperative ultrasonography of laparoscopic hepatectomy: key technique for safe liver transection. J Am Coll Surg 218:e37–e41CrossRefGoogle Scholar
  20. 20.
    Makuuchi M, Hasegawa H, Yamazaki S, Takayasu K, Moriyama N (1987) The use of operative ultrasound as an aid to liver resection in patients with hepatocellular carcinoma. World J Surg 11:615–621CrossRefGoogle Scholar
  21. 21.
    Parker GA, Lawrence W Jr, Horsley JS 3rd, Neifeld JP, Cook D, Walsh J, Brewer W, Koretz MJ (1989) Intraoperative ultrasound of the liver affects operative decision making. Ann Surg 209:569–576 discussion 576–567 CrossRefGoogle Scholar
  22. 22.
    Ishizawa T, Saiura A, Kokudo N (2016) Clinical application of indocyanine green-fluorescence imaging during hepatectomy. Hepatobiliary Surg Nutr 5:322–328CrossRefGoogle Scholar
  23. 23.
    Leen E, Ceccotti P, Moug SJ, Glen P, MacQuarrie J, Angerson WJ, Albrecht T, Hohmann J, Oldenburg A, Ritz JP, Horgan PG (2006) Potential value of contrast-enhanced intraoperative ultrasonography during partial hepatectomy for metastases: an essential investigation before resection? Ann Surg 243:236–240CrossRefGoogle Scholar
  24. 24.
    Donadon M, Botea F, Del Fabbro D, Palmisano A, Montorsi M, Torzilli G (2008) The surgical policy predicts the impact of contrast enhanced intraoperative ultrasound for colorectal liver metastases. Eur J Radiol 67:177–178CrossRefGoogle Scholar
  25. 25.
    Strasberg S, Belghiti J, Clavien P-A, Gadzijev E, Garden J, Lau W-Y, Makuuchi M, Strong R (2000) The Brisbane 2000 terminology of liver anatomy and resections. HPB 2:333–339CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Peng Zhu
    • 1
  • Wei Liao
    • 1
  • Ze-yang Ding
    • 1
  • Hong-chang Luo
    • 2
  • Bin-hao Zhang
    • 1
  • Wan-guang Zhang
    • 1
  • Wei Zhang
    • 1
  • Zhan-guo Zhang
    • 1
  • Bi-xiang Zhang
    • 1
    Email author
  • Xiao-ping Chen
    • 1
    Email author
  1. 1.Hepatic Surgery Center, Tongji HospitalTongji Medical College, Huazhong University of Science and TechnologyWuhanChina
  2. 2.Medical Ultrasound Department, Tongji HospitalTongji Medical College, Huazhong University of Science and TechnologyWuhanChina

Personalised recommendations