Updates in Surgery

, Volume 71, Issue 1, pp 49–56 | Cite as

Ultrasound liver map technique for laparoscopic liver resections: perioperative outcomes are not impaired by technical complexity

  • Alessandro FerreroEmail author
  • Nadia Russolillo
  • Serena Langella
  • Fabio Forchino
  • Matteo Stasi
  • Federico Fazio
  • Roberto Lo Tesoriere
Original Article


Intraoperative liver ultrasound has a crucial role to guide open liver surgery. A 4-step ultrasound liver map technique for laparoscopic liver resection (LLR) has been standardized in our center. The aim of this study was to evaluate outcomes of our technique according to the hepatectomy technical complexity. A difficulty scale (DS) ranging from 1 to 10 was applied to each LLR. A cumulative sum control-chart analysis identified 3 periods of gradually increasing DS. Perioperative outcomes of the 3 periods were compared. 300 LLRs performed between 2006 and 2018 were analyzed. Median DS was 3 for first 100 cases (P1), 5 for cases 101–200 (P2) and 6 for cases 201–300 (P3). A significantly greater percentage of postero-superior segments resections (P1 11%, P2 36%, P3 46%, p < 0.001) were performed in P3. P3 LLRs had a significantly longer transection time (p < 0.001) and wider cut surface area (p < 0.001), but median blood losses were similar among the 3 periods (P1 100 cc, P2 100 cc, P3 140 cc). There were no differences among periods in overall morbidity (P1 12%, P2 17%, P3 17%), major morbidity (P1 1%, P2 2%, P3 3%) and length of hospital stay (5 days in all the three groups). Despite the increasing surgical complexity of LLR, ultrasound liver map technique allows good perioperative outcomes.


Intraoperative liver ultrasound Laparoscopic liver resection Technical difficulty 



We thank Denise Di Salvo, MS, from Edanz Group ( for editing a draft of this manuscript.


The authors have no funding to report.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Appropriate consent was obtained from all individual participant included in this study.

Supplementary material

Supplementary material 1 (MP4 359776 kb)


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Copyright information

© Italian Society of Surgery (SIC) 2019

Authors and Affiliations

  • Alessandro Ferrero
    • 1
    Email author
  • Nadia Russolillo
    • 1
  • Serena Langella
    • 1
  • Fabio Forchino
    • 1
  • Matteo Stasi
    • 1
  • Federico Fazio
    • 1
  • Roberto Lo Tesoriere
    • 1
  1. 1.Department of General and Oncological surgeryMauriziano HospitalTurinItaly

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