title: Ultrasound-guided interventional procedures of the liver during laparoscopy: technical considerations.
abstract: BACKGROUND
  The increased application of laparoscopy to oncological cases has also expanded the applications of laparoscopic ultrasound (LUS). LUS-guided interventional procedures are often used for the staging of neoplastic disease. However, considerable expertise is required to perform the US-guided maneuvers.
  
  
  METHODS
  Based on our 7-year experience with laparoscopic ultrasound, we discuss a number of technical and practical aspects related to the performance of interventional procedures during LUS of the liver.
  
  
  RESULTS
  We performed 146 laparoscopic ultrasound exams in patients with neoplastic diseases. In all, 244 liver lesions were biopsied and 151 needle placements were made to perform radiofrequency ablation or ethanol injection. We discuss our choice of laparoscopic equipment and type of needle required (whether for biopsies or for interventional procedures). We also describe the technical characteristics of ultrasound probes and equipment, the correct approach to the patient, and the method that we employ to identify and then puncture the target lesion.
  
  
  CONCLUSIONS
  The proper technique for interventional procedures during laparoscopic ultrasound can be mastered relatively quickly by a surgeon who is already familiar with traditional ultrasound techniques.
authors.affiliation: Dipartimento di Medicina e Chirurgia San Paolo, Clinica Chirurgica, Università degli Studi di Milano, via A. di Rudinì 8, Milan, Italy. rsantambzogia@mclink.it
authors.forename: R
authors.initials: R
authors.lastname: Santambrogio
authors.forename: P
authors.initials: P
authors.lastname: Bianchi
authors.forename: A
authors.initials: A
authors.lastname: Pasta
authors.forename: A
authors.initials: A
authors.lastname: Palmisano
authors.forename: M
authors.initials: M
authors.lastname: Montorsi
mesh_terms: D001646:Bile / Q000000981:diagnostic imaging; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008099:Liver / Q000000981:diagnostic imaging* / Q000601:surgery*; D008113:Liver Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery; D018084:Ultrasonography, Interventional / Q000379:methods*