title: Impact of intra-operative ultrasonography in liver surgery.
abstract: OBJECTIVE
  Intra-operative ultra-sonography (IOUS) during surgery for primary and metastatic hepatic tumors identifies additional lesions and helps in determining the most optimal surgical strategy. We assessed the impact of IOUS in liver surgery at our hospital, a tertiary-care cancer center.
  
  
  METHODS
  Patients with potentially resectable hepatic tumors underwent surgical exploration. The relationship of the tumor with regard to the intrahepatic vasculature was determined by IOUS. A search was also made for additional lesions not detected by pre-operative imaging modalities. In appropriate cases, IOUS was also used to assist resection and radiofrequency ablation/ethanol injection.
  
  
  RESULTS
  Between January 2003 and January 2005, 52 patients underwent surgery for primary or secondary hepatic tumors. IOUS was performed in 48 of these patients. It detected additional hepatic lesions in 14 patients (29.2%). IOUS contributed to changing the operative plan in 21 patients (43.8%). It was directly responsible for avoiding resection or ablation in 7 patients (14.6%), 5 of whom had multiple bilobar lesions, 1 had IOUS-guided biopsy that revealed caseating granuloma on frozen section, and 1 patient had no lesion on IOUS. Three patients had extent of resection changed based on IOUS findings. IOUS also guided radiofrequency ablation in 8 patients and ethanol injection in one patient.
  
  
  CONCLUSIONS
  IOUS is an essential tool in surgery for hepatic tumors. In addition to accurate staging, it also aids in safe resection and radiofrequency ablation in appropriate cases.
authors.affiliation: Department of GI Surgical Oncology, Tata Memorial Hospital, Mumbai. pjshukla@doctors.org.uk
authors.forename: Parul J
authors.initials: PJ
authors.lastname: Shukla
authors.forename: Durgatosh
authors.initials: D
authors.lastname: Pandey
authors.forename: Pramod P
authors.initials: PP
authors.lastname: Rao
authors.forename: Shailesh V
authors.initials: SV
authors.lastname: Shrikhande
authors.forename: Meenakshi H
authors.initials: MH
authors.lastname: Thakur
authors.forename: Supreeta
authors.initials: S
authors.lastname: Arya
authors.forename: Subhash
authors.initials: S
authors.lastname: Ramani
authors.forename: Shaesta
authors.initials: S
authors.lastname: Mehta
authors.forename: K M
authors.initials: KM
authors.lastname: Mohandas
mesh_terms: D017115:Catheter Ablation; D006801:Humans; D007432:Intraoperative Period; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary / Q000601:surgery*; D014463:Ultrasonography