Liver resection with intraoperative and laparoscopic ultrasound: report of 32 cases : Ultrasonic shears device for liver parenchymal transection.
BACKGROUND
Careful staging of hepatic tumors is mandatory for appropriate selection of patients for liver resection. Number and relationships of liver nodules are issues of utmost importance when evaluating resectability. Sensitivity of preoperative imaging for secondary lesions has been reported between 60-75% with spiral contrast-enhanced computed cosmography (CT), 80-85% with magnetic resonance imaging (MRI), and 90-96% with intraoperative ultrasound (IOUS). Also for primary lesions IOUS has been reported to allow detection of liver nodules in 17% and modify surgical strategy in 10%. The aim of this study was to point out the usefulness of open (IOUS) and laparoscopic (LIOUS) ultrasound in patients undergoing hepatic surgery for liver tumors.


METHODS
In the years 2004-2006, 50 patients, mean age 66 years (range 44-76 years) were evaluated for resective surgery at the General Surgery Department of Monaldi Hospital, Naples, Italy. All of them were studied with biphasic CT and transabdominal ultrasound. Eighteen (36%) were judged unresectable. The others were scheduled for laparoscopy and LIOUS, by means of an ALOKA SSD-5500 (Aloka Co. Ltd. Tokyo, Japan), equipped with linear flexible tip laparoscopic probe.


RESULTS
Six patients (18.7%) were excluded because of pathology diffusion; 26 (81.3%) were resected, using ultrasonic shears (Harmonic ACE, Ethicon Endo-Surgery, Cincinnati Oh., USA) for parenchymal transection, 3 (11.5%) laparoscopically and 23 (88.5%) after laparotomy. IOUS was repeated in the latter group. LIOUS spared useless laparotomies in six patients (18.7%) and, coupled with IOUS, found undetected nodes in five patients (19.2%), changing surgical strategy in three patients (11.5%).


CONCLUSIONS
In our experience LIUOS and IOUS proved to be of utmost importance both in the selection of patients for resective surgery and in planning surgical approach. Ultrasonic shears device and systematic pedicle clamping sped up resection time and reduced intraoperative bleeding.
Piccolboni
Domenico
D
General and Laparoscopic Surgical Department, Monaldi Hospital, Via Bonito 19, Naples, 80129, Italy. domenico.piccolboni@virgilio.it
Ciccone
Francesco
F
Settembre
Anna
A
Corcione
Francesco
F
D000328:Adult; D000368:Aged; D019160:Endosonography / Q000379:methods*; D004867:Equipment Design; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000295:instrumentation*; D006801:Humans; D010535:Laparoscopy; D007813:Laparotomy / Q000379:methods*; D008099:Liver / Q000000981:diagnostic imaging / Q000601:surgery*; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D014465:Ultrasonics