title: Systematic subsegmentectomy by ultrasound-guided finger compression for hepatocellular carcinoma in cirrhosis.
abstract: BACKGROUND
  Systematic and extensive use of intraoperative ultrasound (IOUS) allows us to perform new conservative surgical procedures in liver surgery. This video shows systematic subsegmentectomy by IOUS-guided finger compression for a case of hepatocellular carcinoma (HCC) in cirrhosis.
  
  
  METHODS
  The case of a 69-year-old woman with a single 3.5-cm HCC in segment 3 is presented. The patient has hepatitis C virus (HCV)-related well-compensated cirrhosis. After performing a T-inverted laparotomy, the IOUS is carried out for staging. Then, the area of resection is anatomically marked by IOUS-guided finger compression of the subsegmental portal branch feeding the tumor in segment 3. Thus, the resection is performed under intermittent Pringle maneuver using Pean-clasia and bipolar forceps.
  
  
  RESULTS
  Ninety-day mortality and morbidity for this patient were nil. No blood transfusions were required. The patient was discharged 8 days after surgery.
  
  
  CONCLUSIONS
  Systematic subsegmentectomy by IOUS-guided finger compression is a feasible and effective technique, especially for HCC in cirrhosis. It may be potentially applied in each segment of liver as long as the thickness of the parenchyma and the anatomy of liver are suitable. We believe that this technique should be part of the modern liver surgeon's armamentarium.
authors.affiliation: Third Department of Surgery, Liver Surgery Unit, University of Milan School of Medicine, IRCCS Istituto Clinico Humanitas, Rozzano, Milan, Italy. guido.torzilli@unimi.it
authors.forename: Guido
authors.initials: G
authors.lastname: Torzilli
authors.forename: Matteo
authors.initials: M
authors.lastname: Donadon
authors.forename: Matteo
authors.initials: M
authors.lastname: Cimino
authors.forename: Daniele
authors.initials: D
authors.lastname: Del Fabbro
authors.forename: Fabio
authors.initials: F
authors.lastname: Procopio
authors.forename: Florin
authors.initials: F
authors.lastname: Botea
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D008113:Liver Neoplasms / Q000209:etiology / Q000601:surgery*; D014464:Ultrasonic Therapy