title: Tailoring the area of hepatic resection using inflow and outflow modulation.
abstract: The performance of hepatic surgery without a parenchyma-sparing strategy carries significant risks for patient survival because of the not negligible occurrence of postoperative liver failure. The key factor of modern hepatic surgery is the use of the intraoperative ultrasound (IOUS), not only to stage the disease, but more importantly to guide resection with the specific aim to maximize the sparing of the functional parenchyma. Whether in patients with hepatocellular carcinoma and underlying liver cirrhosis, or in patients with colorectal liver metastasis, IOUS allows the performance of the so-called "radical but conservative surgery", which is the pivotal factor to offer a chance of cure to an increasing proportion of patients, who until few years ago were considered only for palliative care. Using some new IOUS-guided surgical maneuvers, which are based on the liver inflow and outflow modulations, more precise anatomically subsegmental- and segmental-oriented resections can be effectively performed. The present work describes the rationale and the surgical technique for a precise tailoring of the area of hepatic resection using the most recent attainments in IOUS. Such important technical achievements should be a fundamental part of the surgical armamentarium of the modern liver surgeon.
authors: Liver Surgery Unit, Department of General Surgery, University of Milan School of Medicine, Humanitas Clinical and Research Center, 20089 Milan, Italy.
authors: Matteo
authors: M
authors: Donadon
authors: Fabio
authors: F
authors: Procopio
authors: Guido
authors: G
authors: Torzilli
mesh_terms: D000818:Animals; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008102:Liver Circulation; D008113:Liver Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
keywords: Hepatic resection; Intraoperative ultrasound; Liver inflow; Liver outflow; Resection guidance