title: Intraoperative ultrasonography and surgical strategy in hepatic resection: What difference does it make?
abstract: BACKGROUND
  With modern advancements in preoperative imaging for liver surgery, intraoperative ultrasonography (IOUS) may be perceived as superfluous. Our aim was to determine if IOUS provides new information that changes surgical strategy in hepatic resection.
  
  
  METHODS
  We retrospectively analyzed 121 consecutive liver resections performed at a single institution. Preoperative computed tomography and/or magnetic resonance imaging determined the initial surgical strategy. The size, location and number of lesions were compared between IOUS and preoperative imaging. Reviewing the operative report helped determine if new IOUS findings led to changes in surgical strategy. Pathology reports were analyzed for margins.
  
  
  RESULTS
  Of 121 procedures analyzed, IOUS was used in 88. It changed the surgical plan in 15 (17%) cases. Additional tumours were detected in 10 (11%) patients. A change in tumour size and location were detected in 2 (2%) and 3 (4%) patients, respectively. Surgical plans were altered in 7 (8%) cases for reasons not related to IOUS. There was no significant difference (p = 0.74) in average margin length between the IOUS and non-IOUS groups (1.09 ± 1.18 cm v. 1.18 ± 1.05 cm).
  
  
  CONCLUSIONS
  Surgical strategy was altered owing to IOUS results in a substantial number of cases, and IOUS-guided resection planes resulted in R0 resections in nearly all procedures. The best operative plan in hepatic resection includes IOUS.
authors.affiliation: Division of General Surgery, University of Toronto, HPB Service, St. Joseph's Health Centre, Toronto, ON.
authors.forename: Ricky
authors.initials: R
authors.lastname: Jrearz
authors.affiliation: Division of General Surgery, University of Toronto, HPB Service, St. Joseph's Health Centre, Toronto, ON.
authors.forename: Richard
authors.initials: R
authors.lastname: Hart
authors.affiliation: Division of General Surgery, University of Toronto, HPB Service, St. Joseph's Health Centre, Toronto, ON.
authors.forename: Shiva
authors.initials: S
authors.lastname: Jayaraman
mesh_terms: D000368:Aged; D005260:Female; D006498:Hepatectomy / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007430:Intraoperative Care / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D014463:Ultrasonography / Q000706:statistics & numerical data*