Our experience in liver resection with intra-operative and laparoscopic ultrasound: Interest of ultrasonic shears for parenchymal transection

Objectives: 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 pre-operative imaging for secondary lesions has been reported between 60–75% with spiral contrast enhanced CT, 80–85% with MRI, 90–96% with intra-operative ultrasound (IOUS). Also for primary lesions IOUS has been reported to allow detection of further nodules in 17% and modify surgical strategy in 10%. The aim of this presentation is to point out the usefulness of open (IOUS) and laparoscopic (LIOUS) ultrasound in patients undergoing hepatic surgery for primary and secondary lesions.

Methods: In the years 2004–2006, 50 patients, aged 28–79, were evaluated for resective surgery at the U.O.C. General Surgery, Monaldi Hospital,Naples,Italy.All of them were studied with byphasic CT and trans-abdominal ultrasound. 18(36%) were deemed unresectable.The others were scheduled for laparoscopy and LIOUS, by means of an Aloka SSD-5500 (Aloka Co. ltd. Japan), equipped with linear flexible tip laparoscopic probe.

Results: 6 patients (18.7%) were excluded because of pathology diffusion; 26 were resected, using ultrasonic shears (Harmonic ACE, Ethicon Endo-Surgery,Oh.USA), 3 (11.5%)laparoscopically and 23 (88.5%)after laparotomy. IOUS was repeated in the latter group.

LIOUS ruled out radical surgery in 6 patients out of 32 (18.7%). IOUS, performed in 23 patients, gave further anatomic information in all and found non detected nodes in 3 (13%)

Conclusions: In our experience LIOUS and IOUS proved to be of utmost importance in the selection of patients and surgical approach.Ultrasonic shears and pedicle clamping reduced intra-operative bleeding.