Advertisement

World Journal of Surgery

, Volume 43, Issue 10, pp 2607–2611 | Cite as

Ultrasound Liver Map Technique for Laparoscopic Liver Resections

  • Alessandro FerreroEmail author
  • Roberto Lo Tesoriere
  • Nadia Russolillo
Innovative Surgical Techniques Around the World

Abstract

Background

Laparoscopic liver resection (LLR) is reported as a safe procedure with potential advantages over open surgery albeit with inherent limitations, such as loss of haptic perception and spatial orientation. Ultrasound is considered the best tool to identify anatomic landmarks and the transection plane during liver surgery. The aim of this study was to analyse the outcomes of LLR performed with a standardized US guidance technique.

Methods

We have standardized a 4-step technique for ultrasound-guided LLR: (1) compose a 3-D mind map by studying relationships among lesions and surrounding anatomic structures, (2) sketch the map on the liver surface, (3) check, and (4) correct the transection plane in real time.

Results

Between 01/2006 and 12/2016, 190 consecutive patients treated with US-guided LLR were analysed. The indications for LLR included malignant tumours in 148 patients (81.8%). The procedures were classified according to a difficulty scale. There were 18 major hepatectomies (9.9%), 80 anatomic bi- and monosegmentectomies (44.2%), and 101 non-anatomic resections (55.8%). Redo resection was performed in 17 patients (9.4%), and multiple liver resections were performed in 25 patients (24.7%). Median intraoperative blood loss was 100 ± 154 mL. Overall and major morbidity rates were 14.9% and 1.6%, respectively. Mortality was nil.

Conclusions

Ultrasound liver map technique enables planning and real-time guidance during laparoscopic liver resections.

Notes

Compliance with ethical standards

Conflict of interest

The authors declare they have no conflict of interest.

Supplementary material

Supplementary material 1 (MP4 43148 kb)

Supplementary material 2 (MP4 53123 kb)

Supplementary material 3 (MP4 92486 kb)

References

  1. 1.
    Wakabayashi G, Cherqui D, Geller DA et al (2015) Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka. Ann Surg 261:619–629PubMedGoogle Scholar
  2. 2.
    Fretland ÅA, Dagenborg VJ, Bjørnelv GMW et al (2018) Laparoscopic versus open resection for colorectal liver metastases: the OSLO-COMET randomized controlled trial. Ann Surg 267:199–207CrossRefGoogle Scholar
  3. 3.
    Makuuchi M, Hasegawa H, Yamazaki S (1986) Ultrasonically guided subsegmentectomy. Surg Gynecol Obstet 161:346–350Google Scholar
  4. 4.
    Torzilli G, Procopio F, Cimino M et al (2010) Anatomical segmental and subsegmental resection of the liver for hepatocellular carcinoma: a new approach by means of ultrasound-guided vessel compression. Ann Surg 251:229–235CrossRefPubMedGoogle Scholar
  5. 5.
    Machado MA, Surjan RC, Basseres T et al (2016) The laparoscopic Glissonian approach is safe and efficient when compared with standard laparoscopic liver resection: results of an observational study over 7 years. Surgery 160(3):643–651CrossRefPubMedGoogle Scholar
  6. 6.
    Ferrero A, Lo Tesoriere R, Russolillo N et al (2015) Ultrasound-guided laparoscopic liver resections. Surg Endosc 29:1002–1005CrossRefPubMedGoogle Scholar
  7. 7.
    Tomassini F, Scuderi V, Colman R et al (2016) The single surgeon learning curve of laparoscopic liver resection: a continuous evolving process through stepwise difficulties. Med (Baltimore) 95:e5138CrossRefGoogle Scholar
  8. 8.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Slankamenac K, Nederlof N, Pessaux P et al (2014) The comprehensive complication index: a novel and more sensitive endpoint for assessing outcome and reducing sample size in randomized controlled trials. Ann Surg 260:757–762CrossRefPubMedGoogle Scholar
  10. 10.
    Nguyen KT, Marsh JW, Tsung A et al (2011) Comparative benefits of laparoscopic vs open hepatic resection: a critical appraisal. Arch Surg 146:348–356CrossRefGoogle Scholar
  11. 11.
    Cauchy F, Fuks D, Nomi T et al (2015) Risk factors and consequences of conversion in laparoscopic major liver resection. Br J Surg 102:785–795CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  • Alessandro Ferrero
    • 1
    Email author
  • Roberto Lo Tesoriere
    • 1
  • Nadia Russolillo
    • 1
  1. 1.Department of General and Oncological SurgeryMauriziano Hospital “Umberto I”TurinItaly

Personalised recommendations