Advertisement

Surgical Endoscopy

, Volume 29, Issue 4, pp 1002–1005 | Cite as

Ultrasound-guided laparoscopic liver resections

  • Alessandro Ferrero
  • Roberto Lo TesoriereEmail author
  • Nadia Russolillo
  • Luca Viganò
  • Fabio Forchino
  • Lorenzo Capussotti
Video

Abstract

Background

Intraoperative liver ultrasound has an established role in liver surgery to complete staging and to guide resection. The same performances should be expected by laparoscopic ultrasound (LUS).

Methods

LUS is first performed to identify relationships between tumor and vasculo-biliary pedicles. The planes where the main vascular structures run are marked on the liver surface. Parenchymal transection is performed and each vessel recognized during LUS exploration is divided.

Results

From 01/2009 to 10/2013, in 61 out of 742 liver resections (8.2 %), a laparoscopic approach was attempted. The conversion rate was 9.8 % (six patients). No conversion was related to bleeding or intraoperative complications. The remnant 55 patients were affected by benign lesions in 11 cases and malignant tumors in 44. The resections included 3 left hepatectomies, 14 bisegmentectomies Sg2–3, 5 segmentectomies, and 38 wedge resections. Associated procedures were performed in eight patients (14.5 %), including four colorectal resections. Median duration of surgery was 150 min (60–345 min). Median operative blood loss was 100 mL (0–500 mL). Median size of resected tumor was 2.5 cm (0.9–8 cm). Median surgical margin in oncological resections was 7 mm (0–50 mm). Postoperative complications occurred in four patients (7.2 %), all grade 2 according to Dindo classification. No liver-related morbidity occurred. Median length of hospital stay was 5 days (3–9 days).

Conclusions

Ultrasound-guided liver resections can be performed by laparoscopic approach with the same accuracy than open surgery.

Keywords

Laparoscopy Liver surgery Ultrasound 

Notes

Disclosures

Drs. Alessandro Ferrero, Roberto Lo Tesoriere, Nadia Russolillo, Luca Viganò, Fabio Forchino, and Lorenzo Capussotti have no conflicts of interest or financial ties to disclose.

Supplementary material

Supplementary material 1 (WMV 311337 kb)

References

  1. 1.
    Nguyen KT, Laurent A, Dagher I, Geller DA, Steel J, Thomas MT, Marvin M, Ravindra KV, Mejia A, Lainas P, Franco D, Cherqui D, Buell JF, Gamblin TC (2009) Minimally invasive liver resection for metastatic colorectal cancer: a multi-institutional, international report of safety, feasibility, and early outcomes. Ann Surg 250:842–848CrossRefPubMedGoogle Scholar
  2. 2.
    Croome KP, Yamashita MH (2010) Laparoscopic vs open hepatic resection for benign and malignant tumors: an updated meta-analysis. Arch Surg 145:1109–1118CrossRefPubMedGoogle Scholar
  3. 3.
    van Vledder MG, Pawlik TM, Munireddy S, Hamper U, de Jong MC, Choti MA (2010) Factors determining the sensitivity of intraoperative ultrasonography in detecting colorectal liver metastases in the modern era. Ann Surg Oncol 17:2756–2763CrossRefPubMedGoogle Scholar
  4. 4.
    Torzilli G, Montorsi M, Donadon M, Palmisano A, Del Fabbro D, Gambetti A, Olivari N, Makuuchi M (2005) “Radical but conservative” is the main goal for ultrasonography-guided liver resection: prospective validation of this approach. J Am Coll Surg 201:517–528CrossRefPubMedGoogle Scholar
  5. 5.
    Fukuda M, Mima F, Nakano Y (1982) Studies in echolaparoscopy. Scand J Gastroenterol 17:186Google Scholar
  6. 6.
    Machi J, Johnson JO, Deziel DJ, Soper NJ, Berber E, Siperstein A, Hata M, Patel A, Singh K, Arregui ME (2009) The routine use of laparoscopic ultrasound decreases bile duct injury: a multicenter study. Surg Endosc 23:384–388CrossRefPubMedGoogle Scholar
  7. 7.
    Våpenstad C, Rethy A, Langø T, Selbekk T, Ystgaard B, Hernes TA, Mårvik R (2010) Laparoscopic ultrasound: a survey of its current and future use, requirements, and integration with navigation technology. Surg Endosc 24:2944–2953CrossRefPubMedGoogle Scholar
  8. 8.
    Viganò L, Ferrero A, Amisano M, Russolillo N, Capussotti L (2013) Comparison of laparoscopic and open intraoperative ultrasonography for staging liver tumours. Br J Surg 100:535–542CrossRefPubMedGoogle Scholar
  9. 9.
    Araki K, Conrad C, Ogiso S, Kuwano H, Gayet B (2014) Intraoperative ultrasonography of laparoscopic hepatectomy: key technique for safe liver transection. J Am Coll Surg 218:e37–e41CrossRefPubMedGoogle Scholar
  10. 10.
    Buell JF, Cherqui D, Geller DA, O’Rourke N, Iannitti D, Dagher I, Koffron AJ, Thomas M, Gayet B, Han HS, Wakabayashi G, Belli G, Kaneko H, Ker CG, Scatton O, Laurent A, Abdalla EK, Chaudhury P, Dutson E, Gamblin C, D’Angelica M, Nagorney D, Testa G, Labow D, Manas D, Poon RT, Nelson H, Martin R, Clary B, Pinson WC, Martinie J, Vauthey JN, Goldstein R, Roayaie S, Barlet D, Espat J, Abecassis M, Rees M, Fong Y, McMasters KM, Broelsch C, Busuttil R, Belghiti J, Strasberg S, Chari RS (2009) The international position on laparoscopic liver surgery: the Louisville Statement, 2008. Ann Surg 250:825–830CrossRefPubMedGoogle Scholar
  11. 11.
    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 240:205–213CrossRefPubMedCentralPubMedGoogle Scholar
  12. 12.
    Ishizawa T, Gumbs AA, Kokudo N, Gayet B (2012) Laparoscopic segmentectomy of the liver: from segment I to VIII. Ann Surg 256:959–964CrossRefPubMedGoogle Scholar
  13. 13.
    Makuuchi M, Hasegawa H, Yamazaki S (1985) Ultrasonically guided subsegmentectomy. Surg Gynecol Obstet 161:346–350PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Alessandro Ferrero
    • 1
  • Roberto Lo Tesoriere
    • 1
    Email author
  • Nadia Russolillo
    • 1
  • Luca Viganò
    • 1
  • Fabio Forchino
    • 1
  • Lorenzo Capussotti
    • 1
  1. 1.Department of General and Oncological SurgeryOspedale Mauriziano “Umberto I”TurinItaly

Personalised recommendations