Diseases of the Colon & Rectum

, Volume 39, Supplement 10, pp S73–S78 | Cite as

Intraoperative laparoscopic liver ultrasonography for staging of colorectal cancer

Initial experience
  • Pierenrico Marchesa
  • Jeffrey W. Milsom
  • Jonathan C. Hale
  • Charles M. O'Malley
  • Victor W. Fazio
Original Contributions


PURPOSE: This study was undertaken to evaluate the feasibility of intraoperative laparoscopic ultrasonography (ILUS) to completely scan all anatomic segments of the liver through a single port site during laparoscopic resection for colorectal cancer. METHODS: ILUS was performed in patients who were undergoing laparoscopic colorectal cancer surgery using the following approach: 1) presence of a radiologist in the operating room; 2) introduction of the probe through a single cannula site; 3) standardized sequence of four probe positions on liver surface; 4) identification of all major vascular/biliary hepatic structures as a guideline to scan all parenchymal segments of the liver. RESULTS: Twenty-two patients who were undergoing laparoscopic colorectal cancer surgery were prospectively enrolled. Computed tomography (CT) scan films were available for an immediate comparative analysis in the first 12 cases. Mean duration of the procedure was 10 (range, 5–15) minutes. All major vascular and biliary structures were identified in all patients. Sixteen focal abnormalities were identified by ILUS, and ten focal abnormalities were identified by CT scan in the same seven patients. In one patient, detection of a suspected metastasis not seen by preoperative CT scan led to conversion of the surgical procedure to a laparotomy. CONCLUSIONS: ILUS is a safe and expeditious technique that permits scanning of all anatomic liver parenchyma segments through a single cannula site. Because intraoperative palpation of the liver is not possible during laparoscopic colorectal cancer surgery, ILUS should probably be a standard component of the curative laparoscopic colorectal cancer operation.

Key words

Laparoscopy Ultrasonography Liver anatomy Tumor staging Colorectal neoplasms 


  1. 1.
    Monson JR, Darzi A, Carey PD, Guillou PJ. Prospective evaluation of laparoscopic-assisted colectomy in an unselected group of patients. Lancet 1992;340:831–3.PubMedGoogle Scholar
  2. 2.
    Phillips EH, Franklin M, Carroll BJ, Fallas MJ, Ramos R, Rosenthal D. Laparoscopic colectomy. Ann Surg 1992;216:703–7.PubMedGoogle Scholar
  3. 3.
    Stearns MW, Scottenfeld D. Techniques for the surgical management of colon cancer. Cancer 1971;28:165–9.PubMedGoogle Scholar
  4. 4.
    Turnbull RB, Kyle K, Watson FR, Spratt J. Cancer of the colon: the influence of the no-touch isolation technic on survival rates. Ann Surg 1967;166:420–7.PubMedCrossRefGoogle Scholar
  5. 5.
    Dixon AR, Maxwell WA, Holmes TJ. Carcinoma of the rectum: a 10-year experience. Br J Surg 1991;78:308–11.PubMedGoogle Scholar
  6. 6.
    Goligher JC. Surgery of anus, rectum, and colon. London: Baillière Tindall, 1984:488–96.Google Scholar
  7. 7.
    Daly JM, Cady B. Atlas of surgical oncology. St. Louis:Mosby Year Book, 1993:455–600.Google Scholar
  8. 8.
    Soyer P, Levesque M, Elias D, Zeitoun G, Roche A. Detection of liver metastases from colorectal cancer: comparison of intraoperative US and CT during arterial portography. Radiology 1992;183:541–4.PubMedGoogle Scholar
  9. 9.
    Stewart PJ, Chu JM, Kos SC, Chapuis PH, Bokey EL. Intra-operative ultrasound for the detection of hepatic metastases from colorectal cancer. Aust N Z J Surg 1993;63:530–4.PubMedGoogle Scholar
  10. 10.
    Machi J, Sigel B. Intraoperative ultrasonography [review]. Radiol Clin North Am 1992;30:1085–103.PubMedGoogle Scholar
  11. 11.
    Miles WF, Brown SB, Garden OJ. Laparoscopic contact hepatic ultrasonography. Br J Surg 1992;79:419–20.PubMedGoogle Scholar
  12. 12.
    Liu JB, Feld RI, Goldberg BB,et al. Laparoscopic grayscale and color Doppler US: preliminary animal and clinical studies. Radiology 1995;194:851–7.PubMedGoogle Scholar
  13. 13.
    John TG, Greig JD, Carter DC, Garden OJ. Carcinoma of the pancreatic head and periampullary region: tumor staging with laparoscopy and laparoscopic ultrasonography. Ann Surg 1995;221:156–64.PubMedGoogle Scholar
  14. 14.
    Bemelman WA, van Delden OM, van Lanschot JJ,et al. Laparoscopy and laparoscopic ultrasonography in staging of carcinoma of the esophagus and gastric cardia. J Am Coll Surg 1995;181:421–5.PubMedGoogle Scholar
  15. 15.
    Bartlett DL, Conlon KC, Gerdes H, Karpeh MS Jr. Laparoscopic ultrasonography: the best pretreatment staging modality in gastric adenocarcinoma? Case report. Surgery 1995;118:562–6.PubMedGoogle Scholar
  16. 16.
    Bismuth H, Castaing D. Echographie per-operatoire du foie et des voies biliaries. Paris: Flammarion, 1985.Google Scholar
  17. 17.
    Machi J, Sigel B, Zaren HA, Kurohiji T, Yamashita J. Operative ultrasounography during hepatobiliary and pancreatic surgery. World J Surg 1993;17:640–5.PubMedGoogle Scholar
  18. 18.
    Gozzetti G, Mazziotti A, Bolondi L,et al. Intraoperative ultrasonography in surgery for liver tumors. Surgery 1986;99:523–30.PubMedGoogle Scholar
  19. 19.
    Olsen AK. Intraoperative ultrasonography and the detection of liver metastases in patients with colorectal cancer. Br J Surg 1990;77:998–9.PubMedGoogle Scholar
  20. 20.
    Boldrini G, de Gaetano AM, Giovannini E, Castagneto M, Colagrande C, Castiglioni G. The systematic use of operative ultrasound for detection of liver metastases during colorectal surgery. World J Surg 1987;11:622–7.PubMedGoogle Scholar
  21. 21.
    Castaing D, Edmond J, Bismuth H. Utility of operative ultrasound in the surgical management of liver tumors. Ann Surg 1986;204:600–5.PubMedGoogle Scholar
  22. 22.
    Stone MD, Kane R, Bothe A Jr, Milburn Jessup J, Cady B, Steele GD. Intraoperative ultrasound imaging of the liver at the time of colorectal cancer resection. Arch Surg 1994;129:431–5.PubMedGoogle Scholar
  23. 23.
    Paul MA, Sibinga Mulder L, Cuesta MA, Sikkenk AC, Lyesen GK, Meijer S. Impact of intraoperative ultrasonography on treatment strategy for colorectal cancer. Br J Surg 1994;81:1660–3.PubMedGoogle Scholar
  24. 24.
    Rafaelsen SR, Kronborg O, Larsen C, Fenger C. Intraoperative ultrasonography in detection of hepatic metastases from colorectal cancer. Dis Colon Rectum 1995;38:355–60.PubMedGoogle Scholar
  25. 25.
    Shandall A, Johnson C. Laparoscopy or scanning in oesophageal and gastric carcinoma. Br J Surg 1985;72:449–51.PubMedGoogle Scholar
  26. 26.
    Possik RA, Franco EL, Pires DR, Wohnrath DR, Ferreira EB. Sensitivity, specificity, and predictive value of laparoscopy for the staging of gastric cancer and for the detection of liver metastases. Cancer 1986;58:1–6.PubMedGoogle Scholar
  27. 27.
    Warshaw AL, Gu ZY, Wittenberg J, Waltman AC. Preoperative staging and assessment of resectability of pancreatic cancer. Arch Surg 1990;125:230–3.PubMedGoogle Scholar
  28. 28.
    Dagnini G, Marin G, Patella M, Zotti S. Laparoscopy in the diagnosis of primary carcinoma of the gallbladder: a study of 98 cases. Gastrointest Endosc 1984;30:289–91.CrossRefPubMedGoogle Scholar
  29. 29.
    Rosenhoff SH, Young RC, Anderson TC,et al. Peritoneoscopy a valuable staging tool in ovarian carcinoma. Ann Intern Med 1975;83:37–41.Google Scholar
  30. 30.
    John TG, Garden OJ. Laparoscopic ultrasonography: extending the scope of diagnostic laparoscopy. Br J Surg 1994;81:5–6.PubMedGoogle Scholar
  31. 31.
    John TG, Greig JD, Crosbie JL, Anthony Miles WF, Garden OJ. Superior staging of liver tumors with laparoscopy and laparoscopic ultrasound. Ann Surg 1994;220:711–9.PubMedGoogle Scholar
  32. 32.
    Bemelman WA, de Wit LT, van Delden OM,et al. Diagnostic laparoscopy combined with laparoscopic ultrasonography in staging of cancer of the pancreatic head region. Br J Surg 1995;82:820–4.PubMedGoogle Scholar
  33. 33.
    Cuesta MA, Meijer S, Borgstein PJ, Sibinga Mulder L, Sikkenk AC. Laparoscopic ultrasonography for hepatobiliary and pancreatic malignancy. Br J Surg 1993;80:1571–4.PubMedGoogle Scholar
  34. 34.
    Hunerbein M, Rau B, Schlag PM. Laparoscopy and laparoscopic ultrasound for staging of upper gastrointestinal tumours. Eur J Surg Oncol 1995;21:50–5.PubMedGoogle Scholar

Copyright information

© American Society of Colon and Rectal Surgeons 1996

Authors and Affiliations

  • Pierenrico Marchesa
    • 1
  • Jeffrey W. Milsom
    • 1
  • Jonathan C. Hale
    • 1
  • Charles M. O'Malley
    • 1
  • Victor W. Fazio
    • 1
  1. 1.Departments of Colorectal Surgery and RadiologyThe Cleveland Clinic FoundationCleveland

Personalised recommendations