RESUME: Intraoperative ultrasound has become an essential tool for the surgeon in the field of hepatobiliary surgery. No preoperative study has been able to duplicate the sensitivity and specificity of intraoperative ultrasound (IOUS) in the identification of occult lesions. With recent improvements in technology, IOUS has now become an indispensable means of defining the extent of disease and respectability, and providing a guide to an atomic and non-anatomic hepatic resections and minimally invasive and percutaneous ablative techniques. The contrast-enhanced intraoperative ultrasound (CE-IOUS) makes IOUS more accurate, thus enhancing the impact of this technique on operative decision-making for liver tumors. The concept of intraoperative ultrasound (IOUS) was first introduced in the mid-1960s and was used primarily in evaluating choledocholithiasis. More advanced applications were not pursued until the early 1980s, secondary to the limitations of ultrasound technology, which involved large bulky transducers and a relatively poor image quality [1]. Presently, IOUS is a main stay in all oncologic hepatobiliary procedures. Despite all of these technical advances, preoperative detection of preoperative liver lesions remains 60% to 80%. As a reflection of these shortcomings, false negative rates with CT and MRI range from 40% to 70% Table 1 summarizes these findings, the significance of which are demonstrated by several groups citing that in 27% to 49% of cases the operative plan will be changed based on new IOUS findings. These conclusions hold true even in the modern era of advanced preoperative staging. As a result, IOUS has now become a standard part of almost all hepatobiliary cases.
Kruskal JB, Kane RA. Intraoperative ultrasonography of the liver. Crit Rev Diagn Im ag - ing. 1995;36:175-226
Staren ED, Gambla M, Deziel DJ, et al. Intraoperative ul tra sound in the man age - ment of liver neoplasms. Am Surg. 1997;63:591-596
Makuuchi M, Hasegawa H, Yamazaki S. Interoperative ul tra sonic ex am i na tion for hepatectomy. Jpn J Clin Oncol. 1981;11:367-369
Fan MH, Chang AE. Re sec tion of liver tu mors: technical aspects. Surg Oncol. 2002;10:139-152
Rifkin MD, Rosato FE, Branhc HM, et al. Intraoperative ul tra sound of the liver. An im por tant ad junc tive tool for de ci sion mak ing in the op er at ing room. Ann Surg. 1987;205:466-470
Ravikumar TS, Buenaventura S, Sa lem RR, et al. Intraoperative ultrasonography of liver: de - tec tion of oc cult liver tu mors and treat ment by cryosurgery. Cancer Detect Prev. 1994;18:131-138
Wernecke K, Rummeny E, Bongartz G, et al. Detec - tion of hepatic masses in pa tients with car ci noma: com par a tive sen si tiv i ties of sonography, CT, and MR im ag ing. AJR Am J Roentgenol. 1991;157:731-739
Clarke MP, Kane RA, Steele G, et al. Prospective com par i son of pre op er a tive im ag ing and intraoperative ultrasonography in the de tec tion of liver tu mors. Sur gery. 1989;106:849-855
Knol JA, Marn CS, Fran cis IR, et al. Com par i sons of dy namic in fu sion and de layed com puted to mog - ra phy, intraoperative ul tra sound, and pal pa tion in the di ag no sis of liver metastases. Am J Surg. 1993;165:81-88
Ward BA, Miller DL, Frank JA, et al. Prospective eval u a tion of hepatic im ag ing stud ies in the de tec - tion of colorectal metastases: cor re la tion with sur - gi cal find ings. Sur gery. 1989;105:180-187
Gunven P, Makuuchi M, Takayasu K, et al. Preoper - a tive im ag ing of liver metastases. Com par i son of angiography, CT scan, and ultrasonography. Ann Surg. 1985;202:573-579
Machi J, Sigel B. Op er a tive ul tra sound in gen eral surgery. Am J Surg. 1996;172:15-20
Boggs RR, Rouch DA, Chua GT. Intraoperative ul - tra sound of hepatic tu mors. In di ana Med. 1992;85:496-498
Bis muth H, Castaing D, Gar den J. The use of intraoperative ul tra sound in sur gery of pri mary liver tu mors. World J Surg.1987;11:610-614
Parker G, Law rence W, Hors ley S, et al. Intraoperative ul tra sound of the liver af fects op er a tive de ci sion mak ing. Ann Surg.1989;209:569-577
Haider MA, Leonhardt C, Hanna SS, et al. The role of intraoperative ultrasonography in plan ning the re sec tion of hepatic neoplasms. Can Assoc Radiol J. 1995;46:98-104
Cervone A, Sardi A, Conaway GL. Intraoperative ul tra sound (IOUS) is es sen tial in the man age ment of met a static colorectal liver le sions. Am Surg. 2000;66:611-615
Bloed W, van Leeuwen MS, Borel Rinkes IH. Role of intraoperative ul tra sound of the liver with im - proved preoperative hepatic imaging. Eur J Surg. 2000;166:691-695
Healy JE, Schroy PC. Anat omy of the biliary ducts within the hu man liver; anal y sis of pre vail ing pat - tern of branch ing and the ma jor vari a tions of the biliary ducts. Arch Surg. 1953;66:599-616
Couinard C. Lobes et seg ments hepatiques. Presse Med. 1954;62:709
Kanematus T, Sonoda T, Takenaka K, et al. The value of ul tra sound in the di ag no sis and treat ment of small hepatocellular car ci noma. Br J Surg. 1985;72:23-25
Sheu J, Lee C, Sung J, et al. Intraoperative hepatic ultrasonography-an in dis pens able pro ce dure in resection of small hepatocellular carcinomas. Sur - gery. 1985;97:97-103
Zhi-Zhang X. Real-time B mode ultrasonography in lo cal iza tion of subclinical hepatocellular car ci - noma. In: Zhao-You T ed i tors.Subclinical hepatocellular carcinoma. New York: Springer-Verlag; 1985;p. 12-20
Torzilli G, Makuuchi M. Intraoperative ultrasonography in liver can cer. Surg Oncol Clin N Am. 2003;12:91-104
Takigawa Y, Sugawara Y, Yamamoto J, et al. New le sions de tected by intraoperative ul tra sound dur - ing liver re sec tion for hepatocellular car ci - noma. Ul tra sound Med Biol. 2001;27:151-156
Kokudo N, Bandai Y, Imanishi H, et al. Man age - ment of new hepatic nod ules de tected by intraoperative ultrasonography dur ing hepatic re - sec tion for hepatocellular car ci noma. Sur - gery. 1996;119:634-640
Gruenberger T, Jourdan JL, Zhao J, et al. Echogenicity of liver metastases is an in de - pendent prognostic factor after potentially cura - tive treat ment. Arch Surg. 2000;135:1285-1290
Seifert J, Mor ris D. Pretreat ment echogenicity of colorectal liver metastases pre dicts sur vival af ter hepatic cryotherapy. Dis Co lon Rec - tum. 1999;42:43-49
Zhao-You T, Bing-Hui Y. Early detection of subclinical hepatocellular car ci - noma. In: Zhao-You T ed i tors. Subclinical hepatocellular carcinoma. New York: Springer-Verlag; 1985;p. 12-20
Kane RA, Hughes LA, Cua EJ, et al. The im pact of intraoperative ultrasonography on sur gery for liver neoplasms. J Ul tra sound Med. 1994;13:1-6
Brower ST, Schwartz M, Miller C. Intraoperative ul tra sound and liver tu mors. Cancer Treat Res. 1994;69:197-220
Kolecki R, Schirmer B. Intraoperative and lap aro - scopic ul tra sound. Surg Clin North Am. 1998;78:251-271
Meijer S, Paul MA, Cuesta MA, et al. Intra-opera - tive ul tra sound in the de tec tion of liver metastases. Eur J Can cer.1995;31A:1210-1211
Charnley RM, Mor ris DL, Dennison AR, et al. De - tec tion of colorectal liver metastases us ing intraoperative ultrasonography. Br J Surg. 1991;78:45-48
Stew art PJ, Chu JM, Kos SC, et al. Intraoperative ul tra sound for the de tec tion of metastases from colorectal can cer. Aust N Z J Surg. 1993;63:530-534
Machi J, Isomoto H, Kurohiji T, et al. Accuracy of intraoperative ultrasonography in di ag nos ing liver metastases from colorectal can cer: eval u a tion with post op er a tive fol low-up re sults. World J Surg. 1991;15:551-556
Stone MD, Kane R, Bothe A, et al. Intraoperative ul tra sound im ag ing of the liver at the time of colorectal cancer resection. Arch Surg. 1994;129:431-435
Leen E, Angerson WJ, O`Gorman P, et al. Intraoperative ul tra sound in colorectal can - cer patients undergoing apparently curative sur - gery: cor re la tion with two year fol low-up. Clin Radiol. 1996;51:157-159
Velasco JM, Montana L, Vallina V. Intraoperative en dos copy and ultrasonography. Probl Gen Surg. 1990;7:352-370
Makuuchi M, Hawgawa H, Yamazaki S, et al. The use of intraoperative ul tra sound as an aid to liver re sec tion in pa tients with hepatocellular car ci - noma. World J Surg. 1987;11:615-621
Scudmore CH, Patterson EJ, Shapiro AMJ, et al. Liver tu mor ab la tion tech niques. J In vest Surg. 1997;10:157-164
Bezzi M, Merlino P, Orsi F, et al. Lap aro scopic sonography dur ing lap aro scopic sur gery: tech - nique and im ag ing find ings. AJR Am J Roentgenol. 1995;165:1193-1198
Machi J, Schwartz JH, Zaren HA, et al. Tech nique of lap aro scopic ul tra sound ex am i na tion of the liver and pan creas. Surg Endosc. 1996;10:684-689
Cuschieri A. Lap aro scopic man age ment of can cer pa tients. J R Coll Surg Edinb. 1995;40:1-9
Hunderbein M, Rau B, Schlag PM. Lap a ros copy and lap aro scopic ul tra sound for stag ing of up per gas - tro in tes ti nal tu mors. Eur J Surg Oncol. 1995;21:50-55
Gouma DJ, De Wit LT, Nieveen van Dijkum E, et al. Lap aro scopic ultrasonography for stag ing of gas tro in tes ti nal ma lig nancy.Scand J Gastroenterol Suppl. 1996;218:43-49
Goletti O, Buccianti P, Chiarugi M, et al. Lap aro - scopic sonography in screen ing metastases from gastrointestinal cancer: comparative accuracy with tra di tional pro ce dures. Surg Laparosc Endosc. 1995;5:176-182
Tan dan VR, Asch M, Margolis M, et al. Lap aro - scopic vs. open intraoperative ul tra sound ex am i - na tion of the liver: a con trolled study. J Gastrointest Surg. 1997;1:146-151
Hartley JE, Kumar H, Drew PJ, et al. Lap aro scopic ul tra sound for the de tec tion of hepatic metastases during laparoscopic colorectal cancer surgery. Dis Colon Rectum. 2000;43:320-324
Barbot DJ, Marks JH, Feld RI, et al. Im proved stag - ing of liver tu mors us ing lap aro scopic intraoperative ul tra sound. J Surg Oncol.1997;64:63-67
John TG, Greig JD, Crosbie JL, et al. Su pe rior stag - ing of liver tu mors with lap a ros copy and lap aro - scopic ul tra sound. Ann Surg.1994;220:711-719
Machi J, Oishi AJ, Mossing AJ, et al. Hand-assisted lap aro scopic ul tra sound-guided radio fre quen cy ther mal ab la tion of liver tu mors: a tech ni cal re - port. Surg Laparosc Endosc Percutan Tech. 2002;12:160-164
Cuschieri A, Bracken J, Boni L. Initial experience with lap aro scopic ul tra sound-guided radio fre - quen cy ther mal ab la tion of hepatic tu mors. En dos - copy. 1999;31:318-321
Machi J, Uchida S, Sumida K, et al. Ultra - sound-guided radio fre quen cy ther mal ab la tion of liver tu mors: percutaneous, lap aro scopic, and open sur gi cal ap proaches. J Gastrointest Surg. 2001;5:477-489
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