Ultrasound Guided Liver Surgery Makes Tumor Removal Safer

Intraoperative Ultrasound (IOUS) guided finger compression for subsectioning of the liver is a feasible, safe, and effective method, according to a new study.

Researchers at the University of Milan (Italy) developed the further expansion of the ultrasound-guided compression technique, introducing a new modality for performing anatomical right posterior sectionectomy (RPS) of the liver. The technique consists of demarcating the resection area by IOUS-guided finger compression of the right posterior portal pedicle (feeding the right posterior section of the liver) at the level closest to the tumor but oncologically suitable.

To test the new method, 15 patients underwent hepatic resection--out of 289 consecutive patients--that met the eligibility criteria for anatomical RPS by IOUS finger compression. Five patients had hepatocellular carcinoma (HCC), and 11 had colorectal liver metastases; 6 patients had cirrhosis or chronic hepatitis, and 10 had steatosis. The median tumor number was two, and the median tumor size was 2.4 centimeter. The results show that the procedure resulted feasible in all eligible patients, and demarcation area was obtained in all patients within one minute of bimanual IOUS guided compression. There was no mortality or major morbidity, and only two patients experienced postoperative morbidity. The study was published in the June 2011 issue of Updates in Surgery.

“Although the liver has a remarkable ability to regenerate itself, during operations to remove tumors, it is important to try and remove as little healthy liver tissue as possible, whilst still ensuring all the tumor is removed - to reduce the chance of further growth and relapses,” said lead author Professor Guido Torzilli, MD, PhD, of the liver surgery unit. “It is this compromise between removing the tumor and sparing the liver tissue itself that I believe is optimized by the use of bespoke intraoperative ultrasound systems.”

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