Improved staging of liver tumors using laparoscopic intraoperative ultrasound

Abstract

Background: Intraoperative ultrasound has been shown to provide significant assistance in operative staging and management of patients with liver tumors during open surgery. The availability of the 5.0-7.5 Mhz semiflexible ultrasound transducer with gray-scale, color and spectral Doppler capabilities can provide similar information laparoscopically. Methods: Twenty-four consecutive patients with liver tumors (18 metastatic and six primary), in technically resectable locations determined by a variety of conventional imaging studies, were brought to the operating room. There was no known extrahepatic disease, and there was no recurrence at the primary site in the metastatic subgroup. These patients were evaluated intraoperatively with laparoscopy and intraoperative laparoscopic ultrasound to assess resectability prior to performing a major laparotomy. Laparoscopy was successful in 23 of the patients and in 19 of 23, laparoscopic ultrasound was also employed, using the 5.0-7.5 MHz semiflexible transducer. The use of the open entry technique, selection of alternate entry sites, coupled with expertise in laparoscopic lysis of adhesions, has allowed safe laparoscopic tumor staging. Results: The laparoscopic evaluation was aborted only once due to dense adhesions, despite the fact that 67% of the patients had undergone previous abdominal surgery. There was only one complication: bleeding from a liver biopsy in an unresectable cirrhotic patient, necessitating laparotomy. Laparoscopy and ultrasound together predicted nonresectability in six of eight unresectable patients, all of whom were spared an unnecessary laparotomy. Conclusions: Laparoscopic ultrasonographic evaluation for the staging of liver tumors should be a prerequisite to definitive laparotomy, with the objective of avoiding unncessary surgery. J.

Chirurgische Therapie des intrahepatischen cholangiozellulären Karzinoms

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Laparoscopic radiofrequency ablation and hepatic artery infusion pump placement in the evolving treatment of colorectal hepatic metastases

“…Ultrasound has limitations in its ability to determine successful ablations, and operator experience plays an important role in accurate judgment and decision making [15]. Barbot et al [3] found that laparoscopic ultrasound identified unresectable disease in 25% of patients with liver tumors judged to be resectable by conventional imaging studies. Similarly, we found intraopertive ultrasound critical for identification of additional hepatic metastases, recognition of portal adenopathy, defining the relationship between metastases and vital hepatic structures, confirming hepatic vascular and biliary anatomy, guidance of tumor biopsies, placement of RFA probe, and assistance in the determination of complete ablation with margins.…”

Diagnostic laparoscopy: indications and benefits

“…Barbot et al [32] performed staging laparoscopy in 24 consecutive patients with resectable liver tumours (18 metastatic and six primary) as determined by conventional imaging studies. There was no known extrahepatic disease in any of the patients.…”