Laparoscopic intra-operative ultrasound in liver and pancreas resection: Analysis of 93 cases

Abstract

KEYWORDSLiver surgery; Pancreas surgery; Laparoscopic ultrasound.Abstract Introduction: Laparoscopic inspection before pancreatic and liver surgery is a widely accepted approach and has changed the surgical strategy in a growing number of patients for the last 10 years. The addition of intra-operative ultrasound to laparoscopy has further refined surgical judgments. The aim of this study was to evaluate the impact of open (IOUS) or laparoscopic (LIOUS) ultrasound in patients undergoing hepatic or pancreatic resection for benign or malignant lesions. Materials and methods: In the years 2005e2008, 45 patients (aged 42e75 years) were selected for liver resection, and 48 others (aged 14e72 years) were selected for partial pancreatic resection. Intra-operative ultrasound was performed for surgical staging. An Aloka SSD-5500 scanner (Aloka, Tokyo, Japan) was used with a flexible laparoscopic multifrequency linear and an electronic T-shaped linear probe. Results: LIOUS prevented useless laparotomies in six patients (13.3%) with liver tumors and, coupled with IOUS, revealed previously undetected tumors that required a change in the surgical strategy in 5 others (11.1%). In patients with pancreatic disease, LIOUS excluded the possibility of radical surgery in 7 patients (14.4%) due to the presence of mesenteric vein infiltration, involvement of the celiac or para-aortic nodes, or the presence of liver or peritoneal micro-metastases. In 11 patients with benign lesions, it defined the lesions' relation to the Wirsung duct and splenic vessels, and in 6 others it provided guidance for aspiration of fluid for chemical and cytologic analysis. Conclusions: LIUOS and IOUS can play fundamental roles in selecting patients for resective surgery and in planning the surgical approach. They provided information that affected surgical strategies in 11 patients with liver disease (24.4%) and 13 with pancreas disease (27%).Sommario Introduzione: L'ispezione laparoscopica in chirurgia del pancreas o del fegato è un approccio ampiamente utilizzato. L'aggiunta dell'ecografia intra-operatoria alla laparoscopia ha di recente ulteriormente migliorato la valutazione chirurgica. Lo scopo di questo studio è stato di valutare l'impatto dell'ecografia intra-operatoria open (IOUS) o laparoscopica (LIOUS) in chirurgia del fegato e del pancreas. pancreas. L'ecografia intra-operatoria è stata effettuata per mezzo di un apparecchio Aloka SSD-550 (Aloka, Tokyo, Giappone), con sonda lineare laparoscopica a punta flessibile e sonda elettronica lineare a T. Risultati: Tra i pazienti epatici, la LIOUS ha evitato inutili laparotomie in sei pazienti (13,3%) ed, insieme alla IOUS, ha consentito di trovare noduli non diagnosticati ed ha cambiato la strategia chirurgica in cinque pazienti (11,1%). Nel gruppo pancreas, la LIOUS ha escluso 7 pazienti (14,4%) dalla chirurgia radicale, per infiltrazione della vena mesenterica, coinvolgimento dei linfonodi celici o para-aortici, micro-metastasi epatiche e peritoneali. In 11 lesioni benigne, ha consentito la definizion...

The Additional Value of Laparoscopic Ultrasound to Staging Laparoscopy in Patients with Suspected Pancreatic Head Cancer

“…However, study cohorts were small (n < 50), and only few patients were diagnosed with occult distant disease (one and two cases, respectively). 16,17 The outcomes of our study are more in accordance with the results of a larger study in which the role of intraoperative ultrasound during exploratory laparotomy was investigated. In less than 1% of 470 patients the liver metastases found by intraoperative ultrasound resulted in a significant change of management.…”

“…20 In the second study of 48 patients with pancreatic head cancer, LUS had additional value in 7 patients (14.6%), because of mesenteric vein infiltration (4 patients), involvement of the celiac or para-aortic nodes (2 patients), or liver metastases (1 patient). All patients preoperatively underwent staging with biphasic contrast-enhanced CT. 16 In our study, LUS was performed routinely and not for specifically selected high-risk patients. Furthermore, in our cohort, all patients were preoperatively staged using tri-phasic CT.…”

Laparoscopic ultrasound: a surgical �must� for second line intra-operative evaluation of pancreatic cancer resectability

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Laparoscopic Pancreas Surgery: Image Guidance Solutions

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“…LUS plays an integral part in the management of cystic lesions of the pancreas, particularly the characterization of suspected intraductal papillary mucinous neoplasms (IPMNs) [95,97,98]. IPMNs appear as well-defined hypoechoic masses with associated posterior enhancement.…”