Page 40 - World Journal of Laparoscopic Surgery

REVIEW ARTICLE Laparoscopic versus Intraoperative Ultrasound in the Diagnostic of Liver Tumors

Laparoscopic versus Intraoperative Ultrasound

in the Diagnostic of Liver Tumors

María A Matamoros
Director of the Hepatobiliary and Liver Transplant Center, Caja Costarricense del Seguro Social, San José, Costa Rica

Abstract
Introduction: Intraoperative ultrasound has become the gold standard complementary study to surgical decision making in liver surgery.
In this review are analyze different variables to identified if laparoscopy ultrasound findings are equal or better than intraoperative
ultrasound.
Methods: A literature search was performed using Medline and Highwire Press data base. The following search terms were use:
“laparoscopic ultrasonography”, “intraoperative ultrasonography” and “liver tumors”. 447 citations found in total. Criteria for selection of
literature were number of cases (excluded if less than 20), Ultrasonography studies IOU and LU of different types of tumors:
neuroendorcrine, HCC and colon metastasis were included, and method of analysis (statistical or nonstatistical).
Results: The variables analyze in the studies selected were as follows: Method of patients selection, operative technique, operating time,
irresectability, postoperative morbidity, number of new tumors missed by IOU or LIOU, surgical plan changed after IOU or LIUO and
Hospital stay. Patient’s selection was based in patient having any type of liver tumor. Operative technique was performed in cases of
IOU by conventional laparotomy, and in laparoscopy cases were use mainly 2 subcostal ports and the umbilical port. Operating time
was estimated surgical prolongation of 30 minutes in the laparoscopy cases. Morbidity was lower in LIOU cases than in IOU. Lesions
missed by LIOU and IOU, both methods showed a higher sensitivity in finding small lesions than other complementary diagnostic
studies. Hospital stay was considerable shorter in LIOU.
Conclusions: Laparoscopy ultrasound has demonstrated to be very useful in diagnostic of liver tumor lesions. Therefore, there is big
room for the LIOU improved in diagnostic liver tumors. New and improved LIOU probes would very soon allow similar findings than IOU.
Targeting laparoscopy to patients at high risk for unresectable disease requires consideration to avoid unnecessary laparotomy.
Aim and objectives: The aim of this study is to compare the effectiveness of laparoscopic ultrasonography (LU) versus the open
intraoperative ultrasonography.
The following parameters were evaluated for both IOU and LIOU:
1. Method of patients selection.
2. Operative technique.
3. Operating time.
4. Intraoperative and postoperative complications.
5. Postoperative morbidity.
6. Number of new tumors missed by IOU or LIOU.
7. Surgical plan changed after IOU or LIUO.
8. Hospital stay.
Material and methods: A literature search was performed using Medline and Highwire Press data base. The following search terms were
use: “laparoscopic ultrasonography”, “intraoperative ultrasonography” and “liver tumors”. 447 citations found in total. Selected papers
were screened for further references. Criteria for selection of literature were number of cases (excluded if less than 20), Ultrasonography
studies IOU and LU of different types of tumors: Neuroendocrine, HCC and colon metastasis were included, and method of analysis
(statistical or nonstatistical).
Keywords: Laparoscopic ultrasound, diagnostic laparoscopy, laparoscopic tumor resection, laparoscopy for cancers.

INTRODUCTION or split liver and metastasectomy, metastatic survey, intrahepatic
biliary tree and vascular structures evaluation. Laparoscopy
Intraoperative ultrasonography (IOU) has become the gold
standard tool in liver surgery. Patients diagnosed with colon ultrasound is not always available as it is the IOU probes because
cancer approximately one fifth have occult metastases at the not all the ultrasound scanners have adequate their probes to
time of the presentation. It has been demonstrated the sensibility use in laparoscopy. Since it became available, some centers
of IOU in diagnosed liver tumors is high. IOU in combination started to switch form the IOU to laparoscopy ultrasonography.
with other radiological studies prior the surgery improved the The development of dedicated linear array probes improve the
diagnosed of the liver lesions. Nowadays IOU is use to perform feasibility to have a good image and better contact with the
tumor staging, metastatic survey, and guidance for whole organ liver surface. Before, transluminal probes were used through

World Journal of Laparoscopic Surgery, September-December 2009;2(3):43-46 43