Page 41 - World Journal of Laparoscopic Surgery

María A Matamoros

laparoscopic probes making the procedure very cumbersome identifiable lesions were 10 at the primary hepatectomy and 4 at
and had bad image quality of 1.4 cm depth. 1 the second hepatectomy. The lesions missed by IOU were very
A good laparoscopy probe might have less than 10 mm to small, all of them less than 10 mm. Three small lesions out of 10
4
be able to introduce in a 10 mm laparoscopy port. Ideally, the were positive on lipidol CT. When it compares the LIOU with
length of the probe should be 35-50 cm to access adequately CT, LIOU showed more sensitivity than CT in finding lesions
the abdominal cavity. The IOU probes generally come in 5-10 between 0.3 to 2.4 cm. But we can not conclude out of these
MHz. Actually majority of this LS probes come in 5-10 MHz as findings that LIOU is better than IOU because there is more
it is in IOU. The 5-10 MHz probes allow a penetration depth of data need. Actually, it should be more difficult accessing some
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4-10 cm. And the LS come with a flexible tip to maximize it liver segments due to the shape of the LIOU.
capability to scan difficult angles of abdominal organs. IRRESECTABILITY
Regarding the technique of the IOU is use the regular
bilateral subcostal approach used for liver surgery. The most One of the biggest advantage of minimal access surgery in
common technique of laparoscopy approach describe in SAGES terminal patients or patients that do not meet the conditions to
guidelines is one trocar placed periumbilically with other trocar received the benefit of tumor resection, is the feasibility to
subcostally and a last one placed xyphoid or under the left overcome faster the surgical procedure and follow other
costal marging at the level of the midaxillary line and the anterior alternative treatment, like chemotherapy, alcohol injection,
axillary line. 1 chemoembolization or radiofrequency ablation.
The benefit to the patient with unresectable liver disease is
clearly address in several papers, as it is the sensitivity to find
CONTENT
small tumors, and give and early opportunity to the patient
The papers reviews mostly look at the feasibility of increased feasible to go under liver resection.
diagnosed by laparoscopy ultrasonography. It is well known A total of 232 patients in the group of LIOU from 7 studies
the need of intraoperative ultrasound diagnosis in liver surgery. look to the data and refine diagnosed of irresectability. All this
Then we show here the information collected. patients had complementary studies, CT, transabdominal
ultrasound and MRI. The irresectability of the tumor or tumors
NUMBER OF PATIENTS INVOLVED IN THE STUDIES was found in LIOU. Therefore, when this finding is done with
IOU, means for the patient an unnecessary laparotomy with a
A total number 2580 patients are analyze in this review. 2-21 946 larger probability of morbidity, larger length of hospital stay
out of 1290 with different types of tumors received as a and delay in palliative treatment. 268 patients in enroll in 6 studies
complementary diagnostic ultrasound laparoscopy. And total had tumor irresectability after IOU. Majority of the studies of
number of 1290 patients received as a complementary diagnostic IOU compares the IOU with other complementary studies, and
ultrasound with conventional laparotomy. All this studies were did not take in account this important variable of irresectability.
performed in patients with colorectal cancer, primary HCC and
endocrine tumors. SURGICAL PLAN CHANGED
Ninety-six patients out of 1290 that underwent LIOU, the
OPERATIVE TECHNIQUE previous surgical plan were changed to another one in term of
IOU was perform in all of the cases through conventional liver resection. The fact is only 2 papers were looking to this
laparotomy. LIOU approach was carried out under general variable out of 8 papers in the group of LIOU and 4 papers out
4,19-21
anestesia CO pneumoperitoneum was induced by using a of 8 in the IU group. In the group of IOU 72 patients, the
2
standard open technique or a Veress needle. Access to the surgical decision making was changed after different tumor
findings. This variable we are included the patients when this
abdominal cavity was obtained by three 10 or 11 mm trocars variable was included in the study by the authors. Data of
(umbilical and left and right subcostal). Laparoscopic irresectability is not included here, but could also be here in
examination was complete if anterior and posterior surfaces of terms of modification in decision making and surgical plan
the right and left hepatic lobes, the gastrohepatic omentum, changed. It would increase the numbers of patients and it has a
porta hepatis, pelvis, and peritoneal cavity were well-visualized. clear diagnostic impact in the clinical setting.
If feasible, adhesions were taken down laparoscopically. 6,7
SURGICAL TIME
NUMBER OF NEW TUMORS MISSED BY
IOU OR LIOU This variable was address in only 2 papers, one of this compare
IOU time with LIOU. In this comparison time consuming of
Although IOU had the highest sensitivity for the detection of LIOU was just 30 minutes prolonged conventional laparotomy.
HCC lesions, it could not visualize all of the primary tumors in Other paper does not compare but give us their time in LIOU
14 cases (2.6%) in Dr Zhang study of 430 cases. The non- which is 58 ± 19 minutes. 6

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