Page 42 - World Journal of Laparoscopic Surgery

Laparoscopic versus Intraoperative Ultrasound in the Diagnostic of Liver Tumors

MORBIDITY disease without the possibility of leaving a sufficient liver
remnant, precluding radical resection. 6
Three papers out of 8 analyze the morbidity of LIOU. Then There are some issues that are very important do discuss
numbers in each paper describe only minor complications after
LIOU. MD Angelica describes in his data 27% of morbidity here. First, any surgeon performing IOU has to be experience in
after IOU. The same author claim to have only 9% of morbidity transabdominal ultrasonography and have some basic
in the cases performs by LIOU. There is significant difference knowledge in ultrasonography. Second, the surgeon has to be
in morbidity in MD’Angelica study that compares the advantage familiarized with the available probes for the ultrasound scanner,
of LIOU vs IOU. 16 the ones use for transabdominal, intraoperative and
laparoscopy. Third, the experience is very important because
each different probe offers a different image and sometime area
HOSPITAL STAY
and image varies depending on how the ultrasound crystals are
Hospital stay was much shorter in LIOU. Average stay was 2 aligning in the probe. There are new probes coming tote market-
days. The longest stay in patients who underwent LIOU was 5 offering improvements with working channels and biopsy
days. The median hospital stay describe by Dr Lai in the of the needle guide. Other characteristics have to be analyze, for
laparoscopic treatment group was significantly shorter than for example echogenicity of the lever metastasis. But for sure it
the open treatment group for patients with unresectable HCC would take a longer time and experience to raised consistent
3
(5 vs 7 d; P = 0.003). Other authors in the LIOU report a range of conclusions. Many authors agreed that IOU sensitivity might
1.3-1.5 median hospital stay days. If we compare the standard be good for small lesions with different textures. 8
stay of 8 days after IOU perform through a conventional Limitation of the LIUO that require converting the patient
laparotomy approach. There is a remarkable advantage when to open surgery, were cases with multiple adhesions due to
we analyze the hospital stay between these two procedures. previous surgeries. SMM Castro report in his study five patients
(13%) from the LIOU group could not be performed because of
DISCUSSION adhesions from previous surgery. 6

The liver primary and secondary tumors treatment have changed
toward a more aggressive approach. Indications for metastasis CONCLUSION
resection are treated more aggressively and it surgical approach Laparoscopy ultrasound has demonstrated to be very useful in
is perform by local or segmental resection for multiple lesions diagnostic of liver tumor lesions. Therefore, there is big room
and bilobar disease. Definitely, a better definition of liver for the LIOU improved in diagnostic liver tumors. New and
anatomy and the skill evolved in the use of IOUS has led to a improved LIOU probes would very soon allow similar findings
much more safe and practical approach of these lesions. 6 than IOU. Targeting laparoscopy to patients at high risk for
Small liver metastasis about 1 cm can be find with unresectable disease requires consideration to avoid
Intraoperative US (IOUS), for that reason is considered the unnecessary laparotomy.
gold standard, it has a sensitivity of 80% for evaluating this
small liver lesions. 17 REFERENCES
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