Intraoperative and Laparoscopic Ultrasound During Liver Surgery

Intraoperative ultrasound (IOUS) was used primarily in 1960 to localize renal calculi during surgery for nephrolithotomy (Schlegel et al., J Urol 86:367–369, 1961). The first application of IOUS in hepatobiliary surgery was described by Yamakawa in 1951 to detect cholelithiasis using A-mode ultrasound (Yamakawa et al., Jpn J Gastroenterol 55:741, 1958). With the progress in ultrasound technology and the refinement of instruments, by the mid-1970s, real-time two-dimensional B-mode imaging systems became available. In 1977, Makuuchi was the first to use an electronic linear array (2.5- and 3.5-MHz transducers) for IOUS examination of the liver and pancreas (Makuuchi et al., Ultrasonic examination by electronic scanning during operation. Proceedings of the 32nd meeting of the Japan Society of Ultrasonics in Medicine. 1977. p. 129–130). Since then, IOUS of the liver has become an essential tool for hepatobiliary surgery and is essential in planning surgical strategies. Current applications of intraoperative ultrasound include assessment of tumor(s) and vascular involvement in addition to guidance of hepatic resection, whole or split-liver transplantation, and tumor ablation. Traditional ultrasound does not provide information about tumor vascularity and tissue microcirculation; however, contrast agents are becoming available to allow this evaluation (Takigawa et al., Ultrasound Med Biol 27:151–156, 2001; Yamada et al., World J Surg 25:1129–1133, 2001). The purpose of this chapter is to explain how to perform IOUS of the liver. Normal anatomy and anatomic variations, typical features of hepatic tumors, and the different applications of IOUS will be discussed.