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Front Matter |
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Abstract
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Abstract
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Technological Requirements for Ultrasound-Guided Liver Surgery |
Guido Torzilli,Fabio Procopio,Daniele Del Fabbro |
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Abstract
Ultrasound imaging is based on the ‘pulse-echo’ principle: a short burst of ultrasound is emitted from a transducer, directed into a tissue, and as consequence, part of the echoes produced by the interaction of sound with tissue are reflected back to the transducer.
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Technical Tricks to Start Exploring the Liver with Ultrasound |
Guido Torzilli,Daniele Del Fabbro,Matteo Cimino |
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Abstract
The IOUS should always be carried out personally by the surgeon in charge of the surgical procedure, rather than by an assistant, radiologist, or technician. Optimally, ultrasound and operation are done by the same person.
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Exploring the Liver by Ultrasound Along its Anatomy |
Guido Torzilli,Guido Costa,Florin Botea |
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Abstract
Adequate knowledge of liver anatomy, by surgical and ultrasound, is a requirement for performing IOUS: its vascular skeleton composed of the glissonian skeleton with its portal, arterial, and biliary elements and the hepatic veins are landmarks for liver exploration.
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Abstract
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Diagnosis and Staging: Intraoperative Ultrasound |
Guido Torzilli,Matteo Donadon,Matteo Cimino |
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Abstract
Detection and differentiation are the two main targets of IOUS explorations of the liver. IOUS is thus still serves as a reference standard compared to preoperative imaging. However, to make its performance provide the expected results one needs to consider several important aspects which, although basic, if unrecognized could lead to misinterpreting neoplastic or non-neoplastic lesions, normal findings, or artifacts to avoid useless resection and additional risk for the patients.
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Diagnosis and Staging: Contrast-Enhanced Intraoperative Ultrasound (CEIOUS) Using Intravascular Cont |
Guido Torzilli,Matteo Donadon,Guido Costa |
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Abstract
Tumor echogenicity and background liver appearance in IOUS (i.e., cirrhotic, steatotic) can affect our ability to recognize tiny lesions. It has been shown that small metastases can be better recognized if they are hypoechoic rather than isoechoic.
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Contrast-Enhanced Intraoperative Ultrasound Using Liver-Specific Contrast Agents |
Junichi Arita,Norihiro Kokudo |
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Abstract
As already described in the former chapters, the technique of liver surgery has substantially improved over the past few decades, partially because of the invention of IOUS [1].
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Abstract
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Planning of the Surgical Strategy |
Guido Torzilli,Fabio Procopio,Guido Costa |
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Abstract
IOUS exploration of the liver can have a great impact on surgical strategy. However, more recently the impact of IOUS on operative decision making, when compared with those of preoperative imaging techniques, is reported to be just around 4–7 % [1, 2].
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Resection Guidance |
Guido Torzilli,Fabio Procopio,Guido Costa |
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Abstract
The previous chapter described how IOUS with the information provided can lead to otherwise unsuitable approaches.
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Intraoperative Cholangio Ultrasound in the Study of the Biliary Tree |
Guido Torzilli,Fabio Procopio,Angela Palmisano |
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Abstract
It has been shown how IOUS is able to provide precise details about the anatomy of intrahepatic bile ducts, even when not dilated (see .), and their variants with their centripetal bifurcation pattern as compared to the portal branches (Fig. 9.1).
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Abstract
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Liver Transplantation from Deceased Donors |
Matteo Cescon,Fabio Piscaglia,Alessandro Cucchetti,Antonio Daniele Pinna |
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Abstract
Doppler ultrasonography (US) provides an accurate assessment of the hepatic vasculature in liver transplantation (LT). It can be performed perioperatively or at the bedside. The evaluation of the hepatic vessels includes color and spectral Doppler analysis. ColorDoppler provides information regarding the presence and direction of flow, as well as the location of turbulent flow in a post-stenotic segment. Spectral analysis describes the direction, velocity, and phasicity of flow.
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Liver Transplantation from Living Donors |
Kiyoshi Hasegawa,Yasuhiko Sugawara,Norihiro Kokudo |
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Abstract
Surgery to recover a liver graft from a living donor is technically demanding, because it should secure both the safety of a donor and favorable clinical course of a recipient. Intraoperative ultrasonography is an indispensable tool to determine the optimal transection plane in the liver parenchyma and division points of the vessels (the hepatic artery, the portal vein, and the hepatic vein).
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Abstract
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Laparoscopic Ultrasound: Impact in Liver Surgery |
Alessandro Ferrero,Luca Viganò,Roberto Lo Tesoriere,Lorenzo Capussotti |
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Abstract
In recent years laparoscopic liver surgery has become more popular, thanks to technical refinements and standardization of techniques. Its development relied on the capability to reproduce the same surgical steps of open procedures. Intraoperative liver ultrasonography (IOUS) has a fundamental role in liver surgery to complete disease staging and to guide resection. The same performances have to be expected by .laparoscopic ultrasonography (LUS). In this chapter, the contribution of LUS to laparoscopic liver resection will be briefly analyzed. The disease staging by LUS includes different steps: detection and characterization of known lesions, disclosure of additional nodules, and identification of relationships between lesions and vasculo-biliary structures. LUS may detect new malignant nodules in up to 20–30 % of patients. A direct comparison between open IOUS and LUS demonstrated similar performances by the two procedures. In addition, LUS has several roles during liver surgery: it is the only way to understand the precise liver anatomy and to recognize the presence of vasculo-biliary anomalies; it exactly localizes the lesions; it helps to plan the adequate operation. During re
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Ultrasound-Guided Intraoperative Ablation Therapies |
Roberto Santambrogio,Matteo Barabino,Enrico Opocher |
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Abstract
The increased application of laparoscopy in the field of abdominal oncology has led to an increased use of laparoscopic ultrasound (LUS) as a valuable tool for staging of neoplastic diseases [.]. In regard to liver surgery, LUS provides, in experienced hands, a wealth of information for resectability assessment by detecting nonpalpable lesions and visualizing sharp relationships between tumors and vascular structures [., .]. Moreover, LUS can serve as guidance for any interventional procedure such as biopsy or thermal ablation of a lesions in radiofrequency (RFA) or microwave (MWA) ablation [.]. LUS-guided thermal ablation of liver tumors can be mastered relatively quickly by a surgeon already familiar with laparoscopic and ultrasound techniques. The learning curve mainly relates to the interpretation of the ultrasonographic images and to the technical tricks of interventional maneuvers [.].
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Robotic Ultrasound-Guided Liver Resections |
Alberto Patriti,Marco Carlani,Luciano Casciola |
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Abstract
Advances in intraoperative ultrasound are reducing the need for major hepatectomies irrespective of tumor number and location and even in demanding conditions such as tumor invasion of the hepatic veins [.].
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