Utility of intraoperative liver ultrasound

Intraoperative ultrasound has become an essential component in oncologic hepatobiliary surgery. Based on this evaluation, tumor character-istics and resectability can be defined according to their sonographic appearance and their relationship to intrahepatic vasculature. This article outlines sonographic technique and its application, with the pertinent pearls and pitfalls encountered during a systematic evaluation of the liver. The concept of intraoperative ultrasound (IOUS) was first introduced in the mid-1960s and was used primarily in evaluating choledocholithiasis. More advanced applications were not pursued until the early 1980s, secondary to the limitations of ultrasound technology, which involved large bulky transducers and a relatively poor image quality [1]. The modern concept of IOUS was first described in the mid-1980s by several authors demonstrating its clinical utility as an adjunct to biliary and pancreatic surgery [2]. One of these seminal reports included the use of IOUS for hepatectomy [3]. Since then, there has been an exponential growth in the applications of IOUS, including percutaneous ablative techniques and laparoscopic applications. Presently, IOUS is a mainstay in all oncologic hepatobiliary procedures. This article evaluates the role, technique, and recent advances in applications of IOUS. Advantage of intraoperative ultrasound over other preoperative studies There are many approaches available for preoperative imaging of liver Surg Clin N Am 84 (2004) 513–524tumors. Transabdominal ultrasound is noninvasive, fast, the least expensive, and the modality of choice to distinguish between obstructive and nonobstructive causes of jaundice. Transabdominal ultrasound also * Corresponding author