Liver resection by Ultrasonic Dissection and lntraoperative Ultrasonography

Ultrasonic dissetion (USD) and intraoperative ultrasonography (IOUS) have shown encouraging resultsin a retrospective analysis of 109 patients with benign or malignant liver disease. Of 109 patients assessedbetween 1980 and 1993, 84 were resected: 27 by finger fracture technique (FFT) and 57 by USD. Hospitalmortality was 4.8% (4/84) and 30-day mortality was 6.0% (5/84). Overall morbidity was 48.8% (41/84)and liver related morbidity (hepatic bleeding, sepsis, and bile leak) was 34.5% (29/84); of the 29 patients,5 required re-operation. Liver complications occurred in 12/27 (44.4%) in the FFT group as opposed to17/57 (29.8%) in the USD group. The incidence of postoperative hepatic bleeding was significantly lessby USD than by FFT(p=O.03). As well, intraoperative blood loss (p=O.01)number of intraoperativeblood units used (p=0.002), and postoperative length of stay (p=O.O09) have been significantly reducedby USD. IOUS was used on 64 patients. Not only has it improved the sensitivity (99%) and specificity(98%) for detection of hepatic neoplasms, it has also helped increase the precision and accuracy ofanatomical tumour localization. As a result, 11/64 patients (17.2%) had their preoperative planschanged: 8 were abandoned and 3 were revised. In summary, USD has significantly reducedintraoperative blood loss and hence reduced the number of intraoperative transfusions, incidence ofpostoperative complications and postoperative length of stay. IOUS should be routinely employed inpatients undergoing liver resection since it provides critical information that could obviate oncologicallyuseless resections.Peer Reviewe