Intraoperative ultrasonography in hepatobiliary surgery.

Abstract

* Funding source – none Primary liver cancer ranks fifth in terms of malignant neoplasm incidence worldwide. The highest incidence is seen in countries with high prevalence of hepatitis C and B (1). Among primary liver cancer cases, there is observed growing incidence of intrahepatic bile duct cancer. The liver is the most common site for hematogenous metastases from other-organ neoplasms, particularly those of the gastrointestinal system. The incidence of liver metastases is 30-fold higher than that of primary cancers (1). Approximately million cases of colorectal cancer are observed each year worldwide. In the natural course of the disease, liver metastases are present in 50-60% of patients (2, 3), which means that 500,000 patients require treatment for liver metastases each year (4). Imaging examinations preceding the qualification for surgical treatment are greatly limited in terms of accurate evaluation of liver tumours, and are not always sufficient for posing the final diagnosis. Often, even the combining of information from different imaging examinations, such as contrast computed tomography, hepatic angiography (arteriography and portography) and contrast magnetic resonance imaging, does not increase the diagnostic accuracy (5). The above problem relates also to benign lesions, since the commonly available examinations do not allow their differentiation. This is why in many cases the final decision on further surgery is made intraoperatively, following the precise evaluation by intraoperative ultrasound (IOUS). The idea of IOUS was conceived in the 1960s, and initially this method was used in the evaluation of choledocholithiasis. The true development of this technique started in the early 1980s, owing to the significant technological progress and development of available equipment (6, 7). Currently, IOUS is an inseparable element of hepatobiliary surgery. It allows not only the evaluation of liver anatomy, but also serves as a diagnostic and therapeutic tool enabling accurate assessment and proper treatment of diagnosed focal lesions.