chapter1 introduction: brief history - avid science · detect kidney stones in order to perform...

2 3www.avidscience.com

Sonography Sonography

www.avidscience.com

Introduction: Brief HistoryUltrasound has its well-established role in the diagno-

sis guidelines of abdominal pathology, being widely used in the internal medicine, gastroenterology and emergency services. Its use in surgery is best known trough FAST protocols (focused abdominal sonogram for trauma) [1-3], very important in the management of patients present-ing with abdominal trauma or suspected acute abdomen. Under elective conditions, conventional transabdominal ultrasonography has a high sensitivity and specificity in the detection of benign formations located mainly in the parenchymal organs: liver or splenic cysts, hemangioma, etc. [4-6]. In case of neoplasia, the ultrasound provides diagnostic guidance informations about intra-abdominal organs, the preoperative staging being mostly done by computed tomography (CT) or magnetic resonance im-aging (MRI) examinations [7,8].

Technological breakthroughs have allowed the devel-opment of this domain. By introducing contrast agents, diagnosis by ultrasound became more sensitive andits ap-plicability in the surgery field become more certain once high-fidelity transducers valid for intraoperative use were developed. Thus, intraoperative ultrasonography (IOUS) has become an important examination for the surgeon, often having a major role in the intraoperative decision making.

Chapter1

Intraoperative Ultrasound: Applications in Digestive Surgery

Adrian Bartoș1*, Iulia Betea1 and Dana Bartoș1,2

1Surgery Department, Regional Institute of Gastroen-terology and Hepatology ‘’Prof Dr. Octavian Fodor’’, Romania2Anatomy and Embriology Department, UMF “Iuliu Hațieganu”, Romania

*Corresponding Author: Adrian Bartoș, Regional Insti-tute of Gastroenterology and Hepatology ‘’Prof Dr. Octa-vian Fodor’’, Cluj-Napoca, Romania, Tel: 0040744495933; Fax: 0040264334734; Email: [email protected]

First Published May 20, 2016

Copyright: © 2016 Adrian Bartoș, Iulia Betea and Dana Bartoș.

This article is distributed under the terms of the Creative Com-mons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source.



www.avidscience.com

Ultrasound was first used intraoperatively in 1961 to detect kidney stones in order to perform nephrolithotomy [9]. At that time, the method has not been widely accepted becouse of the A-mode imaging mode, difficult in terms of interpretation [10]. The introduction of the B-mode in the 70’s, with real-time and two-dimensional visualiza-tion advantages, led to an increased use of intraoperative ultrasound in abdominal, thoracic, cardiovascular, neu-rological and endocrine surgery [10-12]. In the 90’s, due to scientific papers that highlighted the importance of in-traoperative ultrasound, the technique became a routine one in concern of hepato-bilio-pancreatic and vascular surgeries [10].

Equipment: Learning CurveHigh-end equipment and experienced ultrasonogra-

pher are mandatory for good application of intraoperative ultrasound techniques. Transducers used in IOUS must work at high-frequency (7.5-10 MHz), thereby allowing a higher spatial resolution than obtained with conven-tional transducers (3.5-5 MHz). The last ones can be used at the beginning of the examination of the liver, to get a panoramic overview of the organ’s anatomy [13,14]. Tech-nological developmens have allowed the production of transducers that can work on multiple frequencies, which can be adapted to each individual case, depending on the type and location of the lesion. The ideal transducer for intraoperative use should be small, in order to be able to be easily manipulated in narrow spaces, but at the same

time has to ensure a wide scan area [13] (Figure 1a, 1b).When needs, the IOUS can be applied in laparoscopic or robotic surgery, but with the use of special probes suited for these types of approaches (Figure 2a-b).The option of doing an IOUS with contrast agent (CEIOUS) is an im-portant factor in the choice of equipment. Currently, the most commonly used contrast agents are SonoVue (gase-ous sulfur hexafluoride; Bracco, Milan Italy) and Sonazoid (gaseous perflubtane; GE Healthcare, Norway/Daiichi Sankyo, Japan), both with applications in the characteri-zation of liver and pancreatic lesions, with role in the dif-ferentiation of benign from malignant tumors [13,15-18]. Elastography, the fusion imaging modules of real-time US with CT or MRI and the software that enable 3D ultra-sound reconstruction, usefully in guided surgical resec-tions, have been shown to be feasible, being a real asset when listed on the specifications of the ultrasound ma-chine used intraoperative [19-21].

Ultrasound has been and remains an imaging meth-od operator dependent. According to the literature, the learning curve of intraoperative ultrasound depends on the using purpose of this technique, on the complexity of the desired maneuvers and the targeted organ [22]. Thus, it is considered that the learning curve for screening liver metastases is overcome after a minimal 25 intraoperative examinations [10]. The same value is indicated for intra-operative diagnosis of gallstones. In case of interventional procedures on parenchymal organs (punctures, radiofre-



www.avidscience.com

quency ablation, etc.), the learning curve assume at least 25-40 and 50 ultrasound maneuvers on pancreas respec-tively on liver [10]. Of course, all this after completing the training in general ultrasound, considered by some authors as being easier for surgeons, which have the advantage of knowledge and understanding in detail the three-dimen-sional anatomy [10].

Figure 1a: Intraoperative L46K probe (linear), 13-3 Mhz, 60 mm, Hitachi Aloka Medical Ltd / Japan. Figure 1b: Intraoperative C42T probe (miniconvex),

1-13 MHz, 65°,Hitachi Aloka Medical Ltd / Japan.



www.avidscience.com

Figure 2a: Intraoperative laparoscopic ultrasound of the liver. L44LA intraoperative probe, 13-2 MHz, 36 mm.

Hitachi Aloka Medical Ltd / Japan. (From the personal archive of the authors).

Figure 2b: Intraoperative laparoscopic ultrasound of the liver showing the presence of a metastasis. L44LA

intraoperative probe, 13-2 MHz, 36 mm. Hitachi Aloka Medical Ltd / Japan.

(From the personal archive of the authors).

Intraoperative Ultrasound of the Liver: Diagnostic and Therapeutic Role

Because of high relapse rate after percutaneous punc-tures, simple symptomatic liver cysts benefit from surgi-cal indication. Fenestration or cyst resection is possible through laparoscopic or conventional surgery, the proce-



www.avidscience.com

dure being facile for superficial topography in the II, III, IVb, V, VI segments (after Couinaud) [23]. In case of le-sions located deep in the liver, when surgery is required because of the symptoms given by cyst compression, in-traoperative ultrasound is indispensable for locating the cyst and for establishing its vascular and biliary relations [6].

Intraoperative ultrasound has the same indication for hydatid hepatic cysts and abscesses, being of real help for the surgical team in establishing surgical tactics and to verify treatment radicalism (the remaining cavity contain-ing residual content, multilocular abscess, etc.).

Benign liver tumors can be diagnosed and charac-terized easily by transabdominal ultrasound, especially through the association of contrast agents, which have a role in the differential diagnosis of malignant lesions. IOUS can be useful in tumors with surgical indication (large hemangiomas) to determine the vascular and bil-iary relationship. The same principle is used for malignant tumors where IOUS is generally useful for local tumor staging and confirmation of resectability criteria.

In terms of primary malignant tumors (hepatocellular carcinoma), IOUS is superior in detecting lesions measur-ing less then 1cm, for which MRI has a lower specificity and sensitivity[13,24]. Furthermore, it is proven that in 19-29% of the cases, the results given by contrast IOUS changed the therapeutic plan [25-27]. The CEIOUS utility is obvious in cirrhotic patients for the differential diag-

nosis of suspicious hepatic nodules that can be malignant lesions or regeneration nodules [28,29]. Contrast agents used for this purpose (SonoVue) help to analyze the vas-cularization of concerned lesions with the potential of highlighting the pathognomonic phenomenon of wash-in and wash-out [13,16] (Figure 3).

Figure 3: CEUS of the liver showing a tumor with typical-ly washout effect. (ARIETTA V70. Hitachi Aloka Medical

Ltd / Japan. Contrast Harmonic Imaging Software)(From the personal archive of the authors).

In colorectal liver metastases, CEIOUS can reach an accuracy of 96% versus 74% and 79% for preoperative MRI/CT respectively intraoperative conventional ultra-sound [27,30]. The fact that undetectable colorectal liver



www.avidscience.com

metastases (by preoperative imaging) are the primary cause of recurrent neoplastic disease [31], emphasizes the role that IOUS can play in the management of patients di-agnosed with colorectal cancer. That is why international guidelines recommend routine use of IOUS in patients with this pathology [32].

Chemotherapy is part of adjuvant and neoadjuvant treatment arsenal of colorectal cancer [7,8], with the po-tential to obtain good results in cases with liver metas-tases, translated by stagnation or regression of lesions [33,34]. A particular case is when liver metastases are no longer visible by imaging (CT, MRI) after chemotherapy. Complete response to cancer treatment can be found in 66% of cases [33,35]. For the remaining cases, the chemo-therapy can affect the echogenicity of liver lesions, making them difficult to diagnose by preoperatively CT/MRI or even through IOUS [13,33]. In these particular situations, CEIOUS can underline the diagnosis, making possible to check areas where liver lesions described before chemo-therapy are no longer visible by conventional investiga-tions [13]. The role of this technique is highlighted by the results of multiple studies that show that only the IOUS confirmation of disappearance of liver metastases was as-sociated with a pathologic complete response [33,36].

Navigation technology is coming to help for liver le-sions detection after chemotherapy. This procedure con-sists in the combination and synchronization of CT or

MRI images obtained prior to chemotherapy with real time ultrasound, with the purpose of ultrasound guided procedure. The diagnosis is facilitated by the use of con-trast agents [13,19,37].

Liver tumors elastography evaluates the tissue elastic properties and can be useful in characterizing focal liver lesions [33,38,39]. Combining this technique with IOUS can increase the ability of liver lesions detection by 8% [40], elastography being proved to be useful in the dif-ferentiation of benign and malignant tumors and of liver metastasis and primary tumor [20,33,40,41]. Utility of the procedure has been proven in the assessment of the effica-cy of liver tumors ablation, elastography applied through IOUS being able to better estimate the necrosis areas than gray-scale US [33,42].

In all the situations described above, liver biopsy for suspicious lesions, performed intraoperatively under ul-trasound guidance, can essentially contribute to the prop-er management of patients. Puncture procedure, guided by IOUS, is considered a safe procedure with high diag-nostic accuracy, that can provide sufficient material for extemporaneous histopathological examination, which may have impact on intraoperative decision [33,43]. For example, liver metastases detected intraoperatively and histologically confirmed as having pancreatic origin are contraindications for radical pancreatic surgery [8].



www.avidscience.com

It is known that surgical resection is the standard treatment for malignant liver tumors, being the only pro-cedure that can provide oncological radicalism [8].

Liver parenchyma preservation should be an impor-tant goal for the surgical team, especially in patients with liver cirrhosis on witch the liver function and the progno-sis may be influenced by the extension of the resection. In this regard, the advantages brought by IOUS are indisput-able, thus enabling local assessment of intrahepatic tumor relations, thereby facilitating the limited resection, while maintaining oncological margins.

In addition to the important role that IOUS plays in staging liver lesions, it can guide surgical resection, al-lowing to perform the so-called “radical but conservative surgery” [13,44]. This concept is vital for the radical treat-ment of patients with multiple liver metastases, for which, several years ago, the only therapeutic option was pallia-tive treatment [44,45]. Obtaining continuous intraopera-tive ultrasound information about the relationship that the lesions have with intrahepatic structures, the surgeon can guide the resection line, with respect to the glissonean pedicles and suprahepatic veins in order to preserve as much as possible from the functional hepatic parenchyma [13,37,46]. Moreover, anatomic resections are possible by the use of IOUS. This technique involves compression of the segmental portal branch between the surgeon finger and the transducer, resulting a transient ischemia. The re-

section is being carried out along the emerging demar-cation line [45,47-51]. Same authors (Torzilli et al) have introduced new operations (eg: mini-mesohepatectomy) for tumors located at the confluence of the vena cava and suprahepatic veins [13,37,52]. These hepatic resections are based on IOUS studying of the relationships that tumor has with the suprahepatic veins and blood flow analysis at this level after clamping of the vein proposed for resection. Highlighting the reverse flow direction in the peripheral portion of the compressed vein or shunting collaterals be-tween the clamped vein and another suprahepatic or cava vein will allow limited resections while maintaining the oncological principles and minimalizing the risk of post-operative complications [13,37].

Conservative, local treatment for liver tumors can also be achieved by ablative methods: ethanol injection or induced coagulation necrosis by the use of radiofrequency or microwave [53,54]. These procedures are often used to complete surgical resections. Performed even by laparo-scopic approach, these procedures may be indicated for patients who are on the waiting list for liver transplan-tation or those who cannot benefit from surgical resec-tion due to comorbidities, liver cirrhosis or impaired liver function due to chemotherapy [55-58]. Of course, percu-taneous approach of these lesions is superior in terms of less postoperative pain and shorter length of hospital stay, but does not provide the accessibility that IOUS has on “hard to approach” liver areas, such as the caudate lobe [33,59,60].



www.avidscience.com

Surgical indication may be influenced by CEIOUS. An example is the classification introduced by Torzilli et al. which establishes criteria for surgical resection of the detected lesions, criteria made by the ultrasound appear-ance after intravenous administration of contrast agent (SonoVue) [37]. The authors indicate a sensitivity of 100% and a specificity of 69%, CEIOUS changing surgical strat-egy in 79% of cases [61].

Intraoperative Ultrasound of the Pan-creas: Diagnosis and Treatment Role

IOUS has applicability in pancreatic surgery also. For small benign lesions (eg: insulinoma) done by laparoscop-ic approach, IOUS is indispensable in identifying lesions and thus guide surgical resection (enucleation, limited pancreatic resection). Cephalopancreatic cystic lesions, confirmed as having a benign origin (eg: multiple pancre-atic cysts within Von Hippel Lindau disease) have surgical indication when producing compressive effect on neigh-boring structures (eg: jaundice, portal vein thrombosis). The dome resection of these cystis, especially for intra-pancreatic lesions is facilitated by IOUS which can show the relationships with major vascular structures, all these being done with the intent of a safe surgery (Figure 4a-b).

IOUS utility is also demonstrated in the case of pan-creatic pseudocysts, minimally invasive techniques of laparoscopic transgastric drainage being facilitated by ul-trasound examination, which highlights the vital relation-ships and content of the cyst (eg: necrosis) [62,63].

In cases of pancreatic neoplasia, IOUS allows safe puncture biopsy, by guiding the procedure.

The use of contrast agents (SonoVue) improves the diagnostic accuracy of IOUS, being recommended to characterize lesions detected previously by other meth-ods (conventional ultrasound, CT, MRI) [64]. CEIOUS is superior to pancreatic Doppler ultrasound in visualizing the intra and retropancreatic vascularization, having the ability to highlight any vascular tumor invasion, sparing the surgeon to do an exploratory dissection of that area [65,66]. Also, CEIOUS may be useful in pseudotumoral chronic pancreatitis when, one cannot rule out a malig-nant pancreatic tumor (Figure 5).

By this method, characterization of pancreatic paren-chyma and typical appearance of inflammatory and/or malignant lesions diagnosis can be put easily. Suspected malignant lesions can be biopsied under ultrasound guid-ance during surgery with minimal risk.

Patients with chronic pancreatitis with pancreatic duct litiasis and consecutive obstruction of it, who are candidates for pancreatico-jejunostomy, can benefit of IOUS, useful for quick identification of Wirsung duct and the level of obstruction (Figure 6).



www.avidscience.com

4 (a) Intraoperative aspect.

4 (b) Ultrasonographic aspect of a cystic lesion located in the pancreatic head.

Figure 4: Intraoperative ultrasound of the pancreas. L44LA intraoperative probe, 13-2 MHz, 36 mm, Hitachi

Aloka Medical Ltd / Japan.(From the personal archive of the authors).

Figure 5: CEIOUS of the pancreas with chronic pancreati-tis. L44LA intraoperative probe, 13-2 MHz, 36 mm,Hitachi Aloka Medical Ltd / Japan, Contrast Harmonic Imaging

Software. (From the personal archive of the authors).



www.avidscience.com

Figure 6: IOUS of the pancreas with chronic pancreatitis-showing the dilatation of the Wirsung duct and pancreat-ic duct litiasis (arrow). L44LA intraoperative probe, 13-2

MHz, 36 mm,Hitachi Aloka Medical Ltd / Japan. (From the personal archive of the authors).

Elastography has proven applications for the hepatic parenchyma [20,40,67] but has reduced applicability in concern of pancreatic tissue when the approach is transab-dominal. Used intraoperative, this technique could char-acterize pancreatic lesions, with potential for the differen-tial diagnosis. It is clear that further studies are needed in order to prove the superiority or inferiority of this method in confront with CEIOUS.

Future PerspectivesTechnical progress and research findings will defi-

nitely be followed by improvement of contrast agents, as happened with first generation contrast agents that were abandoned in favor of the second generation: SonoVue and Sonazoid. The second, recently introduced in clinical use, mainly used in Japan, has a high diagnostic accuracy, holding the advantage of Kupffer cell imaging in adition to vascular imaging [13,68]. Certainly, nanotechnology will have a decisive role in the progress of the field, this topic beinga main activity for research teams worldwide [69].

Results so far indicate that elastography and its appli-cations will play an important role in the management of abdominal parenchymal organ’s lesions. Standardization of this technique for the evaluation of liver and pancreatic tumors, with intraoperative application, could increase the minimally invasive nature and accuracy of diagnoses.

Hardware and software developments have resulted in apartition of navigation technology, technique applied in IOUS and compatible with CEIOUS, all contributing to improved methods of liver lesions detection [13,37]. The association of 3-dimensional ultrasound can add more accuracy to these procedures, with potential guidance for liver resection [19].

It is clear that this area is continuously evolving, future progresses and routine application of imaging techniques in the operating room being able to improve the surgical act, with positive impact on patient prognosis.



www.avidscience.com

AcknowledgmentBartoş Adrian is the coordinator of this chapter.

References1. Metsushima K, Frankel H. Trauma Ultrasound.

In: Hagopian E, Machi J, editors. Abdominal Ul-trasound for Surgeons. New York: Springer. 2014; 109-119.

2. Kell MR, Aherne NJ, Coffey C, Power CP, Kirwan WO. Emergency surgeon-performed hepatobil-iary ultrasonography. Br J Surg. 2002; 89: 1402-1404.

3. Burford JM, Dassinger MS, Smith SD. Surgeon-performed ultrasound as a diagnostic tool in ap-pendicitis. J Pediatr Surg. 2011; 46: 1115-1120.

4. Liang P, Cao B, Wang Y, Yu X, Yu D. Differential diagnosis of hepatic cystic lesions with gray-scale and color Doppler sonography. J Clin Ultrasound. 2005; 33: 100-105.

5. Lantinga MA, Gevers TJ, Drenth JP. Evaluation of hepatic cystic lesions. World J Gastroenterol. 2013; 19: 3543-3554.

6. Mulholland M, Hussain H, Fritze D. Hepatic Cyst Disease. In: Yeo C, McFadden D, editors. Shackel-ford’s Surgery of the Alimentary Tract. Philadel-

phia: Elsevier. 2013; 1453-1462.

7. National Comprehensive Cancer Network Guide-lines version 2. 2016. Rectal Cancer. 2016.

8. National Comprehensive Cancer Network Guide-lines version 1. 2016. Pancreatic Adenocarcino-ma. 2016.

9. Schlegel J, Diggdon P, Cuellar J. The use of ultra-sound for localizing renal calculi. J Urol. 1961; 86: 367-369.

10. Parks K, Hagopian E. Introduction: The Impor-tance of Ultrasound in a Surgical Practice. In: Ha-gopian E, Machi J, editors. Abdominal Ultrasound for Surgeons. New York: Springer. 2014; 3-6.

11. Makuuchi M, Torzilli G, Machi J. History of intra-operative ultrasound. Ultrasound Med Biol. 1998; 24: 1229-1242.

12. Machi J, Sigel B. Overview of benefits of operative ultrasonography during a ten year period. J Ultra-sound Med. 1989; 8: 647-652.

13. Donadon M, Costa G, Torzilli G. State of the art of intraoperative ultrasound in liver surgery: cur-rent use for staging and resection guidance. Ultra-schall Med. 2014; 35: 500-511.

14. Torzilli G, Procopio F, Fabbro D. Technologi-cal Requirements for Ultrasound - Guided Liver Surgery. In: Torzilli G, editor. Ultrasound-Guided



www.avidscience.com

Liver Surgery. Italia: Springer. 2014; 3-14.

15. von Herbay A, Westendorff J, Gregor M. Contrast-enhanced ultrasound with SonoVue: differentia-tion between benign and malignant focal liver le-sions in 317 patients. J Clin Ultrasound. 2010; 38: 1-9.

16. Trillaud H, Bruel JM, Valette PJ, Vilgrain V, Schmutz G, et al. Characterization of focal liver lesions with SonoVueÂ®-enhanced sonography: International multicenter-study in comparison to CT and MRI. World J Gastroenterol. 2009; 15: 3748-3756.

17. Luo W, Numata K, Kondo M, Morimoto M, Sugi-mori K. Sonazoid-enhanced ultrasonography for evaluation of the enhancement patterns of focal liver tumors in the late phase by intermittent im-aging with a high mechanical index. J Ultrasound Med. 2009; 28: 439-448.

18. Imazu H, Uchiyama Y, Matsunaga K, Ikeda K, Ka-kutani H, et al. Contrast-enhanced harmonic EUS with novel ultrasonographic contrast (Sonazoid) in the preoperative T-staging for pancreaticobil-iary malignancies. Scandinavian journal of gas-troenterology. 2010; 45: 732-738.

19. Beller S, Hünerbein M, Eulenstein S, Lange T, Schlag PM. Feasibility of navigated resection of

liver tumors using multiplanar visualization of in-traoperative 3-dimensional ultrasound data. Ann Surg. 2007; 246: 288-294.

20. Kato K, Sugimoto H, Kanazumi N, Nomoto S, Takeda S. Intra-operative application of real-time tissue elastography for the diagnosis of liver tu-mours. Liver Int. 2008; 28: 1264-1271.

21. Lee MW. Fusion imaging of real-time ultrasonog-raphy with CT or MRI for hepatic intervention. Ultrasonography. 2014; 33: 227-239.

22. Machi J, Sigel B, Zaren HA, Kurohiji T, Yamashita Y. Operative ultrasonography during hepatobil-iary and pancreatic surgery. World J Surg. 1993; 17: 640-645.

23. Couinaud C. Surgical anatomy of the liver. Several new aspects. Chirurgie. 1986; 112: 337-342.

24. Hammerstingl R, Huppertz A, Breuer J, Balzer T, Blakeborough A. Diagnostic efficacy of gadoxetic acid (Primovist)-enhanced MRI and spiral CT for a therapeutic strategy: comparison with intraop-erative and histopathologic findings in focal liver lesions. Eur Radiol. 2008; 18: 457-467.

25. Leen E, Ceccotti P, Moug SJ, Glen P, MacQuarrie J. Potential value of contrast-enhanced intraopera-tive ultrasonography during partial hepatectomy for metastases: an essential investigation before



www.avidscience.com

resection? Ann Surg. 2006; 243: 236-240.

26. Shah AJ, Callaway M, Thomas MG, Finch-Jones MD. Contrast-enhanced intraoperative ultra-sound improves detection of liver metastases dur-ing surgery for primary colorectal cancer. HPB: the official journal of the International Hepato Pancreato Biliary Association. 2010; 12: 181-187.

27. Bartos A, Iancu C. Tratamentul chirurgical al can-cerului colo-rectal cu metastaze hepatice rezeca-bile. In: Grigorescu M, Irimie A, Beuran M, edi-tors. Tratat de oncologie digestivÄƒ. III. Bucuresti: Editura Academiei RomÃ¢ne. 2015; 425-433.

28. Torzilli G, Olivari N, Moroni E, Del Fabbro D, Gambetti A, et al. Contrast-enhanced intraopera-tive ultrasonography in surgery for hepatocellular carcinoma in cirrhosis. Liver Transpl. 2004; 10: S34-38.

29. Roncalli M, Roz E, Coggi G, Di Rocco MG, Bossi P, et al. The vascular profile of regenerative and dysplastic nodules of the cirrhotic liver: implica-tions for diagnosis and classification. Hepatology. 1999; 30: 1174-1178.

30. Winter J, Auer AC. Metastatic malignant liver tu-mors: colorectal cancer. In: Jarnagin WR, editor. Blumgart’s Surgery of the Liver, Biliary Tract and Pancreas. 2. 5 ed: Elsevier Saunders. 2012; 1290-

1304.

31. Yoshidome H, Kimura F, Shimizu H, Ohtsuka M, Kato A, et al. Interval period tumor progression: does delayed hepatectomy detect occult metas-tases in synchronous colorectal liver metastases? Journal of gastrointestinal surgery: official journal of the Society for Surgery of the Alimentary Tract. 2008; 12: 1391-1398.

32. Claudon M, Dietrich CF, Choi BI, Cosgrove DO, Kudo M, et al. Guidelines and good clinical prac-tice recommendations for Contrast Enhanced Ultrasound (CEUS) in the liver - update 2012: A WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. Ultrasound Med Biol. 2013; 39: 187-210.

33. Joo I. The role of intraoperative ultrasonography in the diagnosis and management of focal hepatic lesions. Ultrasonography. 2015; 34: 246-257.

34. Garden OJ, Rees M, Poston GJ, Mirza D, Saunders M. Guidelines for resection of colorectal cancer liver metastases. Gut. 2006; 55: iii1-8.

35. Auer RC, White RR, Kemeny NE, Schwartz LH, Shia J. Predictors of a true complete response among disappearing liver metastases from colo-rectal cancer after chemotherapy. Cancer. 2010; 116: 1502-1509.



www.avidscience.com

36. Ferrero A, Langella S, Russolillo N, Vigano L, Lo Tesoriere R, et al. Intraoperative detection of dis-appearing colorectal liver metastases as a predic-tor of residual disease. Journal of gastrointestinal surgery: official journal of the Society for Surgery of the Alimentary Tract. 2012; 16: 806-814.

37. Torzilli G, Procopio F, Fabbro D. Ultrasound-Guided Liver Surgery: An Atlas. Torzilli G, editor. Milan: Springer. 2014.

38. Guibal A, Boularan C, Bruce M, Vallin M, Pil-leul F. Evaluation of shearwave elastography for the characterisation of focal liver lesions on ultra-sound. Eur Radiol. 2013; 23: 1138-1149.

39. Cho SH, Lee JY, Han JK, Choi BI. Acoustic radia-tion force impulse elastography for the evaluation of focal solid hepatic lesions: preliminary find-ings. Ultrasound Med Biol. 2010; 36:202-208.

40. Omichi K, Inoue Y, Hasegawa K, Sakamoto Y, Ok-inaga H. Differential diagnosis of liver tumours using intraoperative real-time tissue elastography. Br J Surg. 2015; 102: 246-253.

41. Inoue Y, Takahashi M, Arita J, Aoki T, Hasegawa K. Intra-operative freehand real-time elastog-raphy for small focal liver lesions: “visual palpa-tion” for non-palpable tumors. Surgery. 2010; 148: 1000-1011.

42. Correa-Gallego C, Karkar AM, Monette S, Ezell PC, Jarnagin WR. Intraoperative ultrasound and tissue elastography measurements do not predict the size of hepatic microwave ablations. Acad Ra-diol. 2014; 21: 72-78.

43. Mortensen MB, Fristrup C, Ainsworth A, Pless T, Larsen M, et al. Laparoscopic ultrasound-guided biopsy in upper gastrointestinal tract cancer pa-tients. Surgical endoscopy. 2009; 23: 2738-2742.

44. Torzilli G, Montorsi M, Donadon M, Palmisano A, Del Fabbro D. “Radical but conservative” is the main goal for ultrasonography-guided liver resec-tion: prospective validation of this approach. J Am Coll Surg. 2005; 201: 517-528.

45. Torzilli G, Procopio F, Costa G. Resection Guid-ance. In: Torzilli G, editor. Ultrasound - Guided Liver Surgery. Italia: Springer. 2014; 117-168.

46. Donadon M, Procopio F, Torzilli G. Tailoring the area of hepatic resection using inflow and out-flow modulation. World J Gastroenterol. 2013; 19: 1049-1055.

47. Xiang C, Liu Z, Dong J, Sano K, Makuuchi M. Precise anatomical resection of the ventral part of Segment VIII. Int J Surg Case Rep. 2014; 5: 924-926.

48. Torzilli G, Procopio F, Palmisano A, Donadon M,



www.avidscience.com

Del Fabbro D. Total or partial anatomical resec-tion of segment 8 using the ultrasound-guided finger compression technique. HPB (Oxford). 2011; 13: 586-591.

49. Torzilli G, Procopio F, Palmisano A, Cimino M, Del Fabbro D. New technique for defining the right anterior section intraoperatively using ultra-sound-guided finger counter-compression. J Am Coll Surg. 2009; 209: e8-11.

50. Torzilli G, Makuuchi M. Ultrasound-guided fin-ger compression in liver subsegmentectomy for hepatocellular carcinoma. Surg Endosc. 2004; 18: 136-139.

51. Torzilli G, Donadon M, Cimino M, Del Fabbro D, Procopio F. Systematic subsegmentectomy by ultrasound-guided finger compression for hepa-tocellular carcinoma in cirrhosis. Annals of surgi-cal oncology. 2009; 16: 1843.

52. Torzilli G, Donadon M, Palmisano A, Del Fabbro D, Spinelli A. Back-flow bleeding control during resection of right-sided liver tumors by means of ultrasound-guided finger compression of the right hepatic vein at its caval confluence. Hepatogastro-enterology. 2007; 54: 1364-1367.

53. Van Vledder MG, Boctor EM, Assumpcao LR, Rivaz H, Foroughi P, et al. Intra-operative ultra-

sound elasticity imaging for monitoring of hepatic tumour thermal ablation. HPB: the official journal of the International Hepato Pancreato Biliary As-sociation. 2010; 12: 717-723.

54. Koda M, Murawaki Y, Mitsuda A, Oyama K, Oka-moto K. Combination therapy with transcatheter arterial chemoembolization and percutaneous ethanol injection compared with percutaneous ethanol injection alone for patients with small hepatocellular carcinoma: a randomized control study. Cancer. 2001; 92: 1516-1524.

55. Howard JH, Tzeng CW, Smith JK, Eckhoff DE, Bynon JS. Radiofrequency ablation for unresect-able tumors of the liver. Am Surg. 2008; 74: 594-600.

56. Seidenfeld J, Korn A, Aronson N. Radiofrequency ablation of unresectable liver metastases. J Am Coll Surg. 2002; 195: 378-386.

57. Seidenfeld J, Korn A, Aronson N. Radiofrequency ablation of unresectable primary liver cancer. J Am Coll Surg. 2002; 194: 813-828.

58. Curley SA, Marra P, Beaty K, Ellis LM, Vauthey JN. Early and late complications after radiofre-quency ablation of malignant liver tumors in 608 patients. Ann Surg. 2004; 239: 450-458.

59. Crucitti A, Danza FM, Antinori A, Vincenzo



www.avidscience.com

A, Pirulli PG. Radiofrequency thermal ablation (RFA) of liver tumors: percutaneous and open surgical approaches. J Exp Clin Cancer Res. 2003; 22: 191-195.

60. Machi J, Uchida S, Sumida K, Limm WM, Hun-dahl SA, et al. Ultrasound-guided radiofrequency thermal ablation of liver tumors: percutaneous, laparoscopic, and open surgical approaches. Jour-nal of gastrointestinal surgery: official journal of the Society for Surgery of the Alimentary Tract. 2001; 5: 477-489.

61. Torzilli G, Palmisano A, Del Fabbro D, Marconi M, Donadon M. Contrast-enhanced intraopera-tive ultrasonography during surgery for hepato-cellular carcinoma in liver cirrhosis: is it useful or useless? A prospective cohort study of our experi-ence. Ann Surg Oncol. 2007; 14: 1347-1355.

62. Simo KA, Niemeyer DJ, Swan RZ, Sindram D, Martinie JB, et al. Laparoscopic transgastric en-dolumenal cystogastrostomy and pancreatic de-bridement. Surgical endoscopy. 2014; 28: 1465-1472.

63. Palanivelu C, Senthilkumar K, Madhankumar MV, Rajan PS, Shetty AR. Management of pancre-atic pseudocyst in the era of laparoscopic surgery--experience from a tertiary centre. Surg Endosc. 2007; 21: 2262-2267.

64. Piscaglia F, Nolsøe C, Dietrich CF, Cosgrove DO, Gilja OH. The EFSUMB Guidelines and Recom-mendations on the Clinical Practice of Contrast Enhanced Ultrasound (CEUS): update 2011 on non-hepatic applications. Ultraschall Med. 2012; 33: 33-59.

65. D’Onofrio M, Malagò R, Zamboni G, Vasori S, Falconi M. Contrast-enhanced ultrasonography better identifies pancreatic tumor vascularization than helical CT. Pancreatology. 2005; 5: 398-402.

66. D’Onofrio M, Malago R, Vecchiato F, Zamboni G, Testoni M, et al. Contrast-enhanced ultrasonogra-phy of small solid pseudopapillary tumors of the pancreas: enhancement pattern and pathologic correlation of 2 cases. J Ultrasound Med. 2005; 24: 849-854.

67. Kawaguchi Y, Tanaka N, Nagai M, Nomura Y, Fuks D. Usefulness of Intraoperative Real-Time Tissue Elastography During Laparoscopic Hepatectomy. J Am Coll Surg. 2015; 221: e103-111.

68. Arita J, Takahashi M, Hata S, Shindoh J, Beck Y. Usefulness of contrast-enhanced intraoperative ultrasound using Sonazoid in patients with hepa-tocellular carcinoma. Ann Surg. 2011; 254: 992-999.

69. Zheng SG, Xu HX, Chen HR. Nano/microparti-cles and ultrasound contrast agents. World J Ra-diol. 2013; 5: 468-471.

chapter1 introduction: brief history - avid science · detect kidney stones in order to perform...

Documents