IMPROVED STAGING OF LIVER-TUMORS USING LAPAROSCOPIC INTRAOPERATIVE ULTRASOUND

Background: Intraoperative ultrasound has been shown to provide signif icant assistance in operative staging and management of patients with liver tumors during open surgery. The availability of the 5.0-7.5 Mhz semiflexible ultrasound transducer with gray-scale, color and spectral Doppler capabilities can provide similar information laparoscopically . Methods: Twenty-four consecutive patients with liver tumors (18 meta static and six primary), in technically resectable locations determine d by a variety of conventional imaging studies, were brought to the op erating room. There was no known extrahepatic disease, and there was n o recurrence at the primary site in the metastatic subgroup. These pat ients were evaluated intraoperatively with laparoscopy and intraoperat ive laparoscopic ultrasound to assess resectability prior to performin g a major laparotomy. Laparoscopy was successful in 23 of the patients and in 19 of 23, laparoscopic ultrasound was also employed, using the 5.0-7.5 MHz semiflexible transducer. The use of the open entry techni que, selection of alternate entry sites, coupled with expertise in lap aroscopic lysis of adhesions, has allowed safe laparoscopic tumor stag ing. Results: The laparoscopic evaluation was aborted only once due to dense adhesions, despite the fact that 67% of the patients had underg one previous abdominal surgery. There was only one complication: bleed ing from a liver biopsy in an unresectable cirrhotic patient, necessit ating laparotomy. Laparoscopy and ultrasound together predicted nonres ectability in six of eight unresectable patients, all of whom were spa red an unnecessary laparotomy. Conclusions: Laparoscopic ultrasonograp hic evaluation for the staging of liver tumors should be a prerequisit e to definitive laparotomy, with the objective of avoiding unncessary surgery. (C) 1997 Wiley-Liss, Inc.