1,721,068 research outputs found
Ultrasound-guided finger compression in liver subsegmentectomy for hepatocellular carcinoma
No full textSystematic subsegmentectomy is now accepted as the best option for the surgical management of hepatocellular carcinoma in patients with cirrhosis because it optimizes the balance between oncological requirements and the need to spare functioning liver parenchyma. However, this technique can be difficult because it requires a strong background in ultrasound-guided interventional procedures. We describe a new, simplified technique for the anatomical subsegmental hepatic resection of segment 2 or 3. It consists of IOUS-guided blunt portal branch compression to disclose the subsegmental area to be removed. This technique is a further evolution of so-called systematic subsegmentectomy for tumors located in segments 2 and 3. Its main advantages are that it is easy, fast, and reversible. We believe that it has the potential to lead to new opportunities in subsegmental anatomic liver resection
Tricks for ultrasound-guided resection of colorectal liver metastases
No full textNowadays, tumor clearance for colorectal liver metastases can be achieved in most patients undergoing liver resection with survival benefits. Most merits of conservative and radical resections should probably be addressed to the extensive use of intraoperative ultrasound. Mostly for this reason, surgery can be still considered the treatment of choice. For this purpose, intraoperative ultrasound-guidance technique should be a familiar instrument for the hepatic surgeon. The technical tricks needed to perform a real intraoperative ultrasound-guided hepatectomy in the management of liver metastases from colorectal cancer are described
Intraoperative ultrasonography in liver cancer
No full textIOUS has become increasingly important for surgical resection in patients with cirrhosis and healthy liver. IOUS is important in the diagnosis and staging of liver cancer and as an element of the surgical technique, and IOUS can now be considered a fundamental tool for hepatobiliary and other surgical procedures [3]. The American College of Surgeons has recently recognized the need for surgeons to have specific training in ultrasonography. Meanwhile, dedicated monographs on IOUS have been published in the United States, Chile, and Europe [39-42]
Differences and similarities in the approach to hepatocellular carcinoma between Eastern and Western institutions
No full textIntraoperative procedures
No full textIn various surgical operations, intraoperative ultrasound (IOUS) has changed the pattern of surgical judgement and management. With a revolution in surgical techniques and US technology, IOUS continue to change. By reviewing the past development and present progress, the future perspective of IOUS in the new millennium is highlighted
Hepatic resection for hepatocellular carcinoma in cirrhosis
No full textHepatocellular carcinoma is one of the most common cancers worldwide. Several treatment modalities have been proposed, but hepatic resection is still considered the first-line therapeutic option for most of the patient carries of HCC. The proper selection of patients candidate to hepatic resection for HCC and the eradication whenever is possible of the intrahepatic metastases are the most crucial steps for improving the surgical outcome in HCC. This article reviews the current state of the art of the surgical treatment of HCC
The vascular control in liver resection: revisitation of a controversial issue
No full textLimiting intraoperative blood loss and the consequent need for whole blood transfusion is a widely accepted goal in liver resection. To achieve this goal, liver resection carried out under warm ischemia seems adequate. Methods used for this purpose can be categorized as follows: those with only an inflow control and the one that consists of total vascular exclusion. Liver resections under inflow vascular control are safer than those performed without. Furthermore, up to now the ischemia-reperfusion liver damage does not seem to affect the patients' course. The clinical evidence shows that intermittent warm ischemia seems to be safer than the continuous clamping and guarantees an effective control of the intraoperative bleeding. Conversely, total vascular exclusion is an invasive technique with not negligible morbidity; then its real indications should be restricted to exceptional cases, such as those with infiltration of the inferior vena cava which demands substitution of the involved vessel. In conclusion, up to now intermittent warm ischemia is the most appropriate approach to carry out safe liver resection
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