Écholaparoscopie du foie

Situation

In spite of recent progress in medical imagery, the findings of preoperative investigations of the liver are not always accurate and precise. Since the development of surgical laparoscopy, advantages of the laparoscopic examination are associated with advantages of laparoscopie ultrasonography.

Objective

The purpose of this work is to report the technique of staging laparoscopy with laparoscopic contact ultrasonography in the intraoperative assessment of patients with liver tumors, and to analyse its impact on the selection of patients for hepatic resection with curative intent.

Methods

The basic exploration follows at first portal branches and then hepatic veins. During the course of vascular exploration, the corresponding liver parenchyma is examined. A mobilization of the probe with clockwise or anticlockwise rotation movements allows full exploration of the liver.

Results

The association of laparoscopie examination and laparoscopic ultrasonography allows to localize with accuracy malignant and benign lesions and to perform ultrasound guided biopsy. Liver tumors not visible on preoperative imagery may be identified, relationships with adjacent vessels and presence of tumoral thrombi in major vascular structures may be assessed. Resectability of the liver tumors is at the best specified.

Conclusion

Staging laparoscopy with laparoscopie ultrasonography improves selection of patients for liver resection and facilitates choice and performance of the most appropriate resection.