Trial Information

More Than 400 Hepatectomies Without Intraoperative Cholangiography: Prospective Validation of the Role of Ultrasound

Intraoperative ultrasonography (IOUS) in liver surgery is widely accepted as a fundamental
tool for radical and safe hepatectomy [1]. New technical improvements of IOUS have been
reported in recent years both for tumor characterization and staging [2] and for resection
guidance [3-5]. However, intraoperative cholangiography (IOC) still represents the gold
standard for studying the biliary tract anatomy as well as for guiding reconstruction in
case of bile duct resection and, moreover, with the advent of living donation it is the
standard reference for validating preoperative imaging [6]. Conversely, it could be affirmed
that IOUS in this sense has no role, if not for guiding intraoperative dilated bile duct
drainage [7]. Nevertheless, IOC has not negligible costs, it implies the use of x-ray,
iodated contrast agents and is time consuming.

Herein is proposed a technique for bile duct exploration by means of intraoperative
cholangio-ultrasound (IOCUS) validated on a consecutive series of patients undergoing liver
resection.

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North Am, 84(4): 1085-111

2. Minagawa M, Makuuchi M, Takayama T, Ohtomo K (2001). Selection criteria for hepatectomy
in patients with hepatocellular carcinoma and portal vein tumor thrombus. Ann Surg,
233(3): 379-84

3. Torzilli G, Del Fabbro D, Olivari N, Calliada F, Montorsi M, Makuuchi M (2004).
Contrast-enhanced intraoperative ultrasonography during liver surgery. Br J Surg,
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4. Torzilli G, Makuuchi M. Ultrasound-guided finger compression in liver subsegmentectomy
for hepatocellular carcinoma (2004). Surg Endosc, 18(1):136-9

5. Torzilli G, Takayama T, Hui AM, Kubota K, Harihara Y, Makuuchi M (1999). A new
technical aspect of ultrasound-guided liver surgery. Am J Surg, 178(4): 341-3

6. Lee VS, Krinsky GA, Nazzaro CA, Chang JS, Babb JS, Lin JC, Morgan GR, Teperman LW.
Defining intrahepatic biliary anatomy in living liver transplant donor candidates at
mangafodipir trisodium-enhanced MR cholangiography versus conventional T2-weighted MR
cholangiography. Radiology, 2004; 233(3): 659-66

7. Torzilli G, Makuuchi M, Komatsu Y, Noie T, Abe H, Kobayashi T, Kubota K, Takayama T. US
guided biliary drainage during hepatopancreatico-jejunostomy for diffuse bile duct
carcinoma. Hepatogastroenterology. 1999; 46(26): 863-6.