Purpose: This study was undertaken to evaluate the feasibility of intraoperative laparoscopic ultrasonography (ILUS) to completely scan all anatomic segments of the liver through a single port site during laparoscopic resection for colorectal cancer.
Methods: ILUS was performed in patients who were undergoing laparoscopic colorectal cancer surgery using the following approach: 1) presence of a radiologist in the operating room; 2) introduction of the probe through a single cannula site; 3) standardized sequence of four probe positions on liver surface; 4) identification of all major vascular/biliary hepatic structures as a guideline to scan all parenchymal segments of the liver.
Results: Twenty-two patients who were undergoing laparoscopic colorectal cancer surgery were prospectively enrolled. Computed tomography (CT) scan films were available for an immediate comparative analysis in the first 12 cases. Mean duration of the procedure was 10 (range, 5-15) minutes. All major vascular and biliary structures were identified in all patients. Sixteen focal abnormalities were identified by ILUS, and ten focal abnormalities were identified by CT scan in the same seven patients. In one patient, detection of a suspected metastasis not seen by preoperative CT scan led to conversion of the surgical procedure to a laparotomy.
Conclusions: ILUS is a safe and expeditious technique that permits scanning of all anatomic liver parenchyma segments through a single cannula site. Because intraoperative palpation of the liver is not possible during laparoscopic colorectal cancer surgery, ILUS should probably be a standard component of the curative laparoscopic colorectal cancer operation.