Objective: Laparoscopic inspection before pancreatic and liver surgery for malignancy or benign disease is a gold standard approach, and has been changing the surgical strategy in a growing number of patients, over the last ten years. The addition of intra-operative ultrasound to laparoscopy has recently further refined surgical judgment,. The aim of this study was to evaluate the impact of open (IOUS) or laparoscopic (LIOUS) ultrasound in patients undergoing liver or pancreas surgery for benign or malignant lesions.
Methods: In the years 2005-2008, 45 patients, aged 42-75, were selected for liver resective surgery, and 48, aged 14-72 for pancreatic partial resection. Intra-operative ultrasound was performed for surgical staging, by means of an Aloka SSD-5500 equipment ( Aloka, Tokyo, Japan), provided with linear laparoscopic multifrequency flexible probe and electronic T shaped probe.
Results: Among liver patients, LIOUS spared useless laparotomies in six patients (13.3%) and, coupled with IOUS, found undetected nodes and changed surgical strategy in five patients (11.1%). In the pancreas group, LIOUS excluded 7 patients (14.5%) from radical surgery, because of mesenteric vein ,celiac or para-aortic nodes involvement, liver or peritoneal micro-metastases. In 11 cystic lesions, it allowed definition of relationships to Wirsung duct and splenic vessels, in 6 it guided aspiration of fluid for chemical and cytologic analysis.
Conclusions: In our experience LIUOS and IOUS proved to be of utmost importance both in the selection of patients for resective surgery and in planning surgical approach, affecting surgical therapy in 11 liver (24.4%) and 13 pancreas patients (27%).