KEYWORDSLiver surgery; Pancreas surgery; Laparoscopic ultrasound.Abstract Introduction: Laparoscopic inspection before pancreatic and liver surgery is a widely accepted approach and has changed the surgical strategy in a growing number of patients for the last 10 years. The addition of intra-operative ultrasound to laparoscopy has further refined surgical judgments. The aim of this study was to evaluate the impact of open (IOUS) or laparoscopic (LIOUS) ultrasound in patients undergoing hepatic or pancreatic resection for benign or malignant lesions. Materials and methods: In the years 2005e2008, 45 patients (aged 42e75 years) were selected for liver resection, and 48 others (aged 14e72 years) were selected for partial pancreatic resection. Intra-operative ultrasound was performed for surgical staging. An Aloka SSD-5500 scanner (Aloka, Tokyo, Japan) was used with a flexible laparoscopic multifrequency linear and an electronic T-shaped linear probe. Results: LIOUS prevented useless laparotomies in six patients (13.3%) with liver tumors and, coupled with IOUS, revealed previously undetected tumors that required a change in the surgical strategy in 5 others (11.1%). In patients with pancreatic disease, LIOUS excluded the possibility of radical surgery in 7 patients (14.4%) due to the presence of mesenteric vein infiltration, involvement of the celiac or para-aortic nodes, or the presence of liver or peritoneal micro-metastases. In 11 patients with benign lesions, it defined the lesions' relation to the Wirsung duct and splenic vessels, and in 6 others it provided guidance for aspiration of fluid for chemical and cytologic analysis. Conclusions: LIUOS and IOUS can play fundamental roles in selecting patients for resective surgery and in planning the surgical approach. They provided information that affected surgical strategies in 11 patients with liver disease (24.4%) and 13 with pancreas disease (27%).Sommario Introduzione: L'ispezione laparoscopica in chirurgia del pancreas o del fegato è un approccio ampiamente utilizzato. L'aggiunta dell'ecografia intra-operatoria alla laparoscopia ha di recente ulteriormente migliorato la valutazione chirurgica. Lo scopo di questo studio è stato di valutare l'impatto dell'ecografia intra-operatoria open (IOUS) o laparoscopica (LIOUS) in chirurgia del fegato e del pancreas. pancreas. L'ecografia intra-operatoria è stata effettuata per mezzo di un apparecchio Aloka SSD-550 (Aloka, Tokyo, Giappone), con sonda lineare laparoscopica a punta flessibile e sonda elettronica lineare a T. Risultati: Tra i pazienti epatici, la LIOUS ha evitato inutili laparotomie in sei pazienti (13,3%) ed, insieme alla IOUS, ha consentito di trovare noduli non diagnosticati ed ha cambiato la strategia chirurgica in cinque pazienti (11,1%). Nel gruppo pancreas, la LIOUS ha escluso 7 pazienti (14,4%) dalla chirurgia radicale, per infiltrazione della vena mesenterica, coinvolgimento dei linfonodi celici o para-aortici, micro-metastasi epatiche e peritoneali. In 11 lesioni benigne, ha consentito la definizion...

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. Ultrasonic shears device and systematic pedicle clamping sped up resection time and reduced intraoperative bleeding.

In our experience IOUS and LIOUS were of the utmost importance in better defining staging of disease, infiltration of neighboring structures, number and size of nodular lesions, and anatomy of the hepatic pedicle and intrahepatic structures, thus making it possible to more accurately plan surgical procedures.

In this study, pre-operative US evaluation showed a diagnostic accuracy of 93.3%.

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