Current use of intraoperative ultrasound in modern liver surgery

Abstract

Ultrasound plays an important role not only in preoperative diagnosis but also in intraoperative guidance for liver surgery. Intraoperative ultrasound (IOUS) has become an indispensable tool for modern liver surgeons, especially for minimally invasive surgeries, partially substituting for the surgeon's hands. In fundamental mode, Doppler mode, contrast enhancement, elastography, and real-time virtual sonography, IOUS can provide additional real-time information regarding the intrahepatic anatomy, tumor site and characteristics, macrovascular invasion, resection margin, transection plane, perfusion and outflow of the remnant liver, and local ablation efficacy for both open and minimally invasive liver resections. Identification and localization of intrahepatic lesions and surrounding structures are crucial for performing liver resection, preserving the adjacent vital vascular and bile ducts, and sparing the functional liver parenchyma. Intraoperative ultrasound can provide critical information for intraoperative decision-making and navigation. Therefore, all liver surgeons must master IOUS techniques, and IOUS should be included in the training of modern liver surgeons. Further investigation of the potential benefits and advances in these techniques will increase the use of IOUS in modern liver surgeries worldwide. This study comprehensively reviews the current use of IOUS in modern liver surgeries.