Intraoperative ultrasound for liver tumor resection in children

Hepatoblastoma

“…With IOUS, up to 20% of the patients could have morphologically different results compared to the preoperative MRI examination results, which make it necessary to change the surgical procedure in individual cases. These changes in results mainly concern the relationship between hepatoblastomas and hepatic veins, which is problematic, concerning imaging (72). Apart from the IOUS, an operating microscope and fluorescent dyes, which accumulate in the tumor and make it visible under the operating microscope with special filters, are usually used for tumor and tumor border imaging.…”

Surgical Management of Hepatoblastoma and Recent Advances

“…While the use of IOUS in pediatric liver resections has been reported as early as 1999, most reports were of only a few patients from single center institutions. In 2015, Felsted et al [47] described a study examining the use of IOUS in pediatric patients undergoing liver resection and found that, even with the advances in preoperative MRI imaging, discordant findings were found in approximately 20% of patients intraoperatively with ultrasound that changed the operative management in 14% of cases. While it is established that MRI is the best choice for preoperative imaging of pediatric hepatic malignancies with sensitivity of 1-3 mm, there are cases in which MRI is limited.…”

“…In cases of complex or distorted hepatic vascular anatomy, the use of IOUS can be used to better assess the relationship of the tumor to the corresponding hepatic veins. Of note, particularly challenging in preoperative imaging is that tumors that occupy segment IV can be distorted secondary to the umbilical fissure, unclear middle vein trajectory, and sometimes obliterated left portal vein secondary to tumor involvement [47]. The images of preoperative MRI might also further be distorted secondary to parenchymal compression from local tumor effects as well as motion artifacts during the time of imaging.…”

Hepatic tumors

“…Ameliyatta rezeksiyon sınırlarının tümörsüz olduğu-nu gösterme ve multifokal tümörlerde satellit lezyonları göstermede ultrason yararlıdır (25) .…”

“…SIOPEL sonuçlarına göre primer karaciğer nakli sonrası 10 yıllık sağkalım %85,7 iken, başarısız rezeksiyon sonrası karaciğer naklinde sağ-kalım %40'tır (5,25) .…”