Ultrasound liver map technique for laparoscopic liver resections: tips and tricks

Laparoscopic liver resection (LLR) is safer and more advantageous than open surgery regarding morbidity, blood loss, length of hospital stay. Several radiological studies surgical strategies confirmed that the anatomy complex what Couinad described. Intraoperative ultrasound (IOUS) has become an indispensable tool to identify “real anatomy” plan a tailored LLR because wide sub-segmentary variability lack external indicators for small functional cores. We schematized our standard guidance technique during anatomical non-anatomical as four-step method called Ultrasound Liver Map Technique: (1) Compose three-dimensional mind map study relationships between lesions surrounding vascular elements; (2) create sketch on Glissonian using cautery help surgeon recall map; (3) check section plane while proceeding with transection; (4) correct direction ensure healthy margin concerning lesion point out pedicle correctly not affected structures. Finally, IOUS-Doppler can be used segmental portal flow assess venous drainage remnant parenchyma, avoiding ischemia increasing possibility performing parenchyma-sparing surgery.