Anatomical Resection of the Liver for Hepatocellular Carcinoma: a New Ultrasound Guided Approach

We herein describe a novel technique for the demarcation of the resection area by means of IOUS-guided finger compression to systematically accomplish anatomical segmental and subsegmental resections.

Using the IOUS, the tumor and the level targeted for compression are identified. Than, under the IOUS guidance, the surgeon compresses bilaterally the liver at the targeted position resulting in the compression of the portal pedicle feeding the tumor previously identified. This maneuver is constantly monitored in real-time just using the same microconvex probe, and it is maintained until the surface of the targeted liver area begins to discolor, at that time the first assistant marks the discolored area with the electrocautery, and the compression is released. Once the area is demarcated, liver dissection is started under intermittent Pringle's maneuver.

Inclusion criteria

• Patients suitable for surgical approach carries of HCC
• Serum bilirubin level lower than 1.5 mg/dl

Exclusion criteria

• Presence of ascites
• Serum bilirubin level equal or higher than 1.6 mg/dl
• Conditions (size, vascular relation, or infiltration) demanding resection larger than a segmental area
• Tumor thrombus in portal or hepatic veins