Serednicki Wojciech A, Hołówko Wacław, Tarasik Aleksander, Pierściński Stanisław, Hogendorf Piotr, Mielko Jerzy, Wysocki Michał, Dąbrowska Anna, Pędziwiatr Michał
Department of Medical Education, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland.
Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
Langenbecks Arch Surg. 2025 Jul 3;410(1):212. doi: 10.1007/s00423-025-03790-w.
Laparoscopic liver resection (LLR), being an established method, strongly relies on preoperative and intraoperative imaging. The aim of this study is to assess the utility, with a primary focus on oncological radicality, of intraoperative laparoscopic ultrasonography (IOUS) in nonanatomical laparoscopic liver resections data based on National Polish Registry of Minimally Invasive Liver Surgery.
An observational multicenter cohort study involving data from 8 Polish liver surgery departments was conducted. Patients who underwent minimally invasive nonanatomical liver resection in the years 2010-2024 in Poland were included in the research. Patients were divided into a control group without intraoperative ultrasonography and a study group with IOUS. Statistical analysis was performed to assess the perioperative results of IOUS usage in LLR.
Study results show that IOUS is associated with a considerably higher R0 resection margin (91,6% vs. 84,2%, p = 0,039) with, yet not statistically significant, but higher textbook outcome (82,8% vs. 78,2%, p = 0,258). Other results, such as intraoperative blood loss (median 200 ml vs. 150 ml, p = 0,62 and transfusion rate (9,3% vs. 9,7%, p = 0,896), as well as postoperative complications (11,2% vs. 11,6%, p = 0,175) were similar in both groups. IOUS is associated with longer operation time (median 200 min. vs. 140 min., p < 0,001), however, it is chosen by liver surgeons in more difficult cases (28,4% vs. 15,2% posterosuperior segments, p = 0,003).
Laparoscopic intraoperative ultrasonography is a useful tool in non-anatomical liver surgery, that ensures oncologic radicality with similar other outcomes compared to no IOUS usage. Therefore, it should be considered as mandatory in LLR. Furthermore, IOUS training programmes should be weighed into being a part of LLR training programmes.
腹腔镜肝切除术（LLR）作为一种成熟的手术方法，严重依赖术前和术中成像。本研究旨在基于波兰国家微创肝脏手术登记处的数据，评估术中腹腔镜超声检查（IOUS）在非解剖性腹腔镜肝切除术中的效用，主要关注肿瘤根治性。
进行了一项观察性多中心队列研究，涉及来自8个波兰肝脏外科科室的数据。纳入2010年至2024年在波兰接受微创非解剖性肝切除术的患者。患者分为未进行术中超声检查的对照组和使用IOUS的研究组。进行统计分析以评估IOUS在LLR中的围手术期结果。
研究结果表明，IOUS与显著更高的R0切除边缘相关（91.6%对84.2%，p = 0.039），教科书式结果虽无统计学意义但更高（82.8%对78.2%，p = 0.258）。两组的其他结果，如术中失血量（中位数200 ml对150 ml，p = 0.62）、输血率（9.3%对9.7%，p = 0.896）以及术后并发症（11.2%对11.6%，p = 0.175）相似。IOUS与更长的手术时间相关（中位数200分钟对140分钟，p < 0.001），然而，在更困难的病例中肝脏外科医生更倾向选择IOUS（后上段28.4%对15.2%，p = 0.003）。
腹腔镜术中超声检查是非解剖性肝脏手术中的一种有用工具，与不使用IOUS相比，能确保肿瘤根治性且其他结果相似。因此，在LLR中应将其视为必需。此外应考虑将IOUS培训计划纳入LLR培训计划的一部分。
