PURPOSE

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.

METHODS

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.

RESULTS

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).

CONCLUSION

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.