scholarly journals Intraoperative Ultrasound in Colorectal Surgery

2021 ◽  
Author(s):  
Sinziana Ionescu
Keyword(s):  
Colorectal Surgery ◽  
Liver Metastases ◽  
Intraoperative Ultrasound ◽  
Tumor Location ◽  
Intestinal Wall ◽  
Resection Margins ◽  
Contrast Enhanced ◽  
Colon And Rectum ◽  
Non Palpable Lesions ◽  
Intraoperative Localization

Intraoperative ultrasound (IOUS) in colorectal surgery can be used both in benign and in malignant lesions. In benign cases, such as Crohn’s disease and diverticulitis, it can orient toward the extension of the surgical intervention. In malignant cases, such as colorectal cancer with liver metastases, IOUS/CE-IOUS (contrast-enhanced) improved the intraoperative management of liver metastases by dictating the resection margins in relation to the tumor extension. The IOUS method allows for exact tumor location, intestinal wall visualization, and malignant tumor penetration. The IOUS revealed the tumor and its margin in rectal lesions, making the sphincter-sparing operation easier to perform. In patients with small polyps and early colon and rectum cancers, IOUS works well as a one-of-a-kind intraoperative localization technique. In comparison with IOUS, CE-IOUS offered better detection and resection guidance. Intraoperative ultrasound enables surgeons to easily localize small, non-palpable lesions of the large bowel. Furthermore, it can determine even the aggressive potential of these lesions with high precision.

scholarly journals First application of intraoperative MRI of the liver during ALPPS procedure for colorectal liver metastases

2020 ◽  
Vol 405 (3) ◽  
pp. 373-379
Author(s):  
Carina Riediger ◽  
Verena Plodeck ◽  
Johannes Fritzmann ◽  
Alexander Pape ◽  
Alexander Kohler ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Intraoperative Ultrasound ◽  
Intraoperative Mri ◽  
Portal Vein Ligation ◽  
Liver Remnant ◽  
Enhanced Mri ◽  
Contrast Enhanced ◽  
Contrast Enhanced Mri ◽  
Staged Hepatectomy

Abstract Purpose Intraoperative detection of intrahepatic lesions can be demanding. The use of preoperative contrast-enhanced magnetic resonance imaging (MRI) or computer tomography (CT) combined with intraoperative ultrasound of the liver is state of the art. Near totally regressed colorectal liver metastases (CRLM) after neoadjuvant chemotherapy or nodules in severely altered liver tissue as steatosis or cirrhosis are often hard to detect during the operative procedure. Especially differentiation between benign atypical nodules and malignant tumors can be very difficult. The intraoperative use of contrast-enhanced ultrasound or intraoperative navigation are helpful tools. However, both methods show relevant limitations. The use of intraoperative MRI (ioMRI) can overcome this problem. Relevant structures can be marked within the operative site or immediate control of complete tumor resection can be achieved. This might allow immediate surgical optimization in case of failure. Methods We report the intraoperative application of ioMRI in a case of a 61-year-old male patient suffering from rectal cancer with 10 synchronous bilobar CRLM who was treated stepwise by multimodal treatment and staged hepatectomy. Intraoperative contrast-enhanced MRI of the liver was used during completion procedure of an extended right hemihepatectomy performed as “Associating Liver Partition and Portal vein Ligation for Staged hepatectomy (ALPPS)”. Results ioMRI provided excellent images and showed absence of liver metastases in the liver remnant. Procedure of ioMRI was safe, fast and feasible. Conclusion To the best of our knowledge, we describe the first case of intraoperative application of a contrast-enhanced MRI during open liver surgery at the University Hospital of Dresden.

scholarly journals The role of contrast-enhanced intraoperative ultrasound (CE-IOUS) in surgery for colorectal liver metastases: a meta-analysis

HPB ◽  
2021 ◽  
Vol 23 ◽  
pp. S832-S833
Author(s):  
M. Fergadi ◽  
D. Magouliotis ◽  
M. Vlychou ◽  
C. Rountas ◽  
E. Tatsios ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Meta Analysis ◽  
Intraoperative Ultrasound ◽  
Contrast Enhanced

scholarly journals Contrast-enhanced intra-operative ultrasound as a clinical decision making tool during surgery for colorectal liver metastases: The ULIIS study.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 422-422
Author(s):  
Serge Evrard ◽  
Grégoire Désolneux ◽  
Milene Isambert ◽  
Simone Mathoulin-Pélissier ◽  
Aurélien Dupré ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Clinical Utility ◽  
Detection Rate ◽  
Clinical Decision Making ◽  
Intraoperative Ultrasound ◽  
Added Value ◽  
Focal Liver Lesions ◽  
Contrast Enhanced ◽  
Operative Staging

422 Background: In the era of parenchymal sparing surgery, detecting more colorectal liver metastases (CRLM) is essential to optimize the treatment. We evaluated the added-value of contrast enhanced intraoperative ultrasound (CE-IOUS) with a prospective design. Methods: We used an optimal 2-stage Simon’s design for this two-center study open for patients with operable CRLMs. Primary objective was the justified clinical utility of contrast-enhanced IOUS. Secondary objectives included detection rate of CRLMs, characterization rate of focal liver lesions, specific toxicity and detection of missing CRLMs. Results: Among the 58 eligible patients, 54 were eligible and assessable. Of these 54 patients, 36 were men (66.7%), median age was 63.6 years (range, 37-81), and 43 patients underwent pre-operative chemotherapy. The median number of CRLMs was 2 (range, 1-11). Pre-operative staging was performed using MRI in all 58 eligible patients, CT scan in 41 (70%) and PET-scan in 21 (36%). Compared to pre-operative staging, IOUS allowed identification of 40 new CRLMs in 11 (20.4%) patients. Furthermore, compared to IOUS, CE-IOUS allowed identification of 9 additional CRLMs in 8 (14.8%) patients. The correct detection rate based on pathological exams was 0.94. No additional missing CRLM was diagnosed. The surgical procedure was altered in 5 (9.26%) patients but was justified only in 4 patients (one lesion was ablated without previous biopsy), leading to a clinical utility rate of 7.70% (95 CI, [3.2, 18.6]). There was no specific toxicity reported. Conclusions: Despite the primary endpoint not met for one protocol violation,the Uliis study demonstrates an added-value for CE-IOUS for surgeons treating CRLMs, especially for advanced cases pre-treated by chemotherapy. Clinical trial information: NCT01880554.

Contrast-enhanced intraoperative ultrasound in the resection of colorectal liver metastases with intrabiliary growth

2018 ◽  
Vol 11 (5) ◽  
pp. 348-353 ◽  
Author(s):  
Junko Hiroyoshi ◽  
Suguru Yamashita ◽  
Mariko Tanaka ◽  
Akimasa Hayashi ◽  
Tetsuo Ushiku ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Intraoperative Ultrasound ◽  
Contrast Enhanced ◽  
Intrabiliary Growth

Diagnosis of liver metastases from colorectal adenocarcinoma

1997 ◽  
Vol 38 (6) ◽  
pp. 986-992 ◽  
Author(s):  
M. Strotzer ◽  
J. Gmeinwieser ◽  
J. Schmidt ◽  
C. Fellner ◽  
J. Seitz ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Colorectal Adenocarcinoma ◽  
Intraoperative Ultrasound ◽  
Spiral Ct ◽  
Undergo Liver Resection ◽  
Contrast Enhanced ◽  
Before And After ◽  
Lesion Analysis ◽  
Higher Sensitivity

Purpose: the purpose of this study was to determine whether MR with and without SPIO (AMI-25) could replace spiral-CTAP in the staging of colorectal adenocarcinoma Material and Methods: Thirty-five patients were studied prospectively by means of i.v. contrast-enhanced spiral-CT, spiral-CTAP, and MR of the liver. MR imaging was performed before and after infusion of AMI-25. Diagnoses were compared to intraoperative findings (n=35) which included intraoperative ultrasound (n=21), and follow-up CT (n= 18) Results and Conclusion: Fifteen patients were found to have a total number of 53 liver metastases and 43 benign lesions were detected. Evaluation was performed in four different ways: 1) i.v. contrast-enhanced spiral-CT; 2) i.v. contrast-enhanced spiral-CT + spiral-CTAP; 3) plain MR; 4) plain MR + SPIO-enhanced MR. I.v. contrast-enhanced spiral-CT, spiral-CTAP and SPIO-enhanced MR identified patients with liver metastases with equal sensitivity. However, owing to its significantly higher sensitivity, based on a lesion-by-lesion analysis, spiral-CTAP cannot be replaced by SPIO-enhanced MR in patients who are to undergo liver resection. A limitation in spiral-CTAP is its relatively low specificity

scholarly journals Hand-Assisted Laparoscopic Surgery Is Superior to Open Liver Resection for Colorectal Liver Metastases in the Posterosuperior Segments

2021 ◽  
Vol 8 ◽  
Author(s):  
Omar Abu-Zaydeh ◽  
Muneer Sawaied ◽  
Yael Berger ◽  
Ahmad Mahamid ◽  
Natalia Goldberg ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Liver Resection ◽  
Liver Metastases ◽  
Hospital Stay ◽  
Disease Recurrence ◽  
Tumor Location ◽  
Resection Margins ◽  
Transfusion Rate ◽  
Open Liver Resection ◽  
Posterosuperior Segments

Introduction: Laparoscopic liver resections (LLR) of colorectal metastasis located in posterosuperior segments (1, 4A, 7 and 8) are challenging and highly demanding. The aim of our study is to determine the safety and feasibility of hand-assisted laparoscopic surgery (HALS) in the resections of the posterosuperior lesions and to compare the peri-operative, short-term and long-term outcomes with the open liver resection (OLR) approach.Methods and Results: A retrospective study of patients who underwent either HALS or OLR for metastatic colorectal cancer (mCRC) located in the posterosuperior segments of the liver between 2008 and 2018 in two university affiliated medical centers.Results: A total of 187 patients were identified, of whom 78 underwent HALS and 109 underwent OLR. There was no difference between the HALS and OLR with regard to preoperative factors (age, primary CRC tumor location, number and anatomical distribution of liver metastasis, pre-operative neo-adjuvant treatment, operative time, blood transfusion rate, and resection margins positivity). On the other hand, HALS compared to OLR had a significantly shorter mean hospital stay (4 vs. 6 days; P = 0.003), and a lower total complications rate (25 vs. 47% P = 0.006). Both groups had no 30-day mortality. Also, patients who underwent HALS vs. OLR had similar liver metastases recurrence (55 vs. 51%. P = 0.65) and 5-year survival (47 vs. 45%. P = 0.72).Conclusions: HALS for mCRC located in posterosuperior liver segments is safe and feasible and it is a preferable approach due to its lower complication rate and shorter hospital stay while not compromising survival and disease recurrence.

The surgical policy predicts the impact of contrast enhanced intraoperative ultrasound for colorectal liver metastases

2008 ◽  
Vol 67 (1) ◽  
pp. 177-178 ◽  
Author(s):  
Matteo Donadon ◽  
Florin Botea ◽  
Daniele Del Fabbro ◽  
Angela Palmisano ◽  
Marco Montorsi ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Intraoperative Ultrasound ◽  
Contrast Enhanced ◽  
The Impact
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