[Peroperative exploration of the liver in hepatic tumor surgery]

Intraoperative exploration of the liver and complete abdominal examination are essential before hepatic resection for patients with liver tumors. The surgeon's eye and hand, traditional methods of exploration, are still accurate for abdominal exploration, screening of small superficial liver tumors and evaluation of non-tumoral liver parenchyma. Intraoperative ultrasonography is often superior to preoperative screening methods in diagnosing small liver tumors. Intraoperative ultrasonography identifies variations of intrahepatic vascular structures and reveals exact location of tumors according to functional anatomy. The surgeon's eye and hand and intraoperative ultrasound are complementary for a complete exploration, and may affect operative decision making. Laparoscopy and laparoscopic ultrasonography, when diagnosing non resectable tumors, reduce the number of unnecessary laparotomies. However, the effectiveness of exploration by laparoscopy and laparoscopic ultrasonography is lower than that of laparotomy, which remains indispensable before hepatic resection for malignant tumors.