[Intraoperative hepatic ultrasound, and surgical decision making]

Surgical resection of liver metastases might improve patient survival. Their number, location and relation to the intrahepatic blood vessels are of great importance in deciding whether to operate, the kind of operation (such as lobectomy, segmentectomy, wedge resection) and the surgical approach. Preoperative imaging modalities, including US, CT, MRI, isotope-scanning and sometimes portal angiography, are not sensitive enough to diagnose many liver lesions. Also, in many cases they do not give an absolute answer regarding the exact segmental location of the lesion and its relations to the major blood vessels. Intraoperative ultrasound is sensitive enough to detect most liver lesions, to locate them by liver segment, and to define their relationship to the hepatic vasculature.