Intraoperative and laparoscopic sonography of the liver

Intraoperative sonography is an important aid in the decision making process during open surgery because it can detect additional small liver tumours that may not be depicted preoperatively, even with the use of modern non invasive imaging modalities. A continued important role of intraoperative sonography is to determine hepatic anatomy, allowing for safer and easier hepatic surgery with increased parenchymal preservation. Intraoperative sonography is also used for monitoring cryogenic ablation of hepatic tumour. To overcome the inherent limitations of laparoscopic surgery, laparoscopic sonography can now be used to provide information not available during laparoscopy or laparoscopic surgery alone. In this article, the authors present the most recent techniques for intraoperative sonography. Also they emphasize the important role of intraoperative sonography and laparoscopic sonography in the surgical decision-making process in patients with hepatic or biliary disease and report the most recent advances in intraoperative sonography with respect to the treatment of hepatic tumours. Finally, they try to look forward at the possible use for intraoperative technologies that are now in their early stages.