The feasibility of using EUS (Endoscopic Ultrasound System) in laparoscopic liver surgery

【Background】In laparoscopic liver resection (LLR), the surgeon cannot obtain the information needed to perform the resection by tactile sensation. As a means of overcoming this limitation, intraoperative ultrasonography (IOUS) is useful because it can detect the lesion and the vascular vessels that will provide the landmarks for resection. In practice, however, the performance of IOUS has not yet compensated for its disadvantages. There are many issues that need to be resolved, especially in the puncture maneuver, and therefore, the feasibility of an endoscopic ultrasound system (EUS) during LLR was investigated through its use in animals.【Methods】 EUS was used as a detecting and puncturing tool for gallbladder and blood vessels during laparoscopic hepatectomy in swine.After successful puncture, ICG was injected into the object.The ability to observe the fluorescence of the target or the area dominated by the blood vessels was tested.【Results】One puncture of the gallbladder and four punctures of the portal system were successfully performed, and the ICG clearly fluoresced the gallbladder and bile ducts. The areas dominated by the portal vein were clearly stained as fluorescent areas on the liver surface, respectively. Thus, ICG fluorescence imaging of all targets was successful.【Conclusion】 For use in the human body, there remain issues to be cleared, such as economic issues and safety requirements. However, the use of EUS for LLR has the potential to reduce the complexity of LLR.