Ultrasound-guided liver subsegmentectomy: the peculiarity of segment 4

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Abstract
Although some authors are still skeptical about the usefulness of intraoperative ultrasonography (IOUS) in liver surgery, 1 Finlayson C. Hoffman J. Yeung R. et al. Intraoperative ultrasound does not improve detection of liver metastases in resectable pancreatic cancer. Am J Surg. 1998; 175 : 99-101 Abstract Full Text PDF PubMed Scopus (13) Google Scholar many studies have clearly shown its value and they affirm that nowadays, resective hepatic surgery must be an echo-guided surgical procedure. 2 Makuuchi M. Torzilli G. Machi J. History of intraoperative ultrasound. Ultrasound Med Biol. 1998; 24 : 1229-1242 Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar The ability to carry out anatomic liver resections, especially in patients with hepatocellular carcinomas (HCCs) and liver cirrhosis, without mortality or major complications, is mainly thanks to the availability of IOUS, 3 Torzilli G. Makuuchi M. Inoue K et al. No-mortality liver resection for hepatocellular carcinoma in cirrhotic and noncirrhotic patients is there a way? A prospective analysis of our approach. Arch Surg. 1999; 134 : 984-992 Crossref PubMed Scopus (421) Google Scholar which is not only the best imaging modality for staging, but also guides the surgeon’s hand step by step during parenchymal dissection.
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