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Russolillo et al. Mini-invasive Surg 2023;7:3 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2022.74

Technical Note Open Access

Ultrasound liver map technique for laparoscopic

liver resections: tips and tricks

Nadia Russolillo, Serena Langella, Roberto Lo Tesoriere, Caterina Costanza Zingaretti, Andrea Pierluigi
Fontana, Alessandro Ferrero

Department of General and Oncological Surgery, Mauriziano Hospital, Turin 10128, Italy.
Correspondence to: Dr. Nadia Russolillo, Department of General and Oncological Surgery, Azienda Ospedaliera dell’Ordine
Mauriziano, Largo Filippo Turati 62, Turin 10128, Italy. E-mail: nrussolillo@mauriziano.it; Dr. Serena Langella, Department of
General and Oncological Surgery, Azienda Ospedaliera dell’Ordine Mauriziano, Largo Filippo Turati 62, Turin 10128, Italy. E-mail:
slangella@mauriziano.it

How to cite this article: Russolillo N, Langella S, Tesoriere RL, Zingaretti CC, Fontana AP, Ferrero A. Ultrasound liver map
technique for laparoscopic liver resections: tips and tricks. Mini-invasive Surg 2023;7:3. https://dx.doi.org/10.20517/2574-
1225.2022.74

Received: 25 Jul 2022 First Decision: 8 Sep 2022 Revised: 8 Nov 2022 Accepted: 5 Jan 2023 Published: 1 Feb 2023
Academic Editors: Fernando A. Alvarez, David Geller, Zenichi Morise Copy Editor: Ying Han Production Editor: Ying Han

Abstract
Laparoscopic liver resection (LLR) is safer and more advantageous than open surgery regarding morbidity, blood
loss, and length of hospital stay. Several radiological studies and liver surgical strategies confirmed that the
anatomy of the liver is more complex than what Couinad described. Intraoperative ultrasound (IOUS) has become
an indispensable tool to identify the “real anatomy” and to plan a tailored LLR because of wide sub-segmentary
variability and lack of external indicators for small functional liver cores. We schematized our standard ultrasound
guidance technique during anatomical and non-anatomical LLR as a four-step method called the Ultrasound Liver
Map Technique: (1) Compose the three-dimensional mind map to study the relationships between lesions and
surrounding vascular elements; (2) create a sketch on the Glissonian using cautery to help the surgeon recall the
mind liver anatomy map; (3) check the section plane while proceeding with the transection; and (4) correct the
direction of resection plan to ensure a healthy margin concerning the lesion and to point out the pedicle section
correctly and not affected structures. Finally, IOUS-Doppler can be used to study the segmental portal flow to
assess venous drainage of the remnant parenchyma, avoiding ischemia and increasing the possibility of performing
parenchyma-sparing surgery.

Keywords: laparoscopic liver resection, minor anatomical resection, liver anatomy, intraoperative laparoscopic liver
ultrasound

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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