This chapter provides a comprehensive overview of liver mobilization techniques and the essential role of intraoperative ultrasound in open, laparoscopic, and robotic-assisted hepatic surgery. Detailed surgical anatomy is reviewed, emphasizing the ligamentous attachments of the liver and their relevance during mobilization. Open liver mobilization techniques for right and left hepatic lobes are described with attention to retraction strategies, dissection planes, and critical anatomic landmarks such as the inferior vena cava and hepatic veins. The importance of intraoperative ultrasound is highlighted as a gold-standard tool for lesion localization, surgical planning, and real-time guidance. The chapter outlines key ultrasound settings and techniques for evaluating hepatic parenchyma and vascular structures, and how these inform decisions during parenchymal transection. Minimally invasive approaches, including laparoscopic and robotic mobilization, are discussed with attention to patient positioning, port placement, and device-specific considerations for intraoperative imaging. The benefits and challenges of ultrasound-guided navigation in minimally invasive cases are explored, with strategies to optimize image acquisition and interpretation. By integrating surgical anatomy, mobilization techniques, and advanced imaging, this chapter aims to enhance operative precision and safety in liver resection across surgical platforms.

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Liver Mobilization and Ultrasound

  • James M. McDermott,
  • Jonathan C. Delong,
  • Monica M. Dua

摘要

This chapter provides a comprehensive overview of liver mobilization techniques and the essential role of intraoperative ultrasound in open, laparoscopic, and robotic-assisted hepatic surgery. Detailed surgical anatomy is reviewed, emphasizing the ligamentous attachments of the liver and their relevance during mobilization. Open liver mobilization techniques for right and left hepatic lobes are described with attention to retraction strategies, dissection planes, and critical anatomic landmarks such as the inferior vena cava and hepatic veins. The importance of intraoperative ultrasound is highlighted as a gold-standard tool for lesion localization, surgical planning, and real-time guidance. The chapter outlines key ultrasound settings and techniques for evaluating hepatic parenchyma and vascular structures, and how these inform decisions during parenchymal transection. Minimally invasive approaches, including laparoscopic and robotic mobilization, are discussed with attention to patient positioning, port placement, and device-specific considerations for intraoperative imaging. The benefits and challenges of ultrasound-guided navigation in minimally invasive cases are explored, with strategies to optimize image acquisition and interpretation. By integrating surgical anatomy, mobilization techniques, and advanced imaging, this chapter aims to enhance operative precision and safety in liver resection across surgical platforms.