Intraoperative online navigation of dissection of the hepatical tissue—a new dimension in liver surgery?

The functional–anatomical structuring of the liver according to Couinaud regarding the intrahepatical course of the vascular structures is the base of every modern liver surgery. Consequently, using intraoperative ultrasound is an undisputed requirement for every liver resection. Exact following of the planned resection plane can only be realized with the application of a permanent online navigation, based on intraoperative ultrasound during the dissection of the hepatical tissue. We present the combination of a navigation system (US-Guide 2000®) with an intraoperative ultrasound probe and a waterjet dissection instrument for intraoperative online navigation of parenchymal dissection. The use of the navigated liver resection is being shown by the example of a 79-year-old patient with a HCC in segment 5 and 6.