Anatomic liver resection is indispensable for liver surgeons. However, recognition of the precise intrahepatic resectional plane is difficult because intrahepatic Glissonean branches cannot be visualized. We have devised a new surgical procedure to accurately determine the resectional plane of deep parts of the liver. After dividing the surrounding ligaments, the echo probe is placed on the back of liver and the monitor image is reversed, right to left and up to down. This provides images almost the same as those from the usual position of the echo probe. This method enables the targeted Glissonean pedicle to be approached without losing the intrahepatic resectional plane. Because both the excision side and preserved side are depicted, injury to the hepatic vein and Glissonean branch on the preserved side is readily avoided. Real-time ultrasonographic guidance contributes to not only safe and precise hepatectomy, but also the education of inexperienced liver surgeons.
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