Review for 10.1186/s12876-021-01600-3 (2021)

Reviewer’s report
Title: 
Fluoroless intravascular ultrasound image-guided liver navigation in
porcine models
Version: 
1 
Date: 
17 Nov 2020
Reviewer's report:
This paper reported a very interesting technology that consist of intravascular
ultrasound (IVUS) catheter to explore the liver. This is a proof-of-concept study
that evaluated the feasibility/safety of endovascular exploration, the quality of
images and the identification of usual anatomical landmarks. Authors had used
ex-vivo pig visceral block and in vivo pig model. The interest of this paper is to
evaluated the role IVUS to explore liver anatomy and not only to guide intra-
vascular procedure as already described in human, especially for TIPS.
Furthermore, these procedures were realized under fluoroscopic guidance and the
objective of this study is to explore the interest of this technology without X-Ray
aim to propose IVUS during liver surgery. Two different systems were tested,
one with intravascular transducer including 8F catheter and one with external
transducer. An elegant ex-vivo model of pig visceral block perfused passively
trough the portal vein and the common bile duct was used initially before to test
the device on pig in vivo model. Results and images to illustrate them are very
convincing using three operators. This discussion is clear and report other
experience in the same technology through the portal vein. In conclusion, this
paper that reported a very innovative way to explore the liver with a lot of
potential interest in oncological liver surgery was really impressive and required
without any doubt to be published.
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Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
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