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Surgical Endoscopy

, Volume 7, Issue 3, pp 177–181 | Cite as

Early experience of laparoscopic ultrasonography in the management of pancreatic carcinoma

  • Mahadaven Murugiah
  • Simon Paterson-Brown
  • John A. Windsor
  • W. F. Anthony Miles
  • O. James Garden
Original Articles

Summary

A 7.5-MHz linear array ultrasound probe has been developed for the evaluation of solid organs at laparoscopy. Twelve patients with suspected carcinoma of the head of the pancreas, considered at initial investigation to have resectable disease, were submitted to laparoscopy. In 4 patients, diagnostic laparoscopy revealed hepatic metastases (4 patients), peritoneal dissemination of tumor (2), and malignant ascites (1). Laparoscopic ultrasonography demonstrated hepatic metastases in four patients and hepatic cysts in two further patients. Ultrasound evaluation of the pancreas revealed lymphadenopathy (4 patients), local infiltration (2), and portal vein displacement or invasion (4). An anomalous right hepatic artery arising from the superior mesenteric artery was identified in one patient. Overall, laparoscopy identified advanced disease in four patients. Laparoscopic ultrasonography, while detecting advanced disease in a further two patients, predicted resectable disease in six patients (50%). Only one of the six patients submitted to laparotomy was found to have irresectable disease due to lymph-node metastases. Laparoscopic ultrasound examination of the pancreas and liver has improved the early staging of pancreatic carcinoma and should be undertaken at an early stage in the management of such patients.

Key words

Intraoperative ultrasound Laparoscopy Pancreatic Carcinoma 

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References

  1. 1.
    Bismuth H, Castaing D, Garden OJ (1987) Operative ultrasound in surgery of primary liver tumours. World J Surg 11: 610–614Google Scholar
  2. 2.
    Campbell JP, Wilson SR (1988) Pancreatic neoplasms: How useful is evaluation with ultrasound? Radiology 167: 341–344Google Scholar
  3. 3.
    Carter DC (1990) Cancer of the pancreas. Gut 31: 494–496Google Scholar
  4. 4.
    Cuschieri A, Hall AW, Clark J (1978) Value of laparoscopy in the diagnosis and management of pancreatic carcinoma. Gut 19: 672–677Google Scholar
  5. 5.
    Garden OJ (1992) Intra-operative ultrasonography. Hosp Update 18: 470–479Google Scholar
  6. 6.
    Gillen P, Pell ALG (1986) Failure to improve survival by improved diagnostic techniques in patients with malignant jaundice. Br J Surg 73: 631–633Google Scholar
  7. 7.
    Lindsell DRM (1990) Ultrasound imaging of pancreas and biliary tract. Lancet I: 390–394Google Scholar
  8. 8.
    Norton JA, Sigel B, Baker AR, et al (1985) Localisation of an “occult” insulinoma by intra-operative ultrasonography. Surgery 97: 381–384Google Scholar
  9. 9.
    Okita K, Kodama T, Oda M, Takemoto T (1984) Laparoscopic ultrasonography: Diagnosis of liver and pancreatic cancer. Scand J Gastroenterol 19 (Suppl 94): 91–100Google Scholar
  10. 10.
    Plainfosse MC, Bouillot JL, Rivaton F, Vaucamps P, Hermigon A, Alexandre JA (1987) The use of operative sonography in carcinoma of the pancreas. World J Surg 11: 654–658Google Scholar
  11. 11.
    Shimi S, Banting S, Cuschieri A (1992) Laparoscopy in the management of pancreatic cancer: endoscopic cholecystjejunostomy for advanced disease. Br J Surg 79: 317–319Google Scholar
  12. 12.
    Sigel B, Coelho JCU, Nyhus LM, et al (1982) Detection of pancreatic tumors by ultrasound during surgery. Arch Surg 117: 1058–1061Google Scholar
  13. 13.
    Smith SJ, Vogelzang RL, Donovan J, Atlas SN, Gore RM, Neiman HL (1985) Intra-operative sonography of the pancreas. AJR 144: 557Google Scholar
  14. 14.
    Warshaw AC, Gu ZY, Witternberg J (1990) Pre-operative staging and assessment of resectability of pancreatic cancer. Arch Surg 125: 230–233Google Scholar

Copyright information

© Springer-Verlag New York Inc 1993

Authors and Affiliations

  • Mahadaven Murugiah
    • 1
  • Simon Paterson-Brown
    • 1
  • John A. Windsor
    • 1
  • W. F. Anthony Miles
    • 1
  • O. James Garden
    • 1
  1. 1.University Department of SurgeryRoyal InfirmaryEdinburghScotland, United Kingdom

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