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Intraoperative Ultrasound During Biliary Tract Surgery

  • Ewen M. HarrisonEmail author
  • O. James Garden
Chapter

Abstract

Intraoperative ultrasonography of the biliary tree has existed for five decades, but interest has been rekindled in recent years. The two main drivers are the expansion of hepato-pancreaticobiliary surgery as a specialty, together with the adoption of standard laparoscopic approaches to common procedures such as cholecystectomy and distal pancreatectomy.

The aim of this chapter is to describe the anatomy of the normal biliary tract and highlight the use of intraoperative ultrasonography in the management of common biliary pathologies.

Improvements in the quality of imaging have been key to the development of the technique: high-resolution real-time B-mode ultrasound images are essential and the ability to add colour flow Doppler to visualise blood vessels is now standard. We describe a practical approach to the use of ultrasound at both open and laparoscopic surgery.

The technique remains an essential part of the armamentarium of the hepatobiliary surgeon. Clear delineation of anatomy allows judgements to be made on the nature and extent of disease. It is useful in the detection of common bile duct stones and can dispense with a requirement for cholangiography. There is a learning curve but published studies report high success rates with the advantage of repeating the examination during dissection. In general, it is quicker than alternative imaging modalities and has a lower overall cost.

Keywords

Bile Duct Common Bile Duct Hepatic Artery Laparoscopic Cholecystectomy Biliary Tree 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Supplementary material

Video 14.1

Transverse views of the portal pedicle in a patient with biliary obstruction. A full description is provided in the main text (AVI 142671 kb)

Video 14.2

Longitudinal view of the portal pedicle in a patient with biliary obstruction. The neck of the pancreas can be seen with a visible but non-dilated pancreatic duct. A large gallstone is seen in a thickened common bile duct (note the prominent acoustic shadow). Stents can be seen in the CBD extending below the level of the stone (AVI 172011 kb)

Video 14.3

Longitudinal view of portal pedicle in patient with biliary obstruction. The neck of the pancreas can be seen with a visible but non-dilated pancreatic duct. A large gallstone is seen in a thickened common bile duct (note the prominent acoustic shadow). Stents can be seen in the CBD extending below the level of the stone (AVI 158556 kb)

Video 14.4

Malignant obstruction of the biliary tree. An indistinct mass is seen in the head of the pancreas with dilatation of the pancreatic duct and a metal stent in the common bile duct. The confluence of the superior mesenteric vein (SMV) and splenic vein becomes the portal vein which can be followed beneath the neck of the pancreas. Both the vein and the superior mesenteric artery appear free of tumour (AVI 97220 kb)

Video 14.5

Malignant obstruction of the biliary tree. An indistinct mass is seen in the head of the pancreas with dilatation of the pancreatic duct and a metal stent in the common bile duct. The confluence of the superior mesenteric vein (SMV) and splenic vein becomes the portal vein which can be followed beneath the neck of the pancreas. Both the vein and the superior mesenteric artery appear free of tumour (AVI 151208 kb)

Video 14.6

Segmental obstruction of the biliary tree by large hepatocellular carcinoma (AVI 101603 kb)

Video 14.7

Laparoscopic ultrasound examination of the gallbladder described as suspicious on preoperative imaging. The gallbladder is seen to be smooth and relatively thin walled, with multiple gallstones present within the lumen. No infiltrating lesion was seen (AVI 19122 kb)

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Department of Clinical SurgeryThe University of Edinburgh, Royal Infirmary of EdinburghEdinburghUK

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