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Intraoperative Urologic Ultrasound

  • Fernando J. KimEmail author
  • Kyle Rove
  • David E. Sehrt
Chapter
Part of the Current Clinical Urology book series (CCU)

Abstract

Interventional ultrasonography (US) in urology includes many different diagnostic and therapeutic minimally invasive procedures. It also represents a noninvasive tool that, if placed in the hands of a trained surgeon, can aid various types of urologic interventions, allowing for on-the-fly, real-time visualization of important structures and operative activity that is both safe and inexpensive. Newer machines and probes allow for ultrasound application intraoperatively in virtually all areas of the urogenital tract and are increasingly used by urologists as an adjunct to standard operating techniques.

Procedures guided by dynamic ultrasound scanners produce real-time two-dimensional (2D) images and a needle-steering device mounted on the transducer can direct a needle into the image plane along a predictable route. Transducers are equipped with puncture-guiding devices, either as an external attachment or as an internal biopsy canal. First the transducer is positioned to identify the target. Then, the transducer is angulated using the rocking technique until the target is transected by the puncture line on the monitor. The needle is subsequently inserted through the guiding device and monitored continuously until the tip reaches the target.

During the US, the needle tip may generate reflections and backscattering. Target visualization can be enhanced with color Doppler signals to detect malignant neovascular formations. Recently, the experimental IV ultrasound contrast agents have demonstrated encouraging initial reports. The advancements of minimally invasive surgery required the adaptation and development of newer probes that could deliver the high-quality images via different handles and smaller dimensions. Nowadays, laparoscopic or robotic-assisted nephron-sparing kidney surgery cannot be performed safely without a laparoscopic ultrasound. These refined transducers have reached the pinnacle of portability and now are incorporated into the arms of robotic systems.

According to the American Urological Association Consensus Statement on Urologic Ultrasound Utilization, the appropriate transducer frequencies are 3.0–5.0 MHz for abdominal scanning, 6.0–9 MHz for transrectal, and 7.0–12.0 MHz for genital ultrasound. Intraoperative and laparoscopic renal ultrasound is performed with a 6–10-MHz linear array transducer. Transducers of higher frequency may be used for specialized exams. The equipment should be safe and display mechanical and thermal indices and provide for adjusting power output. Equipment should have software-controlled options which allow the user to obtain the highest-quality image and documentation (http://www.auanet.org/content/guidelines-and-quality-care/policy-statements/c/consensus-statement-on-urologic-ultrasound-utilization.cfm).

We will describe many of the instruments, practical applications, and techniques and describe important findings the urologist should appreciate on ultrasound during these procedures. We will further discuss hallmark ultrasonography images found in intraoperative urologic procedures.

Keywords

Stent Placement Germ Cell Tumor Ultrasound Probe Transrectal Ultrasound Adrenal Cortical Carcinoma 
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.

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of Surgery/UrologyUniversity of Colorado Health Science Center, Denver Health Medical Center, Tony Grampsas Cancer CenterDenverUSA
  2. 2.Department of UrologyUniversity of Colorado Health Science CenterAuroraUSA

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