Laparoscopic Intraoperative Ultrasonography

Abstract

Minimally invasive surgery has progressed to application in complex hepatico-pancreatico-biliary problems as well as to other organ systems. Although indirect palpation can be performed with probes and other instruments during laparoscopy, the sensitive tactile feedback of the surgeon’s hands is lost. Common bile duct (CBD) stones, lymph nodes, liver and pancreatic masses cannot be felt or characterized. This greatly limits the diagnostic and therapeutic capabilities of the laparoscopic approach. Laparoscopic ultrasound (LUS) promises to overcome these limitations and may perhaps exceed the sensitivities of manual palpation used with open surgery. Indeed, LUS is not a new technique but an extension of intraoperative ultrasound, which has been demonstrated to be superior to palpation and preoperative imaging techniques in detecting liver masses, finding insulinomas, characterizing tumors, etc. It has also been shown to be as sensitive and accurate as static intraoperative cholangiograms for finding CBD stones.