Laparoscopic intracorporeal ultrasound cystic duct length measurement

Abstract

The incidence of common bile duct injury remains high. Intracorporeal ultrasound mapping of cystic duct anatomy, prior to laparoscopic cholecystectomy (LC), may assist surgeons in avoiding common bile duct injuries. A technique for intraoperative intracorporeal predissection ultrasound imaging (IIPUI) of the cystic duct length was tested. During LC, gallbladder adhesions were lysed, and with the gallbladder retracted by grasping forceps, the ultrasound examination was performed. Using a 7.5-MHz articulating ultrasound probe, visualization of the extrahepatic biliary tree was obtained in five separate planes. Success in visualizing each plane, time for ultrasound examination, and predissection accuracy of cystic duct length measurement were recorded. Intraoperative cholangiography or direct measurement of the dissected cystic duct was used to determine accuracy of the ultrasound cystic duct length estimates. Forty-three patients underwent IIPUI during LC. The time required to perform the examination varied, with a range of 5 to 17 min (mean 9.5 min). Success of visualization in planes 1 through 5 was 44%, 95%, 98%, 98%, and 70%, respectively. The accuracy rate for cystic duct length ultrasound measurement was 87.1%. No complications related to the examination were observed. In this preliminary study, cystic duct length was determined by predissection intracorporeal ultrasound with a high level of accuracy. Predissection imaging may assist in preventing common bile duct injury during LC.

Routine laparoscopic ultrasound can significantly reduce the need for selective intraoperative cholangiography during cholecystectomy

“…Biffl et al [1] reported that routine LUS reduced bile duct complications during LC significantly, as compared with selective IOC. Several other reports have suggested the potential value of LUS in decreasing bile duct and other injuries [2,3,12,23].…”

The routine use of laparoscopic ultrasound decreases bile duct injury: a multicenter study

“…By clarifying biliary anatomy, LUS is expected to be potentially helpful to avoid BD injury during LC. A few studies of relatively small number of patients have shown the possibility of LUS in preventing BD injury [9][10][11]. However, in order to prove the ability of LUS, a study with a larger number of patients is required because the major BD injury is an uncommon event with a reported rate of 1 out of 200-400 LCs (0.25-0.5%) [12][13][14][15][16].…”

In Vivo Spectroscopic Characterization of Porcine Biliary Tract Tissues: First Step in the Development of New Biliary Tract Imaging Devices

“…15 Intraoperative ultrasound has been proposed for intraoperative bile duct imaging but has not proven to be very effective nor widely adopted in clinical practice. 1,11,17,24 Newer technologies are needed to facilitate surgeon identification of the biliary tree during surgery to eliminate the risk for BDI. Once such a technology is available, it will not only reduce BDI rates, but will also facilitate bile duct visualization during cholecystectomy enabling surgeons to markedly reduce the time taken to perform these operations simultaneous to improving the operations' safety profile.…”