The feasibility and accuracy of laparoscopic ultrasonography during laparoscopic cholecystectomy

Abstract

Background: During laparoscopic cholecystectomy (LC), intraoperative cholangiography (IOC) is currently regarded as the gold standard in the detection of choledocholithiasis. When laparoscopic ultrasonography (LUS) emerged as a viable diagnostic adjunct, it was hypothesized that its routine use would facilitate dissection, detect occult choledocholithiasis, and prevent bile duct injury (BDI) during LC. The aim of this study was to evaluate the feasibility of LUS during LC, and to evaluate its routine use in reducing bile duct complications during LC.

Methods: Forty consecutive patients with gall stones disease scheduled for LC were included in this study. Initial abdominal ultrasound scan was done for all patients. LUS of the liver and the biliary system was done during LC. The success rate of the procedure, operative time, accuracy in the diagnosis of bile duct stones, and delineation of exact biliary anatomy were evaluated.

Results: Forty patients (30 females and 10 males) with a mean age of 43.5 years (range, 26 to 58). The mean time required to complete the LUS examination was 11.40 minutes (range, 5 to 20). Adequate LUS visualization of the common bile duct (CBD) occurred in 40 patients (100%) and of the common hepatic duct (CHD) in 38 patients (95%). It identified 37 patients with gall bladder stones. Thus in terms of the detection and exclusion of gall bladder and common bile duct stones, the sensitivity and specificity of LUS were 94.8 percent and 100 percent respectively. LUS excluded the presence of stones in 3 cases reported to have gall stones by abdominal ultrasound (sensitivity and specificity of abdomen ultrasound were 86.5% and 100% respectively). Bile leak occurred in one patient and was treated nonoperatively. No other major bile duct injury occurred during LC.

Conclusions: LUS gives better identification of vascular structures and anatomic relationship of bile duct to the portal vein and hepatic arteries. The routine use of LUS is safe and accurate and avoids biliary complications during LC.