Advances in Clinical and Experimental Medicine
2019, vol. 28, nr 8, August, p. 1037–1042
Publication type: original article
Using laparoscopic ultrasound to delineate dangerous anatomy during difficult laparoscopic cholecystectomies
1 Department of Minimally Invasive Surgery and Proctology, Wroclaw Medical University, Poland
Background. Bile duct injury (BDI) during laparoscopic cholecystectomy (LC) is not as common now as in the past, but it is still a very debilitating complication. Therefore, there is a very strong need for a method that lowers the number of complications during LC without any additional risks for the patient and the operating team. Laparoscopic ultrasound (LUS), which serves to delineate anatomy, appears to be a very effective and safe technique.
Objectives. The aim of this study was to explore the advantages of performing LUS during difficult LC.
Material and Methods. The study group consisted of 126 patients who underwent surgery between January 2014 and February 2016. All the patients had difficult intraoperative anatomical conditions due to chronic inflammation, previous upper abdominal surgery or biliary pancreatitis in the past. We used a Toshiba PEF-704 LA laparoscopic probe and the Toshiba NemioMX SSA-590A diagnostic ultrasound system (Toshiba Corp., Tokyo, Japan). Doppler sonography was used to differentiate between vascular and biliary structures.
Results. Laparoscopic ultrasound ensured a safe plane of dissection and no biliary or vascular complications were observed. Stent insertion into the common bile duct before the operation undoubtedly made the identification of anatomical structures easier. Conversion to an open procedure was deemed necessary in only 6 patients (4.8%).
Conclusion. Laparoscopic ultrasound facilitates the successful performance of LCs. It can be used at any time during the operation; it is noninvasive; and there is no need to use X-rays or contrast dye, or to cannulate the cystic duct. The most important advantage of LUS is that it leads to a lower number of conversions and intraoperative complications by identifying anatomical relationships in the plane of dissection.
laparoscopic cholecystectomy, bile duct injury, laparoscopic ultrasound
- Tropea A, Pagano D, Biondi A, Spada M, Gruttadauria S. Treatment of the iatrogenic lesion of the biliary tree secondary to laparoscopic chole-cystectomy: A single center experience. Updates Surg. 2016;68(2):143–148.
- Halbert C, Pagkratis S, Yang J, et al. Beyond the learning curve: Incidence of bile duct injuries following laparoscopic cholecystectomy normalize to open in the modern era. Surg Endosc. 2016;30(6):2239–2243.
- Gentileschi P, Di Paola M, Catarci M, et al. Bile duct injuries during laparoscopic cholecystectomy: A 1994–2001 audit on 13,718 operations in the area of Rome. Surg Endosc. 2004;18(2):232–236.
- Nuzzo G, Giuliante F, Giovannini I, et al. Bile duct injury during laparoscopic cholecystectomy: Results of an Italian national survey on 56 591 cholecystectomies. Arch Surg. 2005;140(10):986–992.
- Hamad MA, Nada AA, Abdel-Atty MY, Kawashti AS. Major biliary complications in 2,714 cases of laparoscopic cholecystectomy without intraoperative cholangiography: A multicenter retrospective study. Surg Endosc. 2011;25(12):3747–3751.
- Aziz O, Ashrafian H, Jones C, et al. Laparoscopic ultrasonography versus intra-operative cholangiogram for the detection of common bile duct stones during laparoscopic cholecystectomy: A meta-analysis of diagnostic accuracy. Int J Surg. 2014;12(7):712–719.
- Machi J, Oishi AJ, Tajiri T, Murayama KM, Furumoto NL, Oishi RH. Routine laparoscopic ultrasound can significantly reduce the need for selective intraoperative cholangiography during cholecystectomy. Surg Endosc. 2007;21(2):270–274.
- Yao CC, Huang SM, Lin CC, et al. Assessment of common bile duct using laparoscopic ultrasound during laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech. 2009;19(4):317–320.
- Teefey SA, Soper NJ, Middleton WD, et al. Imaging of the common bile duct during laparoscopic cholecystectomy: Sonography versus videofluoroscopic cholangiography. AJR Am J Roentgenol. 1995;165(4):847–851.
- Röthlin M, Largiadèr F. The anatomy of the hepatoduodenal ligament in laparoscopic sonography. Surg Endosc. 1994;8(3):173–180.
- Wysocki AP. Population-based studies should not be used to justify a policy of routine cholangiography to prevent major bile duct injury during laparoscopic cholecystectomy. World J Surg. 2016;41(1):82–89.
- Beksac K, Turhan N, Karaagaoglu E, Abbasoglu O. Risk factors for conversion of laparoscopic cholecystectomy to open surgery: A new predictive statistical model. J Laparoendosc Adv Surg Tech A. 2016;26(9):693–696.
- Sutcliffe RP, Hollyman M, Hodson J, Bonney G, Vohra RS, Griffiths EA; CholeS study group, West Midlands Research Collaborative. Preoperative risk factors for conversion from laparoscopic to open cholecystectomy: A validated risk score derived from a prospective UK database of 8820 patients. HPB (Oxford). 2016;1365-182X(16):31837–31838.
- Le VH, Smith DE, Johnson BL. Conversion of laparoscopic to open cholecystectomy in the current era of laparoscopic surgery. Am Surg. 2012;78(12):1392–1395.
- Biffl WL, Moore EE, Offner PJ, Franciose RJ, Burch JM. Routine intraoperative laparoscopic ultrasonography with selective cholangiography reduces bile duct complications during laparoscopic cholecystectomy. J Am Coll Surg. 2001;193(3):272–280.
- Machi J, Johnson JO, Deziel DJ. The routine use of laparoscopic ultrasound decreases bile duct injury: A multicenter study. Surg Endosc. 2009;23(2):384–388.
- Jamal KN, Smith H, Ratnasingham K, Siddiqui MR, McLachlan G, Belgaumkar AP. Meta-analysis of the diagnostic accuracy of laparoscopic ultra-sonography and intraoperative cholangiography in detection of common bile duct stones. Ann R Coll Surg Engl. 2016;98(4):244–249.
- Perry KA, Myers JA, Deziel DJ. Laparoscopic ultrasound as the primary method for bile duct imaging during cholecystectomy. Surg Endosc. 2008;22(1):208–213.
- Malik AM. Difficult laparoscopic cholecystectomies. Is conversion a sensible option? J Pak Med Assoc. 2015;5(7):698–700.
- Lee NW, Collins J, Britt R. Evaluation of preoperative risk factors for converting laparoscopic to open cholecystectomy. Am Surg. 2012;78(8):831–833.
- Buddingh KT, Nieuwenhuijs VB, van Buuren L, Hulscher JB, de Jong JS, van Dam GM. Intraoperative assessment of biliary anatomy for prevention of bile duct injury: A review of current and future patient safety interventions. Surg Endosc. 2011;25(8):2449–2461.
- Strasberg SM, Hertl M, Soper NJ. An analysis of the problem of biliary injury during laparoscopic cholecystectomy. Am Coll Surg. 1995;180(1):101–125.