The Usefulness of Intraoperative Ultrasonography during Laparoscopic Cholecystectomy

Hiroyuki Sahara, Taisuke Hasegawa, Shigemi Murayama, Teruhiro Sejima, Keitaro Seto, Takayoshi Akiyama, Hitoshi Saito, Shigeki Takashima

Department of Surgery II, Kanazawa Medical University

Although laparoscopic cholecystectomy (LC) has become a standard treatment for a variety of benign gallbladder diseases, many LC-related complications have been reported, the msot serious being accidental injury to the bile ducts. In order to prevent such complications, it is important to clarify the anatomy of the biliary system during LC. The purpose of this study was to assess the usefulness of intraopertive laparoscopic ultrasonography (LUS) for clarifying the anatomy during LC. Materials &Methods: Since 1992, 117 LCs have been performed in our institution; of these, 69 which included LUS during LC were studied. We performed LUS to visualize the biliary system before and after exposure of the cystic duct. LUS was performed by the water soakage or balloon method. Results: The gallbladder, cystic dust and common hepatic duct were successfully visualized in all cases. The cystic ductcommon hepatic duct junction was visualized in 47% of the cases prior to exposure of the cystic duct. This junction was visualized with difficulty and unclearly before exposure of the cystic duct, but after exposure it was easily and clearly visualized in all but one case. After determining the precise location of the cystic ductcommon hepatic duct junction by LUS, we were able to safely clip and divide the cystic duct without complications during LC. Clear pictures were obtained more easily with the balloon method than with the water soakage method. Conclusion: LUS is useful for clarifying the anatomy of the biliary system to prevent accidental injury to the bile duct during LC.

Key words
laparoscopic cholecystectomy, laparoscopic ultrasonography, prevention of injury to the bile duct

Reprint requests
Hiroyuki Sahara Department of Surgery II, Kanazawa Medical University
1-1 Daigaku, Uchinada-mach, Kahoku-gun, Ishikawa 920-0265 JAPAN

Accepted
May 19, 1998

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