Abstract
Background
Intraoperative fluorocholangiography (IOC) has been the standard method for bile duct imaging during cholecystectomy. Laparoscopic ultrasound (LUS) has been evaluated as a possible alternative, but has been used less frequently. The authors examined the evolving use of these two methods to assess the relative utility of LUS as the primary method for routine bile duct imaging during laparoscopic cholecystectomy (LC).
Methods
This study analyzed a prospective database containing 423 consecutive cholecystectomies performed by one attending surgeon in an academic medical center between 1995 and 2005.
Results
Intraoperative bile duct imaging was performed in 371 (94%) of 396 LCs performed for cholelithiasis. As recorded, IOC was performed in 239 cases, LUS in 236 cases, and both in 104 cases. Choledocholithiasis was present in 50 patients (13%). Common bile duct stones (CBDS) were identified by LUS in 3% of the patients without preoperative indicators of CBDS, and in 10% of the patients with one or more indicators. As shown by the findings, LUS had a positive predictive value of 100%, a negative predictive value of 99.6%, a sensitivity of 92.3%, and a specificity of 100% for detecting CBDS. Also, LUS identified clinically significant bile duct anatomy in 6% of the patients. In 1995, LUS was used for 20% of cases, whereas by 2005, it was used for 97% of cases. Conversely, the use of IOC decreased from 93% to 23%.
Conclusions
With moderate experience, LUS can become the primary routine imaging method for evaluating the bile duct during LC. It is as reliable as IOC for detecting choledocholithiasis. In addition, LUS can locate the common bile duct during difficult dissections. On the basis of this experience, LUS is used currently in nearly all LCs and is the sole method for bile duct imaging in 75% of these cases. IOC is used as an adjunct to LUS when LUS imaging is inadequate, when stronger clinical indicators of choledocholithiasis are present, or when biliary anatomy remains uncertain.
Similar content being viewed by others
References
Barteau JA, Castro D, Arregui ME, Tetik C (1995) A comparison of intraoperative ultrasound versus cholangiography in the evaluation of the common bile duct during laparoscopic cholecystectomy. Surg Endosc 9:490–496
Berber E, Engle KL, Garland A, String A, Foroutani A, Pearl JM, Siperstein AE (2001) A critical analysis of intraoperative time utilization in laparoscopic cholecystectomy. Surg Endosc 15:161–165
Biffl WL, Moore EE, Offner PJ, Franciose RJ, Burch JM (2001) Routine intraoperative laparoscopic ultrasonography with selective cholangiography reduces bile duct complications during laparoscopic cholecystectomy. J Am Coll Surg 193:272–280
Birth M, Carroll BJ, Delinikolas K, Eichler M, Weiser HF (1996) Recognition of laparoscopic bile duct injuries by intraoperative ultrasonography. Surg Endosc 10:794–797
Birth M, Ehlers KU, Delinikolas K, Weiser HF (1998) Prospective randomized comparison of laparoscopic ultrasonography using a flexible-tip ultrasound probe and intraoperative dynamic cholangiography during laparoscopic cholecystectomy. Surg Endosc 12:30–36
Birth M, Lossin P, Brugmans F, Weiser HF (2000) Vascular injuries within the hepatoduodenal ligament: recognition by laparoscopic color Doppler ultrasound. Surg Endosc 14:246–249
Bogokowsky H, Slutski S, Zaidenstein L, Halpern Z, Negri M, Abramsohn R (1987) Selective operative cholangiography. Surg Gynecol Obstet 164:124–126
Catheline JM, Turner R, Paries J (2002) Laparoscopic ultrasonography is a complement to cholangiography for the detection of choledocholithiasis at laparoscopic cholecystectomy. Br J Surg 89:1235–1239
Clair DG, Brooks DC (1994) Laparoscopic cholangiography: the case for a selective approach. Surg Clin North Am 74:961–966
Falcone RA Jr, Fegelman EJ, Nussbaum MS, Brown DL, Bebbe TM, Merhar GL, Jahannigman JA, Luchette FA, Davis K Jr, Hurst JM (1999) A prospective comparison of laparoscopic ultrasound vs intraoperative cholangiogram during laparoscopic cholecystectomy. Surg Endosc 13:784–788
Fletcher DR, Hobbs MST, Tan P, Valinsky LJ, Hockey RL, Pikora TJ, Knuiman MW, Sheiner HJ, Edis A (1999) Complications of cholecystectomy: risks of the laparoscopic approach and protective effects of operative cholangiography: a population-based study. Ann Surg 229:449–457
Halpin VJ, Dunnegan D, Soper NJ (2002) Laparoscopic intracorporeal ultrasound versus fluoroscopic intraoperative cholangiography: after the learning curve. Surg Endosc 16:336–341
Knight PR, Newell JA (1963) Operative use of ultrasonics in cholelithiasis. Lancet 1:1023–1025
Lilimoe KD, Yao CJ, Talamini MA, Wang BH, Pitt HA, Gadacz TR (1992) Selective cholangiography: current role in laparoscopic cholecystectomy. Ann Surg 215:669–676
Machi J, Sibel B (1992) Intraoperative ultrasonography. Radiol Clin North Am 30:1085–1103
Machi J, Tateishi T, Oishi AJ, Furumoto NL, Oishi RH, Uchida S, Sigel B (1999) Laparoscopic ultrasonography versus operative cholangiography during laparoscopic cholecystectomy: review of the literature and a comparison with open intraoperative ultrasonography. J Am Coll Surg 188:360–367
Machi J, Oishi AJ, Uchida S, Furumoto NL, Oishi RH (2000) Simple laparoscopic ultrasound technique for prevention of bile duct injuries. J Laparoendosc Surg Tech 10:165–168
Machi J, Oishi AJ, Tajiri T, Murayama KM, Furumoto NL, Oishi RH (2007) Routine laparoscopic ultrasound can significantly reduce the need for selective intraoperative cholangiography during cholecystectomy. Surg Endosc 21:270–274
Metcalfe MS, Ong T, Bruening MH, Iswariah H, Wemyss-Holden SA, Maddern GJ (2004) Is laparoscopic intraoperative cholangiogram a matter of routine? Am J Surg 187:475–481
Sigel B, Coelho JC, Nyhus LM, Donahue PE, Velasco JM, Spigos DG (1982) Comparison of cholangiography and ultrasonography in the operative screening of the common bile duct. World J Surg 6:440–444
Sigel B, Machi J, Beitler JC, Donahue PE, Bombeck CT, Baker RJ, Duarte B (1983) Comparative accuracy of operative ultrasonography and cholangiography in detecting common duct calculi. Surgery 94:715–720
Siperstein A, Pearl J, Macho J, Hansen P, Gitomirsky A, Rogers S (1999) Comparison of laparoscopic ultrasonography and fluorocholangiography in 300 patients undergoing laparoscopic cholecystectomy. Surg Endosc 13:113–117
Soper NJ (2000) Intraoperative detection: intraoperative cholangiography vs intraoperative ultrasonography. J Gastrointest Surg 4:334–335
Stiegmann GV, McIntyre RC, Pearlman NW (1994) Laparoscopic intracorporeal ultrasound. an alternative to cholangiography? Surg Endosc 8:167–171
Stiegmann GV, Soper NJ, Filipi CJ, McIntyre RC, Callery MP, Cordova JF (1995) Laparoscopic ultrasonography as compared with static or dynamic cholangiography at laparoscopic cholecystectomy: a prospective multicenter trial. Surg Endosc 9:1269–1273
Strasberg SM, Hertl M, Soper NJ (1995) An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg 180:101–125
Thompson DM, Arregui ME, Tetik C, Madden MT, Wegener M (1998) A comparison of laparoscopic ultrasound with digital fluorocholangiography for detecting choledocholithiasis during laparoscopic cholecystectomy. Surg Endosc 12:929–932
Thornton DJA, Robertson A, Alexander DJ (2002) Laparoscopic cholecystectomy without operative cholangiography does not result in significant problems related to retained stones. Surg Endosc 16:592–595
Tranter SE, Thompson MH (2001) Potential of laparoscopic ultrasonography as an alternative to operative cholangiography in the detection of bile duct stones. Br J Surg 88:65–69
Tranter SE, Thompson MH (2003) A prospective single-blinded controlled study comparing laparoscopic ultrasound of the common bile duct with operative cholangiography. Surg Endosc 17:216–219
Woods MS, Traverso LW, Kozarek RA, Tsao J, Rossi RL, Gough D, Donohue JH (1994) Characteristics of biliary tract complications during laparoscopic cholecystectomy. Am J Surg 167:27–34
Woods MS, Traverso LW, Kozarek RA, Donohue JH, Fletcher DR, Hunter JG, Oddsdottir M, Rossi RL, Tsao J, Windsor J (1995) Biliary tract complications of laparoscopic cholecystectomy are detected more frequently with routine intraoperative cholangiography. Surg Endosc 9:1076–1080
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Perry, K.A., Myers, J.A. & Deziel, D.J. Laparoscopic ultrasound as the primary method for bile duct imaging during cholecystectomy. Surg Endosc 22, 208–213 (2008). https://doi.org/10.1007/s00464-007-9558-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-007-9558-4