Intraoperative ultrasound of the biliary system: techniques and clinical applications

Intraoperative ultrasonography (IOUS) of the intra- and extrabepatic biliary system is being used with increased frequency in many medical centers. The value of IOUS in facilitating surgery in patients with complicated diseases of the gallbladder or with stones in the bile ducts is well recognized. However, a variety of less common diseases affect the intrahepatic ducts, many of which require sophisticated surgical techniques when resection is being undertaken. In many situations, these operations can be facilitated by the use of IOUS, both for depicting segmental and ductal anatomy, and in guiding resections and anastomoses. This report summarizes the techniques currently used for performing IOUS of the biliary system, and illustrates the spectrum of clinical applications that may require IOUS guidance.