Intraoperative bile duct sonography during laparoscopic cholecystectomy: experience with a 12.5-MHz catheter-based US...

During elective laparoscopic cholecystectomy, 20 patients underwent intraoperative evaluation of the biliary tract with a commercial 6.2-F, 12.5-MHz catheter-based ultrasound (US) probe. The study tested the feasibility of this technology for mapping the anatomy of the hepatoduodenal ligament and Calot triangle, assessing bile duct integrity, and detecting choledocholithiasis. The duct was studied with a transmural approach, the catheter being placed parallel to, but remaining outside, the bile duct. The common hepatic duct and common bile duct in the vicinity of the cystic duct were seen in all 20 patients; the junction of the cystic duct with the common hepatic duct was seen in nine patients (45%). After the cystic duct was clamped, no sonographic evidence to suggest bile duct injury was noted in any patient. The transmural imaging approach was tested in four pigs in whose common bile duct a single human calculus had been placed. In all instances the size and location of the calculus were accurately detected. Intraoperative US with a catheter-based system is a safe and effective means for interrogation of the extrahepatic biliary tree during laparoscopic cholecystectomy.