Intraoperative ultrasonography of the pancreas: techniques and clinical applications

Intraoperative ultrasound of the pancreas is a dynamic clinical diagnostic field providing crucial information to the surgeon at the time of exploration, and impacting on clinical management decisions and choices of surgical techniques. It is a rapid and effective technique for imaging the entire pancreas, differentiating normal from pathological processes, imaging the pancreatic and common bile ducts, and demonstrating the exact relationship between pathological processes of the pancreas and the adjacent arterial and venous structures, the common bile duct, and the duodenal wall. The demand for intraoperative ultrasound (IOUS) of the pancreas is expected to increase, particularly as management algorithms become accepted clinical practice, due to advances in intraoperative tumor ablation and radiotherapeutic techniques, as well as technical improvements in laparoscopic ultrasound methods and instrumentation. Not only is IOUS of the pancreas becoming a recognized modality for visualizing and characterizing solid and cystic lesions of the pancreas, but it also has superior lesion detection rates over other non-invasive preoperative imaging modalities. Provisional studies from our department suggest that data from IOUS significantly affects surgical decision making.