Current status of laparoscopic ultrasound

The purpose of this chapter is to introduce the beginning surgeon ultrasonographer to the use of ultrasound during laparoscopic surgery. The authors routinely use ultrasound in the intraoperative, endoscopic, and office settings. The importance of ultrasound in the various surgical specialties is well documented in the literature. Since the introduction of minimally invasive techniques to General Surgery, many advanced applications of ultrasonography have been developed. Confident examinations of intraabdominal anatomy, pathologic conditions, and therapeutic procedures can readily be performed. In this chapter, a comprehensive introduction to laparoscopic ultrasound is presented to the practicing General Surgeon. The basic equipment requirements and setup are explained. Fundamental techniques of laparoscopic ultrasound examination are described. The authors' method of screening for common bile duct stones during routine laparoscopic cholecystectomy is illustrated. Examination of the normal biliary tree with helpful hints is presented. The authors' systematic technique of visualizing the normal liver parenchyma is described. Common benign and malignant findings are elucidated. A brief synopsis of pancreatic ultrasonography with attention to pathologic findings is provided. Uses of ultrasound in unanticipated situations are introduced. With perseverance, the reader will discover that laparoscopic ultrasound skills can be readily attained.