The efficacy of intraoperative ultrasonography during laparoscopic cholecystectomy

Intraoperative ultrasonography (IOUS) has been used to delineate anatomy during laparoscopic cholecystectomy (LapC) and screen for common bile duct stones (CBDS), however no consensus about its efficacy has been reached in Japan. In this study, we compared and evaluated the performance of intraoperative cholangiography(IOC) and IOUS during LapC.

We evaluated 295 cases of cholecystolithiasis that underwent surgery from 2005- 2009 at our hospital. Frequency of CBDS and duration of surgery was examined in cases with IOC alone or IOC and IOUS in combination.

There were 5 cases (1.7%) in which IOUS or IOC detected CBDS that had not been detected by preoperative evaluation using abdominal CT, abdominal ultrasonography or MRCP. Out of 62 LapC cases involving both IOC and IOUS, 60 cases showed the same findings, i.e. no false-negative results, indicating that IOUS is a trustworthy examination method. The mean duration of surgery involving IOUS alone was 135 minutes while a longer mean time of 163 minutes was found for that involving IOC alone or IOC and IOUS in combination.

This study shows that IOC can be considered useful as it did not produce any false-negative results in screening CBDS and it also shortened the operation time. We also found some problems associated with IOC, such as small calculi falling within the gallbladder during examination procedures and the irradiation of patients and staff.