Laparoscopic ultrasonography

Laparoscopic surgery imposes limitations on the surgeon not present in open surgery, including restricted degrees of freedom of instrument movement, lack of binocular vision, and severely restricted tactile feedback from the tissues. An aggressive effort is being made to apply technology to overcome some of these limitations and the adaptation of ultrasound probes for laparoscopic use now allows the surgeon to not only examine the surface of structures but to look into them with ultrasonic imaging. Laparoscopic ultrasonography has been used to evaluate the biliary tree during laparoscopic cholecystectomy both to delineate the biliary anatomy and look for common duct stones. This technology may have its widest use in the future in examining the liver for metastatic disease in patients undergoing laparoscopic colon resection. It must be realized that this is a technology in its infancy and further studies need to be done to evaluate areas where laparoscopic ultrasonography will have its greatest clinical utility.