Using laparoscopic ultrasound to delineate dangerous anatomy during difficult laparoscopic cholecystectomies

Bile duct injury (BDI) during laparoscopic cholecystectomy (LC) is not as common now as in the past, but it is still a very debilitating complication. Therefore, there is a very strong need for a method that lowers the number of complications during LC without any additional risks for the patient and the operating team. Laparoscopic ultrasound (LUS), which serves to delineate anatomy, appears to be a very effective and safe technique.

The aim of this study was to explore the advantages of performing LUS during difficult LC.

The study group consisted of 126 patients who underwent surgery between January 2014 and February 2016. All the patients had difficult intraoperative anatomical conditions due to chronic inflammation, previous upper abdominal surgery or biliary pancreatitis in the past. We used a Toshiba PEF-704 LA laparoscopic probe and the Toshiba NemioMX SSA-590A diagnostic ultrasound system (Toshiba Corp., Tokyo, Japan). Doppler sonography was used to differentiate between vascular and biliary structures.

Laparoscopic ultrasound ensured a safe plane of dissection and no biliary or vascular complications were observed. Stent insertion into the common bile duct before the operation undoubtedly made the identification of anatomical structures easier. Conversion to an open procedure was deemed necessary in only 6 patients (4.8%).

Laparoscopic ultrasound facilitates the successful performance of LCs. It can be used at any time during the operation; it is noninvasive; and there is no need to use X-rays or contrast dye, or to cannulate the cystic duct. The most important advantage of LUS is that it leads to a lower number of conversions and intraoperative complications by identifying anatomical relationships in the plane of dissection.