Intraoperative ultrasound enhancing safety of key steps in complex laparoscopic cholecystectomy: a single-blinded...

Patients with benign gallbladder diseases (BGBD) in China are characterized by prolonged illness duration, recurrent acute inflammation and poor medical compliance, all increase difficulty of laparoscopic cholecystectomy (LC). Complications including biliary injury, residual stones and intraoperative iatrogenic rupture (IIR) of the gallbladder wall (GBW) resulting in incidental gallbladder cancer (IGBC) exposure all warrant vigilance. This study aims to evaluate whether intraoperative ultrasound (IOUS) could enhance safety of crucial steps of LC.

Patients enrolled in this single-center randomized controlled trial were initially diagnosed with BGBD and randomly assigned to two groups at a 1:1 ratio, based on whether IOUS scanning was conducted during LC. The primary aim was to assess whether IOUS could: (1) Identify adherent gastrointestinal tracts within the surgical field; (2) diagnose cystic duct (CD) stones; and (3) guide the selection of appropriate dissection approaches of GBW to prevent IIR according to the modified Gallbladder Reporting and Data System (GB-RADS).

A total of 152 patients were enrolled in this trial. IOUS helped in differentiating CD stones and adhered gastrointestinal tissues within the surgical area. IOUS effectively reduced IIR (3.95% vs. 17.11%, p = 0.017) because it clearly demonstrated morphology of GBW layers under different levels of inflammation. Additionally, among patients classified as GB-RADS 2B and 2C, the proportion of cases with atypical hyperplasia was notably higher than those with GB-RADS 2A and 1 (p = 0.002).

IOUS plays a pivotal role in enhancing the safety of critical steps during LC surgeries for selected complex cases. Integrating IOUS with GB-RADS is of great value in guiding the selection of safe GBW approaches and preventing IIR in cases with canceration risk.