[Initial experiences with laparoscopic intraoperative ultrasound]

Area of Science:

• Minimally Invasive Surgery
• Diagnostic Imaging
• Gynecologic Oncology

Background:

• Preoperative and intraoperative laparoscopic diagnoses have limitations in surgical management.
• Laparoscopic surgery is technically advanced, requiring precise patient benefit decisions.
• Adhesions and limited external views can obscure lesions during laparoscopy.

Purpose of the Study:

• To evaluate the utility of laparoscopic ultrasound for intraoperative diagnosis.
• To assess the advantages of ultrasound at the lesion site for improved resolution and visualization.
• To investigate the use of a novel laparoscopic ultrasound probe.

Main Methods:

• A specially designed laparoscopic ultrasound scanhead (Toshiba) was used, integrating a 7.5 MHz linear array into a gastroscope.
• Color Doppler sonography was feasible with the developed scanhead.
• 19 patients (16 with ovarian tumors) underwent examination, including visualization of the uterus and liver.

Main Results:

• Laparoscopic ultrasound revealed solid inner structures in six ovarian tumors initially diagnosed as purely cystic by transvaginal sonography.
• Intraoperative ultrasound successfully detected ovarian lesions in five cases where direct laparoscopic visualization was impossible due to severe adhesions.
• The technique provided enhanced visualization of structures not visible externally with laparoscopy.

Conclusions:

• Laparoscopic ultrasound offers significant advantages over conventional methods by providing high-resolution, on-site imaging.
• It overcomes limitations posed by adhesions and improves the characterization of lesions, particularly in gynecologic surgery.
• This technology enhances diagnostic capabilities and aids surgical decision-making in minimally invasive procedures.