Surgeon-performed ultrasound: its use in clinical practice

To highlight areas where surgeon-performed ultrasound (US) is an effective diagnostic and therapeutic tool.

The success of US in trauma and technologic advances have enhanced the interest and ability of surgeons to perform their own US examinations.

General surgeons perform US examinations of the thyroid gland, breast, gastrointestinal tract, peritoneal cavity (laparoscopy), and vascular system. Essentials of these examinations are discussed and a plan for educating surgical residents in US is outlined.

Focused assessment for the sonographic examination of the trauma patient, or FAST, is replacing central venous pressure measurements to detect hemopericardium and diagnostic peritoneal lavage to detect hemoperitoneum. Bedside US can be used to detect a pleural effusion so well in critically ill patients that lateral decubitus x-rays are rarely needed. US-directed biopsy of breast lesions is a common office procedure. Laparoscopic US allows tumor staging without formal celiotomy, and many hepatic and pancreatic surgical procedures include US as an adjunct. Endoscopic and endorectal US have added a new dimension to the assessment of many gastrointestinal lesions. Color flow duplex imaging and endoluminal US have significantly expanded the diagnostic and therapeutic aspects of vascular imaging. The training program developed at Emory University and Grady Memorial Hospital is offered as a model for educating surgical residents in US techniques.

US is a valuable addition to the general surgeon's diagnostic armamentarium and is rapidly becoming an integral part of the surgeon's clinical practice.