Authors
Vozlyublennyj D.E.1, Cherkasov D.M.2, Cherkasov M.F.2, Vozlyublennyj E.I.1, Galashokyan K.M.2
1 Medical Center «Sem’ja», Rostov-on-Don
2 Rostov State Medical University, Rostov-on-Don
Abstract
Backgraund: for the purpose of navigation during laparoscopic cholecystectomy, intraoperative laparoscopic ultrasound (IUS, LUS) has been actively used. This technique is non-invasive, non-irradiating and can be performed repeatedly. LUS has high sensitivity and specificity of 93% and 96%, respectively, and is also characterized by the high quality of intraoperative diagnostics of choledocholithiasis in real time, the absence of invasiveness, short imaging time, the ability to repeat imaging at any stage of the operation, and the absence of ionizing radiation.
Aims: improve the results of laparoscopic cholecystectomy using laparoscopic ultrasound.
Materials and methods: a review of the results of 455 LUS performed during laparoscopic cholecystectomy for cholelithiasis and its complicated forms since 2013 is presented. Patients range in age from 28 to 75 years. Aloka Prosound 6 device and UST-5550 linear laparoscopic high-frequency ultrasound transducer were used to perform LUS, with a movable distal working area, the possibility of using color and pulse Doppler examination.
Results: LUS allows you to assess the condition of gallbladder walls, its lumen, condition of nearby organs, to obtain information about the topographic anatomy of bile ducts, as well as the structure of walls and contents of the bile ducts. The study allows to prevent vascular injury around the Calo triangle, to assess the condition of the lymph nodes of hepatoduodenal ligament. By means of a LUZI, visualization of instruments inserted into the lumen of the bile ducts is possible, which allows you to perform an operational manual under control.
Conclusions: in all cases, the ultrasound was performed without complications, and no contraindications to the study were revealed. The average study time was about 4 minutes. Ultrasound allows you to identify in real time the anatomical features of the structure of the biliary tract and blood supply of a particular patient, assess the condition of the lumen of the biliary tract, assess the condition of the walls of the gallbladder and bile ducts, and the surrounding tissues. The ability to visualize instruments in the lumen of the bile ducts, as well as calculi and sludge, allows simultaneous intervention to be performed under LUS control.
Keywords: Intraoperative ultrasound, laparoscopic cholecystectomy, bile duct injury, choledocolithiasis, biliary anomalies.
References
1. Schendel J, Ball C, Dixon E, Sutherland F. Prevalence of anatomic landmarks for orientation during elective laparoscopic cholecystectomies. Surgical Endoscopy. 2019; 34(8): 3508-12. doi: 10.1007/ s00464-019-07131-z.
2. Turbin MV, Cherkasov MF, Degtyarev OL. Experience of laparoscopic cholecystectomy applied for complicated forms of acute cholecystitis. Sovremennye problemy nauki i obrazovaniya. 2018; 5: 58. (In Russ.)
3. Dili A, Bertrand C. Laparoscopic ultrasonography as an alternative to intraoperative cholangiography during laparoscopic cholecystectomy. World Journal of Gastroenterology. 2017; 23(29): 5438. doi: 10.3748/wjg.v23.i29.5438.
4. Mangieri CW, Hendren BP, Strode MA, et al. Bile duct injuries (BDI) in the advanced laparoscopic cholecystectomy era. Surgical Endoscopy. 2018; 33(3): 724-30. doi: 10.1007/s00464-018-6333-7.
5. Sebastian M, Sebastian A, Rudnicki J. The evaluation of B-SAFE and ultrasonographic landmarks in safe orientation during laparoscopic cholecystectomy. Videosurgery and Other Miniinvasive Techniques. 2020; 546-52. doi: 10.5114/wiitm.2020.100972.
6. Koo JGA, Chan YH, Shelat VG. Laparoscopic subtotal cholecystectomy: comparison of reconstituting and fenestrating techniques. Surgical Endoscopy. 2020; 35(3): 1014-24. doi: 10.1007/s00464-020-08096-0.
7. Buddingh KT, Nieuwenhuijs VB, van Buuren L, et al. Intraoperative assessment of biliary anatomy for prevention of bile duct injury: a review of current and future patient safety interventions. Surgical Endoscopy. 2011; 25(8): 2449-61. doi: 10.1007/s00464-011-1639-8.
8. Atstupens K. The Role of Laparoscopic Ultrasonography in the Evaluation of Suspected Choledocholithiasis. A Single-Center Experience. Medicina. 2020; 56: 246. doi: 10.25143/prom-rsu_2020-11-dts.
9. Machi J, Oishi AJ, Uchida S, et al. Simple Laparoscopic Ultrasound Technique for Prevention of Bile Duct Injuries. Journal of Laparoendoscopic & Advanced Surgical Techniques. 2000; 10(3): 165-8. doi: 10.1089/lap.2000.10.165.
10. Machi J, Sigel B, Zaren HA, et al. Technique of ultrasound examination during laparoscopic cholecystectomy. Surgical Endoscopy. 1993; 7(6): 544-9. doi: 10.1007/bf00316701.
11. Deziel DJ. Laparoscopic Ultrasound for Bile Duct Imaging during Cholecystectomy: Clinical Impact in 785 Consecutive Cases. Journal of the American College of Surgeons. 2022; 234(5): 849-60. doi: 10.1097/ xcs.0000000000000111.
12. Jamal K, Smith H, Ratnasingham K, et al Meta-analysis of the diagnostic accuracy of laparoscopic ultrasonography and intraoperative cholangiography in detection of common bile duct stones. The Annals of The Royal College of Surgeons of England. 2016; 98(04): 244-9. doi: 10.1308/rcsann.2016.0068.
13. Borsukov AV, Bezaltynnykh AA, Mamoshin AV. Sravnitel’nye vozmozhnosti transabdominal’nogo i laparoskopicheskogo ul’trazvuka pri zabolevaniyakh pecheni, zhelchnykh protokov, zhelchnogo puzyrya, podzheludochnoi zhelezy. Vestnik novykh meditsinskikh tekhnologii. 2013; 20(1): 85-89. (In Russ.)
14. Studenova EA. Intraoperatsionnoe UZI – tekhnologiya nastoyashchego, tekhnologiya budushchego. V kn.: Innovatsionnoe razvitie nauki i obrazovaniya. Penza: Nauka i Prosveshchenie, 2021. Р.107-118. (In Russ.)
