Dedicated laparoscopic ultrasound probes may be passed through the laparoscopic port during surgical procedures to investigate the liver, biliary tree, pancreas and other viscera without the need for open surgery (Fig. ultrasound images).
Laparoscopic ultrasound demonstrating multiple liver metastases in a patient with carcinoma in the tail of the pancreas. The trend towards laparoscopic rather than open cholecystectomy has increased the need for accurate laparoscopic exploration of the biliary ductal system to confirm the presence or absence of stones. Laparoscopic ultrasound is better at demonstrating stones in the duct and anatomical ductal variations than conventional intraoperative cholangiography.
Laparoscopic ultrasound has also proven advantageous in staging patients with hepatic tumours for liver resection, demonstrating deep tumours not visible on surgical laparoscopy, or by preoperative imaging methods and so avoiding the need to proceed to open hepatic resection in some patients.
Patients with pancreatic head and ampullary carcinomas are potentially resectable in only a minority of cases. Preoperative imaging is known to underestimate the extent of the disease, and so many patients traditionally undergo a staging laparotomy before resection is attempted. However, over onethird of patients previously considered resectable will demonstrate occult metastases, often in the peritoneum.
Staging laparoscopy still cannot demonstrate intrahepatic metastases, and the use of laparoscopic ultrasound at this stage greatly increases the accuracy of staging and influences the surgical decision Laparoscopic ultrasound is also useful in staging patients with gastric cancer and colorectal cancer. Curative resection of bowel cancer can be performed with either open surgery or laparoscopic resection. Laparoscopic ultrasound can be used to examine the liver to confirm the absence of metastases: this is particularly useful in a laparoscopic resection as the surgeon is unable to palpate the liver under these circumstances. This laparoscopic approach reduces patient morbidity when compared with open surgical exploration.
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