VALUE OF LAPAROSCOPIC ULTRASONOGRAPHY IN STAGING OF PROXIMAL BILE-DUCT TUMORS

The additional value of laparoscopic ultrasonography was evaluated pro spectively in 35 patients undergoing diagnostic laparoscopy for a susp ected potentially resectable proximal bile duct tumor. Findings were c ompared with transabdominal ultrasonography, laparoscopy, surgery, and pathology. Laparoscopic ultrasonography was able to visualize the pre sence and origin of small bile duct tumors or stones and small liver m etastases, which could not be seen or could be visualized only doubtfu lly by ultrasonography and laparoscopy. Laparoscopic ultrasonography w as more useful in staging of small tumors of the gallbladder or proxim al common bile duct than in staging bifurcation (Klatskin) tumors. Add itional information provided by laparoscopic ultrasonography led to a change in diagnosis or tumor stage in eight patients (23%) and to avoi dance of laparotomy in three patients (9%).