PRELIMINARY EXPERIENCE WITH INTRACORPOREAL LAPAROSCOPIC ULTRASONOGRAPHY USING A SECTOR SCANNING PROBE - A PROSPECTIVE COMPARISON WITH INTRAOPERATIVE CHOLANGIOGRAPHY IN THE DETECTION OF CHOLEDOCHOLITHIASIS

Laparoscopic ultrasonography is a novel technique which may be useful in screening for choledocholithiasis during laparoscopic cholecystecto my. Following concerns regarding the ''learning curve'' and accuracy a ssociated with the adoption of this user-dependent technology, we have prospectively evaluated a commercially available 90-degrees sector sc anning laparoscopic ultrasound probe during elective laparoscopic chol ecystectomy. Laparoscopic ultrasonography was performed in 60 patients and identified common duct stones in nine patients (one ''false posit ive'' and ''one false negative''), and previously unsuspected duct sto nes were defined in three out of four patients. The gallbladder and po rtal vein were constantly defined anatomical landmarks throughout the study, whereas the suprapancreatic bile duct, intrapancreatic bile duc t, and pancreatic duct were identified in 100%, 80%, and 85% of patien ts in the third consecutive group of 20 patients examined. Laparoscopi c ultrasonography has the potential to accurately identify common duct stones during laparoscopic cholecystectomy and thereby implement a po licy of ''superselective'' operative cholangiography. However, adequat e training for surgeons unfamiliar with this technology is recommended .