Laparoscopic intracorporeal ultrasound cystic duct length measurement - A new technique to prevent common bile duct injuries

The incidence of common bile duct injury remains high. Intracorporeal ultra sound mapping of cystic duct anatomy, prior to laparoscopic cholecystectomy (LC), may assist surgeons in avoiding common bile duct injuries. A techniq ue for intraoperative intracorporeal predissection ultrasound imaging (IIPU I) of the cystic duct length was tested. During LC, gallbladder adhesions w ere lysed, and with the gallbladder retracted by grasping forceps, the ultr asound examination was performed. Using a 7.5-MHz articulating ultrasound p robe, visualization of the extrahepatic biliary tree was obtained in five s eparate planes. Success in visualizing each plane, time for ultrasound exam ination, and predissection accuracy of cystic duct length measurement were recorded. Intraoperative cholangiography or direct measurement of the disse cted cystic duct was used to determine accuracy of the ultrasound cystic du ct length estimates. Forty-three patients underwent IIPUI during LC. The ti me required to perform the examination varied, with a range of 5 to 17 min (mean 9.5 min). Success of visualization in planes 1 through 5 was 44%, 95% , 98%, 98%, and 7090, respectively. The accuracy rate for cystic duct lengt h ultrasound measurement was 87.1% . No complications related to the examin ation were observed. In this preliminary study, cystic duct length was dete rmined by predissection intracorporeal ultrasound with a high level of accu racy. Predissection imaging may assist in preventing common bile duct injur y during LC.