A prospective comparison of laparoscopic ultrasound us intraoperative cholangiogram during laparoscopic cholecystectomy

Background: The laparoscopic ultrasound (US)probe provides a new modality f or evaluating biliary anatomy during laparoscopic cholecystectomy (LC). Methods: We performed a laparoscopic US examination in 65 patients without suspected common bile duct (CBD) stones prior to the performance of a lapar oscopic cholangiogram (IOC). We then compared the cost, time required, surg eon's assessment of difficulty, and interpretations of findings. Results: There was a significant difference in the cost of US versus the co st of IOC ($362 +/- 12 versus $665 +/- 12; p < 0.05). Surgeons who had perf ormed >10 US (EXP) were compared with those who had performed less than or equal to 10 (NOV). There were significant differences between the EXP and N OV groups in ease of examination, visualization of biliary anatomy, and acc uracy of measurement of the CBD. Conclusions: The use of laparoscopic US for the accurate evaluation of the CBD and biliary anatomy requires that the surgeon has surpassed the learnin g curve, which we have defined as having performed >10 US exams.