Intraoperative ultrasound during biliary tract surgery

Abstract

Intraoperative ultrasonography of the biliary tree has existed for five decades, but interest has been rekindled in recent years. The two main drivers are the expansion of hepato-pancreaticobiliary surgery as a specialty, together with the adoption of standard laparoscopic approaches to common procedures such as cholecystectomy and distal pancreatectomy. The aim of this chapter is to describe the anatomy of the normal biliary tract and highlight the use of intraoperative ultrasonography in the management of common biliary pathologies. Improvements in the quality of imaging have been key to the development of the technique: high-resolution real-time B-mode ultrasound images are essential and the ability to add colour flow Doppler to visualise blood vessels is now standard. We describe a practical approach to the use of ultrasound at both open and laparoscopic surgery. The technique remains an essential part of the armamentarium of the hepatobiliary surgeon. Clear delineation of anatomy allows judgements to be made on the nature and extent of disease. It is useful in the detection of common bile duct stones and can dispense with a requirement for cholangiography. There is a learning curve but published studies report high success rates with the advantage of repeating the examination during dissection. In general, it is quicker than alternative imaging modalities and has a lower overall cost.