Intraoperative Ultrasonography

Abstract

AbbreviationsCT, computed tomography; IOUS, intraoperative ultrasonography; LUS, laparoscopic ultrasonography; MRI, magnetic resonance imaging t is a privilege to contribute an article on intraoperative ultrasonography (IOUS) to the series of articles on the history of ultrasound in commemoration of the 50-year anniversary of the American Institute of Ultrasound in Medicine in 2005. On approaching my own 30th anniversary in the practice of diagnostic radiology, it is amazing to reflect back on the uses of A-mode, B-scanning on nonpersistent green fluorescent oscilloscopes, and bistable B-mode scanning as the first primitive diagnostic ultrasonographic tools. Although IOUS began developing in earnest in the late 1970s and early 1980s, after the development of gray scale B-mode ultrasonography and especially after the development of real-time imaging, early investigators were using the more primitive tools as early as the 1960s.One of the very first reports of IOUS was by Schlegel et al 1 in 1961, who used A-mode ultrasonography for the localization of renal calculi ( Figure 1). A-mode was also reported as useful in detection of stones in the gallbladder and common duct in an article by Knight and Newell 2 in 1963 and in another article by Eiseman et al 3 in 1965. A-mode echoencephalography was also reported as useful in delineation of intracerebral mass lesions in a study by Dyck et al 4 in 1966. The inability to display tissue texture in A-mode or bi-stable B-scanning as well as the rather large, bulky size of the equipment limited the more widespread use of IOUS. A small direct-contact ophthalmic B-scanner was developed and proved useful for B-scan ultrasonography during orbital surgery for tumors, as reported by Purnell et al 5 in 1973 (Figure 2), but very little further development was reported until the advent of real-time scanners and smaller, more portable equipment. One of the first reports of real-time B-mode ultrasonographic scanning was by Sigel et al 6 in 1982, which described the use of ultrasonography for precise localization of renal calculi, thereby allowing for the use of smaller nephrotomy incisions, reduced operating room time, and determination that all stone fragments were removed before completion of the procedure. My own experience with IOUS began rather inadvertently in 1983, when I received a call from a distraught surgeon in the operating room, who could not find the intrahepatic abscess that we had shown on preoperative ultrasonography and computed tomography (CT) in a patient

Binocular Goggle Augmented Imaging and Navigation System provides real-time fluorescence image guidance for tumor resection and sentinel lymph node mapping

“…Slow image reconstruction, lack of microscopic imaging capability, and disruptive information display on a remote monitor affects their wide adoption in the OR for real-time image guidance 13 . Intraoperative ultrasonography can be used for tumor detection based primarily on tissue morphology, leading to significant false positive and negative rates 14 15 16 17 . As a contact based method with relatively poor resolution, intraoperative ultrasonography is less useful for identifying tumor boundaries or microscopic tumors during open surgeries.…”

The role of intraoperative ultrasonography in the diagnosis and management of focal hepatic lesions

“…Intraoperative ethanol injection, RFA, and MWA by open surgical or laparoscopic approaches are frequently used for the local treatment of hepatic tumors [ 9 - 11 ]. These local therapies employ a range of basic mechanisms.…”

“…IOUS-guided therapeutic procedures for liver tumors include ethanol ablation, radiofrequency ablation (RFA), and microwave ablation (MWA). Previous studies have shown that a combination of IOUS-guided tumor ablation with hepatic resection can, in fact, extend the limits of hepatic surgery [ 9 - 11 ]. In this article, we examine the current role of IOUS in the field of hepatic surgery and review the clinical applications of IOUS in the diagnosis and management of focal hepatic lesions.…”

Fluorescent imaging of cancerous tissues for targeted surgery

“…Until now, many different non-invasive molecular imaging modalities have been used in targeted surgery, either with or without combination with a navigation system. Those that could provide intraoperative guidance for the tumor resection, mainly including MRI [12, 13], US[14], and FI were of special focus. Each of these modalities has its own merits and limitations in visualizing tumors for targeted surgery, as reviewed previously[11].…”