Operative ultrasonography during hepatobiliary and pancreatic surgery

Abstract

On the basis of our experience with operative ultrasonography during hepatobiliary and pancreatic surgery, its indications, benefits, and disadvantages are summarized. High-resolution operative ultrasound scanning of the liver, biliary tract, and pancreas was performed during 357, 735, and 242 operations, respectively. The benefits of operative ultrasonography were categorized as acquisition of diagnostic information otherwise not available, replacement for or complement to operative radiography, and guidance of surgical procedures. Operative ultrasonography provided beneficial information during 73 of 82 hepatic operations (89.0%), 57 of 69 noncalculous biliary operations (82.6%), and 177 of 242 pancreatic operations (73.1%). Operative ultrasonography was significantly superior (sensitivity 93.3%) to other screening tests for diagnosing liver metastasis from colorectal carcinoma evaluated in 189 patients, and it detected previously unrecognized metastatic tumors in 18 patients (9.5%). For screening common bile duct calculi during 666 operations, operative ultrasonography and operative cholangiography were comparable in all indices of accuracy except for a higher predictability of a positive test of operative ultrasonography (94.8% versus 71.7%). For diagnosing portal vein invasion of pancreatic carcinoma, operative ultrasonography provided better overall accuracy than preoperative studies (89.7% versus 64.1%). On the basis of operative ultrasound findings, previously planned surgical procedures were altered in 32 of 82 hepatic operations (39.0%) and 24 of 145 pancreatic operations for chronic pancreatitis (16.6%). Operative ultrasound guidance of various surgical procedures was performed during 88 hepatic and 84 pancreatic operations, including 40 ultrasound-guided hepatectomies and 42 pancreatotomies. Operative ultrasonography has a number of advantages, such as safety and speed in performance, wide application, high diagnostic accuracy, and ability of guiding procedures. Its disadvantages are the limitation of the fields of view in certain applications, the need for special equipment, and a slow learning curve.

The role of intraoperative ultrasound for the assessment of the focal liver lesions in patients with colorectal cancer

“…It allows for a very good characterization of focal liver lesions, with both sensitivity and specificity values over 90% [10][11][12][13][14]. Of the 73 patients included in the study in 41 (56.2%) patients the focal liver lesions found at IOUS were classified as malignant and in 32 (43.8%) patients the focal liver lesions found at IOUS were classified as benign.…”

Intraoperative Ultrasonography

“…Another area of notable early success for IOUS was in pancreatic imaging, as first reported by Sigel et al 15 in 1982, in which the utility of IOUS during surgery for obstructive jaundice was described in terms of detecting biliary dilatation, the presence or absence of biliary stones, and the pattern of obstruction of the duct, including demonstration of a mass in the periampullary region ( Figure 6), as well as directing biopsy into such a pancreatic mass. With technical advancements, particularly in abdominal CT, detection of pancreatic masses was improved considerably, but Machi et al 16 showed an additional role for IOUS in assessment of the resectability of pancreatic cancers by assessing the presence of extrapancreatic spread, invasion or occlusion of the portal venous system, or the presence of hepatic metastases, all of which would render a patient unresectable.…”

Avaliação do uso do ultra-som intra-operatório na cirurgia hepatobiliar e pancreática

“…No final dos anos 80 e começo da década de 90, surgem os primeiros relatos na literatura americana demonstrando índices significativos de mudança na conduta cirúrgica variando de 19 a 49% após a realização do UIO (Rifkin et al, 1987;Parker et al, 1989;Machi et al, 1993;Haider et al, 1995).…”

“…Sua sensibilidade, maior que a combinação dos métodos de avaliação pré-operatórios, varia de 79 a 100% (Gozzetti et al, 1986;Rifkin et al, 1987;Parker et al, 1989;Machi et al, 1993;Kane et al, 1994;Hagspiel et al, 1995). Mesmo após a realização de extensa investigação pré-operatória com USG, angiografia digital, TC, TC com angioportografia e após a exploração cirúrgica com palpação e inspeção do abdome, tumores hepáticos ocultos são identificados pelo UIO (Fortunato et al, 1995;Soyer et al, 1997).…”

“…Esses estudos relatam mudança no planejamento cirúrgico em 24 a 68% dos pacientes (Castaing et al, 1986;Gozzetti et al, 1986;Parker et al, 1989;Boutkan et al, 1992;Machi et al, 1993;Kane et al, 1994) Com todo o avanço tecnológico das modalidades de avaliação por imagem pré-operatória que vivenciamos recentemente coloca-se o questionamento sobre a validade da realização do UIO. Conlon e colaboradores, em estudo com 18 pacientes, relatam que o UIO forneceu informação adicional relevante em 47% dos casos e mudou o planejamento terapêutico em 18% deles, com ampliação da ressecção em 15%, utilizando a RM como método de avaliação pré-operatório (Conlon et al, 2003).…”