A prospective comparison of laparoscopic ultrasound vs intraoperative cholangiogram during laparoscopic cholecystectomy.
BACKGROUND
The laparoscopic ultrasound (US) probe provides a new modality for 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 laparoscopic cholangiogram (IOC). We then compared the cost, time required, surgeon's assessment of difficulty, and interpretations of findings.


RESULTS
There was a significant difference in the cost of US versus the cost of IOC ($362 +/- 12 versus $665 +/- 12; p < 0.05). Surgeons who had performed >10 US (EXP) were compared with those who had performed </=10 (NOV). There were significant differences between the EXP and NOV groups in ease of examination, visualization of biliary anatomy, and accuracy 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 learning curve, which we have defined as having performed >10 US exams.
Falcone
R A
RA
College of Medicine, Department of Surgery, University of Cincinnati Medical Center, Post Office Box 670558, Cincinnati, OH 45267, USA.
Fegelman
E J
EJ
Nussbaum
M S
MS
Brown
D L
DL
Bebbe
T M
TM
Merhar
G L
GL
Johannigman
J A
JA
Luchette
F A
FA
Davis
K
K
Hurst
J M
JM
D000328:Adult; D000368:Aged; D001659:Biliary Tract / Q000000981:diagnostic imaging; D002758:Cholangiography; D017081:Cholecystectomy, Laparoscopic; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014463:Ultrasonography / Q000379:methods*