Intraoperative ultrasound as an educational guide for laparoscopic biliary surgery.
OBJECTIVE
To analyze the efficacy of routine intraoperative ultrasound (IOUS) as a guide for understanding biliary tract anatomy, to avoid bile duct injury (BDI) after laparoscopic cholecystectomy (LC), as well as any burden during the learning period.


METHODS
A retrospective analysis was performed using 644 consecutive patients who underwent LC from 1991 to 2006. An educational program with the use of IOUS as an operative guide has been used in 276 cases since 1998.


RESULTS
IOUS was highly feasible even in patients with high-grade cholecystitis. No BDI was observed after the introduction of the educational program, despite 72% of operations being performed by inexperienced surgeons. Incidences of other morbidity, mortality, and late complications were comparable before and after the introduction of routine IOUS. However, the operation time was significantly extended after the educational program began (P < 0.001), and the grade of laparoscopic cholecystitis (P = 0.002), use of IOUS (P = 0.01), and the experience of the surgeons (P = 0.05) were significant factors for extending the length of operation.


CONCLUSIONS
IOUS during LC was found to be a highly feasible modality, which provided accurate, real-time information about the biliary structures. The educational program using IOUS is expected to minimize the incidence of BDI following LC, especially when performed by less-skilled surgeons.
Hakamada
Kenichi
K
Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan. hakamada@cc.hirosaki-u.ac.jp
Narumi
Shunji
S
Toyoki
Yoshikazu
Y
Nara
Masaki
M
Oohashi
Motonari
M
Miura
Takuya
T
Jin
Hiroyuki
H
Yoshihara
Syuichi
S
Sugai
Michihiro
M
Sasaki
Mutsuo
M
D000328:Adult; D000368:Aged; D001652:Bile Ducts / Q000000981:diagnostic imaging* / Q000293:injuries*; D001660:Biliary Tract Diseases / Q000000981:diagnostic imaging* / Q000601:surgery*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000193:education*; D002983:Clinical Competence; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D015397:Program Evaluation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional