The Role of Intraoperative Ultrasound in Establishing the Surgical Strategy Regarding Hepato-Bilio-Pancreatic Pathology
S. Cirimbei, C. Puşcu, L. Lucenco, E. BrătucuOriginal article, no. 5, 2013
Intraoperative ultrasound examination plays a more and moreimportant role in open or laparoscopic abdominal surgery,satisfying the surgeon’s need to correctly characterize lesions,bringing various benefits regarding topography and localregionalextension, relations between neighbouring structuresand, finally, disease staging. Intraoperative ultrasound is usedespecially in hepato-bilio-pancreatic tract interventions, givenits diagnostic and therapeutic values. Between 2009-2012 inthe IOB First Surgery Clinic 57 intraoperative echographieswere performed, in patients with hepato-bilio-pancreatic pathologies, leading to intraoperative guided punctures withdiagnostic or therapeutic purpose (in case of hepatic abscesses),detection of new hepatic metastases, their ablation under ultrasoundguidance, exploration of the local-regional topographywith the aim of an optimal hepatic resection. Intraoperativeultrasound allowed radioablation under echographic guidancein 43 patients, the majority presenting multiple hepatic metastasesin different areas, this method also enabling control overcomplete lesional destruction. Also, in 11 cases (22.915), anumber of hepatic 20 metastases which had not been visibleon preoperative imaging scans were detected, and afterwardstreated through RFA; also, in 14 cases intraoperative echographyrevealed the presence and nature of the hepatictumours, leading to a correct histopathological diagnostic andan adequate therapy. The method was useful in pancreaticpathologies as well, in complicated forms of acute or chronicpancreatitis, tracking the Wirsung duct within the scleral andcalcified mass of pancreatic tissue, through an ultrasoundguided puncture, as well as in locating pancreatic cystic masses,determining the optimal puncture or pericystic-digestivedrainage areas. Intraoperative ultrasound is an inexpensive, easymethod, which allows real time exploration throughout theentire surgical process of hepato-bilio-pancreatic lesions, aidingthe surgeon in modifying decisions regarding the interventionand preventing complications.
