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The routine use of laparoscopic ultrasound decreases bile duct injury: a multicenter study

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Laparoscopic ultrasound (LUS) has been used for over 15 years to screen the bile duct (BD) for stones and to delineate anatomy during laparoscopic cholecystectomy (LC). LUS as a modality to prevent BD injury has not been investigated in a large series. This study evaluated the routine use of LUS to determine its effect on preventing BD injury.


A multicenter retrospective study was performed by reviewing clinical outcome of LC in which LUS was used routinely.


In five centers, 1,381 patients underwent LC with LUS. LUS was successful to delineate and evaluate the BD in 1,352 patients (98.0%), although it was unsuccessful or incomplete in 29 patients (2.0%). LUS was considered remarkably valuable to safely complete LC, avoiding conversion to open, in 81 patients (5.9%). The use of intraoperative cholangiography (IOC) varied depending on centers; IOC was performed in 504 patients (36.5%). For screening of BD stones (which was positive in 151 patients, 10.9%), LUS had a false-positive result in two patients (0.1%) and a false-negative result in five patients (0.4%). There were retained BD stones in three patients (0.2%). There were minor bile leaks from the liver bed in three patients (0.2%). However, there were no other BD injuries including BD transection (0%). Retrospectively, IOC was deemed necessary in 25 patients (1.8%) to complete LC in spite of routine LUS.


LUS can be performed successfully to delineate BD anatomy in the majority of patients. The routine use of LUS during LC has obviated major BD injury, compared to the reported rate (1 out of 200–400 LCs). LUS improves the safety of LC by clarifying anatomy and decreasing BD injury.

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  1. 1.

    Yamashita Y, Kurohiji T, Hayashi J, Kimitsuki H, Hiraki M, Kakegawa T (1993) Intraoperative ultrasonography during laparoscopic cholecystectomy. Surg Laparosc Endosc 3:167–171

  2. 2.

    Machi J, Sigel B, Zaren HA, Schwartz J, Hosokawa T, Kitamura H, Kolecki RV (1993) Technique of ultrasound examination during laparoscopic cholecystectomy. Surg Endosc 7:544–549

  3. 3.

    Machi J, Tateishi T, Oishi AJ, Furumoto NL, Oishi RH, Uchida S, Sigel B (1999) Laparoscopic ultrasonography versus operative cholangiography during laparoscopic cholecystectomy: review of the literature and a comparison with open intraoperative ultrasonography. J Am Coll Surg 188:360–367

  4. 4.

    Winslow ER, Soper NJ (2005) Intraoperative and laparoscopic ultrasound of biliary tract. In: Machi J, Staren ED (eds) Ultrasound for surgeons, 2nd edn. Lippincott Williams Wilkins, Philadelphia, pp 289–313

  5. 5.

    Menack Mj, Arregui ME (2000) Laparoscopic sonography of the biliary tree and pancreas. Surg Clin North Am 80:1151–1170

  6. 6.

    Rothlin MA, Schob O, Schlumpf R, Largiader F (1996) Laparoscopic ultrasonography during cholecystectomy. Br J Surg 83:1512–1516

  7. 7.

    Siperstein A, Pearl J, Macho J, Hansen P, Gitomirsky A, Rogers S (1999) Comparison of laparoscopic ultrasonography and fluorocholangiography in 300 patients undergoing laparoscopic cholecystectomy. Surg Endosc 13:113–117

  8. 8.

    Tranter SE, Thompson MH (2003) A prospective single–blinded controlled study comparing laparoscopic ultrasound of the common bile duct with operative cholangiography. Surg Endosc 17:216–219

  9. 9.

    Biffl WL, Moore EE, Offner PJ, Franciose RJ, Burch JM (2001) Routine intraoperative laparoscopic ultrasonography with selective cholangiography reduces bile duct complications during laparoscopic cholecystectomy. J Am Coll Surg 193:272–280

  10. 10.

    Machi J, Oishi AJ, Uchida S, Furutmoto NL, Oishi RH (2000) A simple laparoscopic ultrasound technique for prevention of bile duct injuries. J Laparoendosc Adv Surg Techn 10:165–168

  11. 11.

    Tomonaga T, Filipi CJ, Lowham A, Martinez T (1999) Laparoscopic intracorporeal ultrasound cystic duct length measurement. A new technique to prevent common bile duct injuries. Surg Endosc 13:183–185

  12. 12.

    Larson GM (2006) Laparoscopic biliary tract injury: what are the limits of prevention? Surg Endosc 20:1635–1637

  13. 13.

    Deziel DJ, Millikan Kw, Economou SG, Doolas A, Ko S-T, Airan MC (1993) Complication of laparoscopic cholecystectomy: a national survey of 4292 hospitals and an analysis of 77604 cases. Am J Surg 165:9–14

  14. 14.

    Strasberg SM (2005) Biliary injury in laparoscopic surgery; part 1 and part 2. J Am Coll Surg 201:598–611

  15. 15.

    Strasberg SM, Hertl M, Soper NJ (1995) An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg 180:101–125

  16. 16.

    National Institute of Health (1993) Consensus development conference statement on gallstones and laparoscopic cholecystectomy. Am J Surg 165:390–396

  17. 17.

    Machi J, Oishi AJ, Tajiri T, Murayama KM, Furumoto NL, Oishi RH (2007) Routine laparoscopic ultrasound can significantly reduce the need for selective intraoperative cholangiography during cholecystectomy. Surg Endosc 21:270–274

  18. 18.

    Velanovich V, Morton JM, McDonald M, Orlando R, Maupin G, Traverso LW (2006) Analysis of the SAGES outcomes initiative cholecystectomy registry. Surg Endosc 20:43–50

  19. 19.

    Callery MP (2006) Avoiding biliary injury during laparoscopic cholecystectomy: technical consideration. Surg Endosc 20:1654–1658

  20. 20.

    Traverso LM (2006) Intraoperative cholangiography lowers the risk of bile duct injury during cholecystectomy. Surg Endosc 20:1659–1661

  21. 21.

    Debru E, Dawson A, Leibman S, Richardson M, Glen L, Hollinshead J, Falk GL (2005) Does routine inraoperative cholangiography prevent bile duct transaction? Surg Endosc 19:589–593

  22. 22.

    Fletcher DR, Hobbs MS, Tan P, Valinsky LJ, Hockey RL, Pikora TJ, Knuiman MW, Sheiner HJ, Edis A (1999) Complications of cholecystectomy: risks of the laparoscopic approach and protective effects of operative cholangiography: a population–based study. Ann Surg 229:449–457

  23. 23.

    Flum DR, Dellinger EP, Cheadle A, Chan L, Koepsell T (2003) Intraoperative cholangiography and risk of common bile duct injury during cholecystectomy. JAMA 289:1639–1644

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Correspondence to Junji Machi.

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Machi, J., Johnson, J.O., Deziel, D.J. et al. The routine use of laparoscopic ultrasound decreases bile duct injury: a multicenter study. Surg Endosc 23, 384 (2009). https://doi.org/10.1007/s00464-008-9985-x

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  • Laparoscopic ultrasound
  • Laparoscopic cholecystectomy
  • Bile duct
  • Injury
  • Complication