General Principles Of Laparoscopic Ultrasound

Laparoscopic ultrasonography has been integrated into advanced laparoscopic urological surgery in recent years. This technology was initially applied in gastrointestinal surgery during the early 1990s since dedicated high-resolution B-mode (gray-scale two-dimensional image) laparoscopic ultrasound probes became available (1). Laparoscopic ultrasonography can provide the laparoscopic surgeon with information that may be unobtainable by laparoscopy alone.

Inability to palpate tissues remains one inherent limitation of laparoscopic surgery; however, laparoscopic ultrasonography can compensate for the loss of tactile feedback in laparoscopic surgery by enabling the surgeon to "look" into tissues being operated upon.

Laparoscopic ultrasonography can identify and characterize lesions seen on pre-operative imaging and may potentially discover new lesions not detected by preoper-ative imaging or intraoperative laparoscopic inspection. The essential advantage of laparoscopic ultrasonography is the visualization of tissues beyond the two-dimensional laparoscopic picture, thereby enhancing the information available to the surgeon (2). As such, laparoscopic ultrasonography may enhance intraoperative surgical decision making.

Laparoscopic ultrasonography has the potential to improve anatomic localization of tumor or pathologic lesion, to improve visualization of cancerous extension, to guide real-time needle biopsy or ablative therapy, and to optimize the extent of surgical resection regarding completeness of tumor excision and preservation of functional anatomy.

The depth of ultrasound penetration with 7.5 MHz transducers is approximately 6-8 cm, which is commonly adequate for laparoscopic surgery, because laparo-scopic ultrasonography scanning is performed directly on the surface of the target organ or lesion (contact scanning). Laparoscopic ultrasonography can detect stones as small as 1 mm, cysts as small as 2 mm, and tumors as small as 3 mm with reliable accuracy.

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