Prospects And Limitations For Laparoscopic Ultrasonography And New Technology

The most common applications of laparoscopic ultrasonography have been for hepato-biliary, pancreatic, gastrointestinal, and gynecological surgery. Several authors have reported that laparoscopic ultrasonography has the potential to enhance laparoscopic detection of intraabdominal metastasis and multifocal tumors in patients with gastroe-sophageal, liver, or pancreatic tumors (53-58). However, laparoscopic ultrasonography is sensitive in detecting macroscopic but not microscopic metastatic pelvic lymph nodes in patients with cervical carcinoma (59).

The recent availability of three-dimensional ultrasonography is an exciting arena for future investigation. Future aspects include the use of navigated three-dimensional laparoscopic ultrasonography in computerized simulation tools for multiple applicators, use of ultrasound energy for reliable tumor destruction, the possibility of highly precise monitoring of the therapeutic ablation while avoiding unnecessary sacrifice of adjacent blood vessels or collecting system (60).

Novel ultrasound technologies including the four-dimensional (dynamic three-dimensional, i.e., three-dimensional plus time) ultrasound imaging system, and the

Laparoscopic approach assisted by laparoscopic ultrasonography with color Doppler function facilitated accurate localization of the calculus and optimal selection of a relatively thin, avascular site for the nephrotomy, allowing complete stone fragment clearance.

ultrasound and computed tomography fusion system technology (real-time virtual sonography, providing real-time ultrasound image along with synchronized computed tomography/magnetic resonance imaging) (61) have been reported. These modalities are likely to enhance real-time guidance during tissue ablative therapy. Finally, laparo-scopic ultrasonography tissue elastography imaging may help to compensate the laparoscopic surgeon's inability to palpate tissue, which has remained a significant limitation of laparoscopic surgery.

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