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Operative Ultrasound of the Liver and Biliary Ducts

Operative ultrasound, which permits direct We have divided the material into three placement of the probe on the organ to be principal sections: hepatic surgery, biliary studied during surgery, has been in existence surgery, and the surgery of portal hyperten- for over 20 years. Early experiences with its sion. Our experience with operative ultra- use in urologic [15] and biliary surgery [7, 8, sound in pancreatic disease is not adequate 9] were limited by technical difficulties but for discussion in this manual, although many the evolution of B-mode, real-time ultra- useful applications have been suggested. sound has made possible the broad applica- Each chapter includes an anatomical review tion of ultrasound in the operating room. and a presentation of the basic sonographic The goal of operative ultrasound is to signs to clarify the diagnosis and therapy of provide the surgeon with information about a pathologic conditions. Emphasis has been solid organ which is not obvious from its ex- placed on the practical applications of opera- ternal morphology. What is the nature of the tive ultrasound. lesion? What is its precise localization within With most of the ultrasound images (all the organ? What vascular and anatomical are presented on a black background) two constraints limit its surgical treatment? Mod- schematic diagrams are shown: ern ultrasound technology, which produces The first indicates the position of the probe an image faithful to the true anatomy, per- on anterior and lateral projections.
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Table of Contents

References.- 1 General Considerations in Operative Ultrasound.- How Is the Ultrasound Image Formed?.- Operation of the Ultrasound Equipment.- The Gain Curve.- Other Modes of Regulation.- Choice of Equipment.- Pulse-Processing Systems.- The Transducer Probe.- Ancillary Equipment.- Technique of Operative Ultrasound.- Sterilization of Equipment.- Utilization of Equipment.- 2 Operative Ultrasound in Hepatic Surgery.- Technique of Exploration.- Incisions.- Methodology.- Exploration.- Ultrasound Anatomy of the Liver.- The Inferior Vena Cava and the Hepatic Veins.- The Portal Pedicles.- Tumors.- Ultrasound Signs of Hepatic Tumors.- General Technique of Exploration.- Modification of Surgical Tactics.- Operative Ultrasound in the Surgery of Hydatid Cysts.- Operative Ultrasound in the Treatment of Pyogenic Liver Abscesses.- References.- 3 Operative Ultrasound in Biliary Surgery.- Anatomical Study.- Gallbladder.- Intrahepatic Bile Ducts.- Extrahepatic Bile Ducts.- Cholelithiasis.- Patients Undergoing Nonbiliary Abdominal Surgery.- Microlithiasis of the Gallbladder.- Intrahepatic Lithiasis.- Choledocholithiasis.- Ultrasound Signs of Common Bile Duct Calculi.- Efficacy of Operative Ultrasound in Biliary Disease.- Completion Study After Surgery for Biliary Lithiasis.- Cholangiocarcinoma.- Ultrasound Signs of Bile Duct Tumors.- Modification of Surgical Tactics.- References.- 4 Operative Ultrasound in the Surgery of Portal Hypertension.- Anatomical Exploration.- Detection of Portal Vein Thrombosis.- Evaluation of Completed Anastomoses.- References.- Conclusion.

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