The utility of vessel tracking technique using Doppler ultrasonography for laparoscopic surgery in biliary tract and pancreas

Kosei Maemura, Yuko Mataki, Hiroshi Kurahara, Yota Kawasaki, Koji Minami, Satoshi Iino, Masahiko Sakoda, Shinichirou Mori, Shinichi Ueno, Hiroyuki Shinchi, Shoji Natsugoe. Kagoshima University Graduate School of Medical and Dental Sciences

Background: Doppler ultrasonographic imaging provides visualization of vessels in the body. Doppler flow meter makes possible to detect invisible vessels buried in the tissue. As these techniques are non-invasive and easy to perform during the surgery, we have introduced these techniques in laparoscopic surgery in order to reduce operative unexpected vessel injury. We evaluated the utility of the intraoperative Doppler ultrasonography guided vessel detection and tracking technique (Dop-US) for laparoscopic surgery in biliary tract and pancreas.

Patients and methods: Consecutive 20 patients who received laparoscopic cholecystectomy (LC) and 10 patients who received laparoscopic distal pancreatectomy (Lap-DP) were introduced Dop-US method and investigated. The Dop-US was performed using the bidirectional Doppler flow meter laparoscopic probe for searching vessels during operation. We identified the right hepatic artery (RHA) and cystic artery (CA) in LC, common hepatic artery (CHA) and splenic artery (SA) in Lap-DP by measuring flow speed and wave shape pattern. The detection rate of each artery was compared with Dop-US and preoperative enhanced CT with three-dimensional image.

Results: The wave form pattern of RHA and CA acquired by Dop-US differed clearly.  The average of maximum flow speed was 30.3 cm/sec in RHA and 8.1 cm/sec in CA with statistical significant difference (p<0.001). Dop-US identified RHA in all cases. The detection rate of CA was 60% (12/20) in CT and 90% (18/20) in Dop-US. Dop-US achieved complete detection of CHA and SA in all patients of Lap-DP without any pancreas parenchyma injury.

Conclusions: It was quite simple and easy to perform vessel detection technique using Doppler US in LC and Lap-DP. This approach was suggested to be the contributing procedure for improvement in safety of laparoscopic surgery in biliary tract and pancreas.

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