Laparoscopic intracorporeal ultrasound versus fluoroscopic intraoperative cholangiography

Background: The purpose of this study was to compare the results of laparoscopic intracorporeal ultrasound (LICU) to those of fluoroscopic intraoperative cholangiography (FIOC) during laparoscopic cholecystectomy (LC) after the initial learning curve for LICU. Methods: Data were prospectively collected on patients undergoing LC. A consecutive series of 394 LICU patients was compared to a consecutive series of 400 FIOC patients when each imaging procedure was preferentially performed. Patients during the transition period, including the first 100 LICU patients, were excluded. Results: Demographics and preoperative diagnoses were similar in the two groups. Excluding those who were converted to open cholecystectomy and those in whom an imaging exam was not attempted, FIOC was successful in 361 of 374 (97%) patients and LICU was successful in 377 of 380 (99%) patients (p < 0.03). The mean times (±SEM) to complete FIOC and LICU were 16.0 (±0.5) min and 5.1 (±0.1) min (p < 0.0001), respectively, Choledocholithiasis was detected in 25 patients (7%) undergoing FIOC and in 39 patients (10%) undergoing LICU (p = 0.1). During LICU the common bile duct was visualized in continuity from the cystic duct to ampulla in 90% of cases. The common bile duct could not be completely visualized in continuity at the middle or distal portion of the common bile duct in 5% and 6% of LICU cases, respectively. One LICU patient (0.3%) with an incompletely visualized duct had a suspected stone confirmed by postoperative endoscopic retrograde cholangiopancreaticography (ERCP). One patient with negative FIOC (0.3%) had a retained stone treated by postoperative ERCP. Conclusion: LICU is safe and accurate, and it permits a more rapid evaluation of bile duct stones than FIOC during laparoscopic cholecystectomy. The false-negative rate of both imaging techniques is less than 1%.