The use of ultrasound in the operating room by the surgeon is on the increase, and the use of ultrasound for endoscopists Laparoscopists and develop. These guidelines are intended to provide current recommendations on the use and benefits of laparoscopic ultrasonography (LUS) for surgeons. They are not intended to show the unique benefits and applications than those that are available to make a recommendation data. All the endorsements are based on current medical evidence, and are reported according to the evidence.
Clinical practice guidelines are intended to indicate the best way available for medical conditions determined by systematic review of available data and expert opinion. The proposed approach is not necessarily the only acceptable approach taking into account the complexity of the health care environment. These guidelines are designed to be flexible, as the surgeon should always choose the method that best suits variables of patients and in the time of the decision. These guidelines apply to all doctors with sufficient professional recognition, regardless of specialty and deal with the clinical condition in question.
These guidelines have been developed under the auspices of the wise, the Committee guidelines and approved by the Governing Council. The recommendations from each guideline undergo multidisciplinary examination and is deemed at the time of manufacture on the basis of available data. New developments in research and practice relating to each line medical director discussed and guidelines will be updated periodically.
Moderate literature applies to Laparoscopic Ultrasound. The systematic literature search of MEDLINE for the period from 1966 to 15 May 2007, limited to articles in English identified 146 relevant reports. The strategy for search uses the terms "laparoscopic ultrasound", "training ultrasound", "bile Ultrasound", "Ultrasound pancreas", "adrenal ultrasound", "liver ultrasound," "ultrasound gynecology", "renal ultrasound" and. "Ultrasound stomach" articles are divided into the following classes:
Randomized trials, meta-analyzes and systematic reviews.
A retrospective study.
All clinical cases, old exams and fewer studies are disabled.
To increase the efficiency of the survey, subjects were divided into the following topics:
The liver and gall bladder.
A variety of topics.
Reviewers rated the level of evidence for each article and manually literature additional items that may have been overlooked in the original search looking for. Additional relevant articles were included in the review process and rank. Based on the classification of all items examiners, we have developed recommendations in these guidelines.
Levels of evidence and recommendations
Level I: randomized controlled study conducted properly. Level II: Evidence from controlled randomized trials without; Group studies or case-control; multiple time series; no dramatic experiences. Level III: descriptive series of cases; Notice of expert groups.
Grade: Based on the high level (level I or II), unique interpretations and conclusions of the study carried out by the expert group as well.
Class B: Based on high-level, well-conducted studies with different interpretations and conclusions of the expert group.
Level C: Based on the lower level (level II or less) to the disputed results and / or different interpretations or conclusions of the expert group.
Technical aspects of laparoscopic ultrasound
Ultrasound equipment has two components: a sensor and a scanner connected via a cable.
The compact, real-time system in the way mobile B and high image quality are the most important characteristics of an ultrasound system in the operating room. Doppler capabilities, preferably color Doppler, highly desirable and, in fact, essential in the use of laparoscopic to allow visualization of the vascular tubular structures. Other improvements such as 3D visualization in real time combine several series of 2D images and the possible combination of computed tomography (CT) preoperative scan data with the data "live" ultrasound to better image the 'development.
Initially, transluminal probes are available have been used by laparoscopic port. The picture was 360 with 1-4 cm depth. Probes are wrapped in a plastic bag filled with a sterile saline solution to allow good acoustic scanning. They were difficult to use and had poor picture quality. With the development of the matrix linear dedicated probes, most of these problems are solved. Ideally, the probe should have a diameter less than 10 mm to allow insertion through a laparoscopic port 11mm. The probe should be 35-50 cm in length to provide access to all parts of the abdominal cavity. Linear probes are most commonly used frequency range of 5 to 10 MHz, penetration depth of approximately 4-10 cm. Flexible advice improve scan angle.
Being a relatively new area of research, it is interesting to note that the number of research groups in this area appears to be 10-11. Based on the list, we were able to identify key issues and identify future opportunities in the region to improve surgical condition in the operating room. Based on the results from the literature and nearly two decades of work with surgeons to develop advanced laparoscopic surgery, a complete system designed to navigate LUS could be used in accordance with the following clinical features:
- Preoperative data is imported and reconstructed in 3D; various structures and bodies are automatically segmented (eg vessel contrast CT) or semiconductor (the seed point, for example, placed within the tumor).
- Plan a quick viewing is just before surgery navigation system, or perhaps for other preparations.
- Recording is done without sights using the cursor (patient orientation) and two reference points for a first approximation.
- Before mobilization target organs (eg, liver) 3D scanning LUS major vessels near or around the tumor is performed.
- LUS images are reconstructed in 3D and boats under the automatic mode (ultrasound CT) was performed to refine the shooting.
- Augmented reality display, for example, on / off overlapping data preoperative and LUS laparoscope to View Video is performed in accordance with the requirements of the surgeon during the procedure
- LUS 3D scanning updated several times during the procedure, while the real-time 2D image LUS is available as:
· Full-size image with the appropriate indications in 3D display orientation and position of CT or
· Layer to view video laparoscope with or without elements of CT data (for example, segmented structures).
To navigate the rigid member, one preoperative investigation, very precise tracking (optical) and rigid surgical tools are sufficient for the conduct of the proceedings. However, for soft tissue navigation, additional tools necessary for distortion and mobile organs in the abdominal cavity, resulting in more complex devices in the operating room of additional systems. LUS can provide real-time information back surface (tissue blood flow, elasticity). When combined with advanced visualization techniques and preoperative imaging, LUS can improve the scene augmented reality images are updated information relevant to the high precision of treatment, thereby improving the perception of surgeons in minimal access therapy. Integrated with a miniature tracking technology LUS is likely to play an important role in the future of laparoscopic surgery management role.
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