Contrast-enhanced intraoperative ultrasonic cholangiography in living donor hepatectomy.

Radiographic intraoperative cholangiography (R-IOC) has been widely used to reduce the incidence of biliary complications in living donor hepatectomy (LDH), but it has some drawbacks including radiation exposure and difficulty with handling a C-arm machine for generating 3D images and delineating thin caudate branches. We recently developed contrast-enhanced intraoperative ultrasonic cholangiography (CE-IOUSC) as a tool for biliary navigation in hepatobiliary surgery. We compared the feasibility and usefulness of CE-IOUSC and R-IOC in LDH for visualizing the biliary system and facilitating bile duct division. Seven consecutive patients who underwent LDH using CE-IOUSC and R-IOC between January 2013 and December 2015 in our institute were enrolled. The detectability of each hepatic duct, biliary configuration types, and caudate branches around the cutting point of the hepatic duct was compared. The detectability of each hepatic duct and biliary configuration types was 100%, 100%, 86%, and 100% in drip infusion cholangiography-computed tomography, R-IOC, and 3D/2D CE-IOUSC, respectively. 2D CE-IOUSC could detect caudate branches draining into the cutting side of the hepatic duct, similar to R-IOC (p<0.01). In conclusion, CE-IOUSC is a novel intraoperative cholangiography technique for LDH, it provides excellent visualization of the biliary tree. It facilitates identification of the biliary system, guidance for bile duct division, and confirmation of the remnant biliary system. This article is protected by copyright. All rights reserved.