The use of a Doppler ultrasound probe during vascular dissection in laparoscopic renal surgery.

Introduction And Objective: There have been many reports regarding the use of intraoperative ultrasound to identify vascular structures. However, few have examined the application of Doppler technology for the identification and dissection of hilar vessels during laparoscopic renal surgery (LRS). We describe the design and utility of what is, to our knowledge, the only available disposable laparoscopic Doppler probe (LDP).

Methods: A disposable 18-inch, 8-MHz LDP (Vascular Technology, Inc., Nashua, NH) was inserted through a 5-mm laparoscopic port during LRS and moved systematically in a cephalad direction along the medial aspect of the kidney in an attempt to obtain an audible signal from the vessels of the renal hilum. Various endpoints such as ease of probe use, time to identification of vessels, and detection of aberrant vessels were recorded.

Results: A total of 20 patients underwent LRS by a single surgeon (C.P.S.). The LDP was shown to be very easy to use in the identification of the renal hilum. The mean time for the identification of all renal vessels by LDP survey was 34.9 seconds. The mean time to surgical isolation of all hilar vessels was 44.6 minutes. There were no technical difficulties or complications as a result of Doppler probe use.

Conclusions: The use of the LDP provides a fast, efficient, and simple means of identifying the renal hilum during LRS. This technology may have added benefit and utility in patients with anomalous vessels, significant adhesions, or during laparoscopic surgery by less experienced surgeons.