Definitions of the levels of evidence (I, II, III) and the grades of the recommendations (A, B, C) are provided at the end of the "Major Recommendations" field.
Guidelines for the Use of Laparoscopic Ultrasound (LUS) in Gastric Cancer
LUS for the staging of gastric cancer patients can be performed safely, adds little time to the duration of staging laparoscopy, and does not increase significantly patient morbidity (Grade A). The routine use of staging laparoscopy and LUS after a negative preoperative work-up (computed tomography [CT] with or without endoscopic ultrasound [EUS]) is recommended (Grade B).
Guidelines for the Use of Laparoscopic Ultrasound in Esophagogastric Cancer
Because of the limited quality of the available evidence (Level III) showing a benefit of staging laparoscopy and the absence of clear description of the additional benefit of LUS in this setting, the ability to provide a strong recommendation for the routine use of LUS in pretherapeutic staging of esophageal cancer is limited. Nevertheless, diagnostic laparoscopy (DL) with ultrasound should be considered in patients with esophagogastric malignancies who do not have metastatic disease on high quality staging CT scan (Grade C).
Guideline for the Use of Laparoscopic Ultrasound in Adrenal Surgery
LUS as an adjunct to laparoscopic adrenalectomy has benefits in selected cases (Grade C). It can assist in localizing the gland when it is hidden within retroperitoneal adipose tissue (Grade B), localizing the adrenal vein (Grade C), and assessing invasion (Grade C).
Guideline for the Use of Laparoscopic Ultrasound in Biliary Disease
LUS is a good alternative to intraoperative cholangiogram (Grade B). Compared to intraoperative cholangiogram, it costs less to perform (Grade B) and takes less time (Grade C).
Guidelines for the Use of Laparoscopic Ultrasound in Gynecologic Procedures
LUS can be used in early cervical carcinoma to help identify metastasis (Grade C). Although, small series of LUS have demonstrated reasonable diagnostic accuracy compared to other radiologic studies, further research is needed to determine the true value of LUS (Grade C). LUS may also be useful in the identification of myomas of the uterus (Grade C). Generally, there is a paucity of literature in this area and firm recommendations cannot be made.
Guideline for the Use of Laparoscopic Ultrasound in Kidney Disease
LUS is useful for intraoperative localization of deep anatomical structures that are not obvious on visual inspection during kidney surgery (Grade C). This feature may help improve patient safety by helping the surgeon avoid injuries to structures such as the ureters or the renal or iliac vessels (Grade C).
Guidelines for the Use of Laparoscopic Ultrasound in Liver Disease
LUS is useful for staging of hepatocellular and metastatic colon and rectal cancers and can help guide treatment or avoid unnecessary open operations (Grade B) and detect metastasis from other cancers (Grade C).
Guidelines for the Use of Laparoscopic Ultrasound for the Pancreas
LUS can be performed safely in patients with pancreatic adenocarcinoma and other pancreatic diseases (Grade B). LUS provides additional prognostic information to DL in a fraction of examined patients with pancreatic adenocarcinoma and further decreases the rate of unnecessary laparotomies (Grade C). Based on the available evidence, selective rather than routine use of the procedure for pancreatic cancer staging may be better justified and more cost-effective (Grade C). LUS is also useful in other pancreatic diseases and can help localize and guide the resection of tumors such as insulinomas (Grade C). Further, better quality studies needed to document the value of LUS for the management of pancreatic disease.
Levels of Evidence
Level I: Evidence from properly conducted randomized, controlled trials.
Level II: Evidence from controlled trials without randomization; cohort or case-control studies; multiple time series; dramatic uncontrolled experiments.
Level III: Descriptive case series; opinions of expert panels.
Grades of Recommendation
Grade A: Based on high level (Level I or II), well-performed studies with uniform interpretation and conclusions by the expert panels.
Grade B: Based on high level, well-performed studies with varying interpretations and conclusions by the expert panels.
Grade C: Based on lower level evidence (Level II or less) with inconsistent findings and/or varying interpretations or conclusions by the expert panels.