Thanks to recent advances in ultrasound (US) technology, biliary puncture is now easily performed under US-guidance.
Although this invasive procedure should be performed by an experienced and skilled sonographist, most procedures are performed
by clinicians lacking sufficient experience, and a number of complications have been reported. The aim of this article
is to describe important ways to minimize such problems. 1) Localization of puncture point: theoretically it should be performed
through the left lateral segment. 2) Determination of the most desirable field of view: The needle path must avoid vessels
by using color Doppler US. 3) Determination of the most desirable path: the shortest path to the lesion (or puncture point)
should be sought. 4) Determination of the most optimal angulation: it is to have the US beam perpendicular to the needle as
it passes through the liver. The instantaneous dynamic visualization of the needle permits fine adjustments in angulation and
depth. 5) Insertion of puncture needle: it should be performed at one try. The greater the number of punctures is the more postpuncture
problems there will be. 6) A better knowledge of US artifacts helps one perform an accurate and safe puncture.
Finally, young beginners must keep the following in mind when performing a US-guided puncture. If you have limited experience,
seek the advice of a more skilled and experienced sonographist to assist you.