WO2006040309A1

WO2006040309A1 - Ultrasound imaging apparatus for ultrasound-guided surgery

Info

Publication number: WO2006040309A1
Application number: PCT/EP2005/055139
Authority: WO
Inventors: Christoph De Haen
Original assignee: Bracco Imaging SpA
Current assignee: Bracco Imaging SpA
Priority date: 2004-10-12
Filing date: 2005-10-10
Publication date: 2006-04-20
Anticipated expiration: 2007-04-12
Also published as: WO2006040309A8

Abstract

Ultrasound imaging apparatus for ultrasound-guided surgery, comprising a probe (106), a display unit (104), an electronic control unit (100), a first arm (102), a supporting member (101) connected to said arm (102), means for holding said display unit (104), means (105) for holding said probe (106) , means for holding said control unit (100), wherein said means for holding the control unit (100) are associated to said first arm (102) .

Description

ULTRASOUND IMAGING APPARATUS FOR ULTRASOUND-GUIDED SURGERY

Technical field

The invention relates to an ultrasound imaging apparatus for ultrasound-guided surgery. It also relates to a flexible support structure for said apparatus and to a chirurgical method for ultrasound-guided surgery using said apparatus .

Background of the invention

Ultrasound echography allows imaging of internal structures of the human body. Ultrasound imaging is commonly performed by a clinician using a hand held probe which is positioned adjacent to a patient. Ultrasound echography typically involves taking planar images of a sector parallel to the probe. The clinician explores a three-dimensional territory by moving the hand-held probe to let the sector cover the entire territory of interest.

Echographic visualization of internal structures in principle allows ultrasound-guided surgery. Localized applications, such as biopsies, thermoablation or localized injection of therapeutic substances, as in brachiterapy for example, are currently performed in combination with imaging means, and particularly in combination with ultrasound probes. Ultrasonic imaging allows to see minimally invasive surgical utensils (e.g. needles) and the target region to safely orient and move them to the target point. However holding an ultrasound scanning probe while performing surgery is not practical. Having a second person holding the probe is disturbing the surgeons liberty of movement. Support structures capable of positioning a medical imaging device, such as a probe, and maintain it in a fixed position are known. For instance, US patent 5,022,410 describes a support structure to be used for non-invasive cardiac output monitor and more particularly for positioning a transducer for long term or continuous use in such monitoring.

US patent 6,261,231 discloses an ultrasound probe holder which allows reducing frame-to-frame variability in images due to the movement of the probe between successive images and monitoring an organ of interest while the patient is undergoing exercise-induced stress.

US patent 6,732,988 discloses an articulated arm system for attaching different medical imaging devices to support structures. Said arm is used to ensure that the imaging device will stay in place during imaging.

The applicant has now observed that, further to the problem of holding the probe when performing ultrasound- guided surgery, the clinician shall be provided with an ergonomic way of operating the whole ultrasound apparatus while performing surgery. As a matter of fact, ultrasound imaging machines are rather complex and are usually formed of various medical imaging devices, other than the probe, that require the surgeon's attention. The screen is one of them. As the surgeon needs to look sideways at the screen located on the imaging machine, his view may be distracted from the operating field. As observed by the Applicant it would thus be desirable to conceive a viewing configuration that facilitates the surgeons viewing of ultrasound image and operating field without head movement while contemporarily freeing his hands from holding the ultrasonic probe.

The control-panel is another part of an imaging machine that may divert the surgeon' s attention from the operating field. As the surgeon may want to adjust some ultrasound operating parameter during operation, he may do this by asking a collaborator to operate the control-panel, but it would be desirable for the surgeon himself to be able to operate the control panel, always with minimal movement. That may be possible only if the control panel is adequately supported close to the screen and the operating field.

Document WO-A-02/30348 describes a surgical system having a swing arm for holding a video screen and flexible arms for holding various working instruments close to the surgery region, such arms being connected to a main workstation. However such a system is quite complex as it is mainly concerned with controlling several types of working instruments and/or medical imaging devices. This is achieved by a central control unit interfaced with modular subunits accommodated in the workstation. Hence this configuration does not allow the surgeon to fully control the surgical system without relaying on an assistant.

Summary of the invention

The present invention provides an improved integrated support structure for the various imaging devices forming an ultrasound imaging apparatus, said devices being positionable close to the surgery region, thus allowing minimal movements of the surgeon fully operating such apparatus thus improving the effectiveness and quality of ultrasound-guided surgery.

The invention offers unprecedented ease of use with little encumbrance of the vicinity of the surgical field. This provides advantages in terms of number of people needed for ultrasound-guided surgery and, through the ergonomic optimization, it favors efficiency and quality of surgery.

An aspect of the invention relates to an ultrasound imaging apparatus for ultrasound-guided surgery, comprising a probe, a display unit (e.g. a screen, a monitor or the like) , an electronic control unit for driving the probe, processing the received echo signals to form ultrasound images onto the display unit and controlling the overall operations, a first displaceable arm, a supporting member connected to said arm, means for holding said display unit, means for holding said probe, means for holding said control unit, wherein said means for holding the electronic control unit are associated to said first arm.

By moving the control unit from the mounting structure to the holding arm, it is possible to provide for a simple and cost effective integrated structure with a reduced number of wires and connections allowing full control of the ultrasound imaging system directly by the surgeon without relaying on an assistant. The number of pads or switches that can be used as input to the control unit are, in fact, not limited by the complexity of the wiring extending from the far-end of the arm close to the surgery region to the mounting structure, thus allowing a full control-panel to be displaced and located close to the surgery region, in particular close to the monitor. Preferably, the control panel is integrated into the monitor, e.g. in the form of a touch-pad.

In the context of the present invention, the expression "close to the surgery region", when referred to the location of a device (e.g. display, electronic unit, control panel etc.), means that said device is positionable in a region close to the operating surgeon, such that the surgeon can substantially avoid any action or movement, to interact with said device, which may distract himself from the surgical operations.

According to an embodiment of the invention, the display unit is held in a stable position close to the surgery region by holding means associated to a portion of the first displaceable arm. The means for holding the probe are advantageously associated to a portion of a second displaceable arm independently movable and lockable from the first arm. The second arm can be directly connected, i.e. without interposing elements, to the first arm or to the supporting member. According to another embodiment the means for holding the display unit are advantageously associated to the second arm.

According to a further embodiment of the invention, the electronic control unit and the display unit of the ultrasonic imaging apparatus are integrated to form a single device and are held in stable position close to the surgery- region by holding means associated to said first arm.

According to a further embodiment of the invention, the ultrasound imaging apparatus further comprises a control- panel which is displaceable and locatable close to the surgery region. The control-panel is an input of the electronic control unit and preferably comprises touch- sensitive means, like a touch screen, that can be advantageously integrated in the display. The control-panel is associated to the arm provided for holding the display unit and is preferably held by the same means used for holding the display unit, when, for example, the touch- sensitive means and the display unit are part of the same device. The control-panel may also be advantageously associated to the arm provided for holding the probe or to the supporting member, for example using a further displaceable arm. The touch-screen is preferably covered by a disposable cover, typically of plastic material, for sterility reasons .

Another aspect of the invention relates to a flexible support structure for ultrasound-guided surgery comprising a first displaceable arm, a supporting member connected to said arm, means for holding a first medical imaging device in a stable position, means for holding at least a second medical imaging device in a stable position, means for holding electronic control means (100) of an imaging apparatus, said means for holding electronic control means being associated to a portion of said arm. According to an embodiment of the invention, the at least second medical device is held in a stable position by a second arm independently movable and lockable from the first arm. The means for holding the second medical imaging device are associated to a portion of the second arm that can be directly connected to the first arm or to the supporting member, thus allowing maximum flexibility of use.

Preferably the means for holding one of the at least two medical imaging devices are suitable for holding an ultrasonic probe, typically a volumetric scanning probe, of an ultrasound imaging apparatus . The means for holding the other of the at least two medical imaging devices are suitable for holding the display unit, such as a monitor, of an ultrasound imaging apparatus close to the surgery region. Preferably one of the two arms comprises means for holding in a stable position close to the surgery region both the electronic control means and the display unit of an integrated ultrasound imaging apparatus .

According to a preferred embodiment of the invention, the flexible support comprises means for holding touch- sensitive means, such as a touch screen, to be used for example, as control-panel or generically as input of an ultrasound imaging apparatus . Such holding means are associated to the displaceable arm provided for holding the display means and preferably are the same means used for holding the display unit, when, for example, the touch- sensitive means and the display unit are part of the same device. The means for holding the touch-sensitive means may be also advantageously associated to the arm provided for holding the probe or to the supporting member, for example using another displaceable arm.

According to another aspect, the invention provides a method for ultrasound-guided surgery comprising the steps of imaging the region to be subjected to ultrasound-guided surgery with an ultrasound imaging apparatus in order to find proper displacement of the probe, placing the probe in position and fixing it, placing the display unit close to the surgery region, adjusting the imaging parameters by acting on a control panel interfaced with the control unit, starting imaging the region of surgery on the display unit, surgically operating on such zone under the guide of such imaging, all with minimal movements of the surgeon operating the ultrasound imaging apparatus while performing surgery. The characteristics of the invention and the advantages derived therefrom will appear more clearly from the following description of non limiting embodiments, illustrated in the annexed drawings, in which:

Brief description of the drawings

Fig. 1 to 6 schematically show some embodiments of the invention.

Fig. 7 (which is a particular of figure 1 of US 5,957,423) illustrates a support with one arm to be fixed to flat side rails of an operating table.

Fig. 8 shows a support clamped onto a mounting rod from the ceiling.

Fig. 9 shows the same flexible support of fig 8 clamped onto a mounting rod on a heavy floor stand on wheels.

Fig. 10 (corresponding to fig. 2 of US 5,022,410) and fig.

11 (corresponding to fig. 1 of US 6, 732, 988) show some prior art articulated arms .

Fig. 12 shows an exemplary lay out of an operating room for ultrasound-guided surgery (e.g. sentinel lymph node resection in the breast) according to the invention.

Detailed description of the invention

With reference to fig. 1, a first embodiment of the invention is schematically shown. Two displaceable arms, for example of the lockable articulated type, 102, 103 are connected to a supporting member 101 acting as a mounting structure like a pillar, a wall or operating table rails. The first arm 102 holds the electronic control unit 100 and an image screen 104 while the second arm 103 holds an ultrasound probe (or transducer) 106 through a probe holder 105. The image screen 104 is preferably an Led supported by a holder that may be of any known type such as the one described in US patent 5,854,735.

As ultrasound echography typically involves taking planar images of a sector parallel to the probe, when the clinician needs to explorate a three-dimensional territory, he moves the hand-held probe to let the sector cover the entire territory of interest. "Volume-scanning" probes are probes which can mechanically, electronically or part mechanically, part electronically move the angulation of the sector, when the probe is held in fixed position. The periodic movement of the sector through an angle thus allows to monitor a three-dimensional territory. The probe 106 is preferably of the volume-scanning type. This allows to scan the entire surgery region with minimum interaction between the surgeon and the probe that needs only to be initially placed by the surgeon himself. The probe holder 105 is advantageously one of the type described in US patent 5,022,410.

An alternative embodiment is shown in fig.4 where the arm 103 is attached onto the arm 102.

In fig. 2 a second embodiment of the invention is shown. Here the first arm 102 is used for holding the whole ultrasound apparatus, with the image screen 104 integrated into the control unit 100 . This is the case of a portable ultrasound apparatus where the screen is typically a liquid crystal display (led) . Commercially available portable ultrasound apparatus are, for example, CarisPlus by Esaote or Aquila or Falco by PieMedical Imaging.

An alternative embodiment is shown in fig.5 where displaceable arm 102, holding the integrated image screen 104 and control unit 100, also holds the second displaceable arm 103.

In fig. 3 a third embodiment is shown, where an improved integration is achieved. The ultrasound apparatus has a touch screen 107, which is held by a holder attached to the first arm 102 used also for holding the image screen 104, typically a led, and the control unit 100. The led 104 is used as output for the echographic images of the zone under investigation, while the touch screen 107 is used by the surgeon for inputting data and commands . The touch¬ screen 107 and the led 104 can be integrated together so that only one device needs to be supported by the arm 102.

An alternative embodiment is shown in fig.6 where the second displaceable arm 103 is attached onto the first arm 102, which holds the image screen 104, the touch screen 107 and the control unit 100. The supporting member can be clamped to a mounting rod 801 attached to the ceiling 802 as shown in fig. 8. Alternatively it can be clamped on a mounting rod 801 on a heavy floor stand 901 on wheels 902 as shown in fig. 9. Stable positioning is achieved with lockable wheels and lockable rising and lowering rail grips.

The supporting member can also be attached to operating table rails 74 through a rail grip 56, as disclosed e.g. in US patent 5,957,423, here incorporated by reference, from which figure 7 of the present application has been taken. As shown in figure 7, a pivot assembly 44 is mounted atop a keyed shank 52 by a clamp assembly 54 having a handle 55. Shank 52 is matingly insertable in a base 56. A base clamp assembly 60 secures shank 52 at any desired height providing a multiplicity of height settings for the pivot assembly 44 and provides for attachment to mounting rail 74. Each displaceable arm is preferably an articulated arm comprising a parallelogram device including a counterbalancing mechanism for holding the arm itself and the device supported by it in place when the device is located in the desired imaging position. An example of such an arm is disclosed in US patent 6,732,988, here incorporated by reference, from which figure 11 of the present application has been taken.

According to fig. 11, the articulated arm system 20 comprises a first parallelogram device 15a, a spacing piece 10 and a second parallelogram device 15b. The first parallelogram device 15a is attached through a connecting piece 18 and articulation pieces 13 and 12 to the support member 14. At the free end of the second parallelogram device 15b is attached, for example, the led 11 through a connecting piece 19. Both parallelogram devices 15a, 15b comprise parallel strut bars 6, 7 which are connected to the spacing piece 10 and the connecting pieces 18 and 19 by means of articulations 8a and 8b. The mutual distance between the pivots 8a in the connecting piece 18 of the parallelogram device 15a is equal to the mutual distance between the pivots 8b in the spacing piece 10, and correspondingly, the mutual distance between the pivots 8a in the parallelogram device 15b is equal to the mutual distance between the pivots 8b. This means that when the articulated arm is used for adjusting the device 11 into the correct position, the spacing piece 10 will remain in essentially the same position throughout.

Both parallelogram devices have a counterbalancing mechanism with an additional strut bar 1, around which there is a counterbalancing spring 16 for holding the articulated arm and the device supported by it in place. The additional strut bar 1 is preferably round and connected with bar 9 in parallelogram device 15a to the connecting piece 18 and in parallelogram device 15b with the spacing piece 10. To prevent unintentional movement of the articulated arm braking and/or locking means have been mounted around the additional strut bar 1. These means comprise a locking piece 2 which includes a sleeve part surrounding the additional strut bar 1. This piece 2 is connected to a lever arm 3 which is loaded by force F to press the sleeve against the additional strut bar 1. The force F is generated by means of the spring 4. The locking is normally always on, and in order to adjust the device into the desired position, at the end of the lever arm 3 are arranged actuators 5, for example, a solenoid, which is made to pull by pressing the switch button 17 on the connecting piece 19, whereby the lever arm 3 presses against the force of the spring 4, allowing easy movement of the additional strut bar 1 inside the sleeve part of the locking piece 2. The use of this locking piece 2 can also be implemented vice versa, whereby the lever arm 3 is normally turned in such a way that the additional strut bar 1 is able to move inside the sleeve part, and when the articulated arm is to be locked, for example, a solenoid 5 is used for turning the lever arm 3 in such a way that the sleeve part presses against the additional strut bar 1. Instead of a spring 4 and a solenoid 5, the actuator of the lever arm 3 may be, for example, a motor equipped with a self-locking worm gear, or even manual operation.

Each of the arms may also be telescoping two axis pivotable arms with elbow articulation such as those sold by Baitella AG, Zurich under the tradename Fisso Endoskophalterung or lockable snake arms such as those sold by SonoTech Medical Electronics AG, Neu-Ulm, Germany. Here locking occurs by increasing the tension on the central cord. An example of such lockable snake arm can be found in in US 5,022,410, here incorporated by reference, from which figure 10 of the present application is taken. In figure 10, the tension device 1010 may advantageously be a pistol-grip device that allows generation and release of tension in a cord inside the lockable snake arm.

Fig. 12 shows a typical lay out of an operating room for ultrasound-guided surgery according to the invention. A patient (represented under cover sheets) lies on the surgery- table 209 wearing anesthesia mask 212. The surgery table 209 is of the type with side rails 207a and 207b. The mounting device 101 of the support structure is attached to the side rail 207 opposite to the surgeon. The support structure is of the type with two displaceable arms with one arm connected to the other as in fig.6. The first arm 102 is of the lockable pivot type and is used for holding a portable ultrasound apparatus 200, including an image viewing screen 201 (with an integrated touch screen control panel, not shown) and an electronic control input device 202. The second arm 103 is of the lockable snake type and is used for holding the ultrasound probe 106 close to the area of intervention 211. The cables 208 for electric supply and for the control of the ultrasound probe 106 and image viewing screen pass through respective cavities (not shown) provided in the two arms 102 and 103 of the supporting structure.

As it can be seen, this configuration facilitates the surgeons 203 viewing of ultrasound image and operating field while contemporarily freeing his hands from holding the ultrasonic probe and allowing minimal movements, thus improving the effectiveness and quality of ultrasound-guided surgery at surgery location 204.

Claims

1. Ultrasound imaging apparatus for ultrasound-guided surgery, comprising a probe (106), a display unit (104), an electronic control unit (100) , a first displaceable arm (102), a supporting member (101) connected to said arm (102), means for holding said display unit (104), means

(105) for holding said probe (106) , means for holding said control unit (100) , characterized in that said means for holding the electronic control unit (100) are associated to said first arm (102) .

2. Ultrasound imaging apparatus according to claim 1, characterized in that it comprises a second displaceable arm (103) independently movable and lockable from the first arm (102), the means (105) for holding the probe (106) being associated to a portion of said second arm (103) .

3. Ultrasound imaging apparatus according to claim 1 or 2, characterized in that the means for holding the display unit (104) are associated to the first arm (102) .

4. Ultrasound imaging apparatus according to claim 1 or 2, characterized in that the means for holding the display unit (104) are associated to the second arm (103) .

5. Ultrasound imaging apparatus according to any of the preceding claims 2 to 4, characterized in that the second arm (103) is directly connected to the first arm (102) .

6. Ultrasound imaging apparatus according to any of the preceding claims 2 to 4, characterized in that the second arm (103) is connected to the supporting member (101) .

7. Ultrasound imaging apparatus according to any of the preceding claims 1 to 6, characterized in that the probe

(106) is a volumetric scanning probe.

8. Ultrasound imaging apparatus according to any of the preceding claims 1 to 7, characterized in that the electronic control unit (100) and the display unit (104) are integrated to form a single device to be held in stable position by one of the two arms (102, 103) .

9. Ultrasound imaging apparatus according to any of the preceding claims 1 to 8, characterized in that it further comprises means for holding touch-sensitive means (107) interfaced with the electronic control unit (100) .

10. Ultrasound imaging apparatus according to claim 9, characterized in that the means for holding the touch- sensitive means (107) are associated to the arm (102) provided for holding the display unit (104) .

11. Ultrasound imaging apparatus according to claim 10, characterized in that the means for holding the touch- sensitive means (107) are the same means for holding the display unit (104), being the touch-sensitive means (107) and the display unit (104) part of the same device.

12. Ultrasound imaging apparatus according to claim 9, characterized in that the means for holding the touch- sensitive means (107) are associated to the arm (102) provided for holding the probe (106) .

13. Ultrasound imaging apparatus according to claim 9, characterized in that the means for holding the touch- sensitive means (107) are associated to the supporting member (101) .

14. Ultrasound imaging apparatus according to claims 9 to 13, characterized in that the touch-sensitive means (107) comprise a touch-screen.

15. Ultrasound imaging apparatus according to claim 14, characterized in that the touch-screen (107) is covered by a disposable cover.

16. Flexible support structure for ultrasound-guided surgery comprising a first displaceable arm (102), a supporting member (101) connected to said arm (102), means for holding a first medical imaging device in a stable position (105) , , means for holding at least a second medical imaging device (104, 107) in a stable position, means for holding electronic control means (100) of an imaging apparatus, characterized in that said means for holding electronic control means (100) are associated to a portion of said arm (102) .

17. Flexible support structure according to claim 16, characterized in that it comprises a second displaceable arm (103) independently movable and lockable from the first arm (102), the means for holding the at least second medical imaging device (105) being associated to a portion of said second arm (103) .

18. Flexible support structure according to claim 17, characterized in that the second arm (103) is directly connected to the first arm (102) .

19. Flexible support structure according to claim 17, characterized in that the second arm (103) is connected to the supporting member (101) .

20. Flexible support structure according to any of the preceding claims 16 to 19, characterized in that the means for holding one of the at least two medical imaging devices (105) are suitable for holding an ultrasonic probe (106) of an ultrasound imaging apparatus .

21. Flexible support structure according to claim 20, characterized in that the means for holding one of the at least two medical imaging devices (105) are suitable for holding a volumetric scanning probe.

22. Flexible support structure according to claim 20 or 21, characterized in that the means for holding the other of the at least two medical imaging devices are suitable for holding the display unit (104) of an ultrasound imaging apparatus (100) .

23. Flexible support structure according to claim 22, characterized in that one of the two arms (102, 103) comprises means for holding both the electronic control means (100) and the display unit (104) of an integrated ultrasound imaging apparatus .

24. Flexible support structure according to claims 22 to 23, characterized in that it further comprises means for holding touch-sensitive means (107) to be used as input to an ultrasound imaging apparatus (100) .

25. Flexible support structure according to claim 24, characterized in that the means for holding the touch- sensitive means (107) are associated to the arm (102) provided for holding the display means (104) .

26. Flexible support structure according to claim 25, characterized in that the means for holding the touch- sensitive means (107) are the same means for holding the display means (104) in ultrasound imaging apparatus (100) sharing the touch-sensitive means (107) and the display means (104) in the same device.

27. Flexible support structure according to claim 24, characterized in that the means for holding the touch- sensitive means (107) are associated to the arm provided for holding the probe (106) .

28. Flexible support structure according to claim 24, characterized in that the means for holding the touch- sensitive means (107) are associated to the supporting member (101) .

29. Flexible support structure according to any of the preceding claims 16 to 28, characterized in that at least one of the arms (102, 103) is an articulated arm comprising at least one parallelogram device (15a, 15b) including a counterbalancing mechanism (16) for holding the articulated arm and the imaging device supported by it in place when the device is located in the desired imaging position.

30. Flexible support structure according to any of the preceding claims 16 to 29, characterized in that at least one of the arms is a lockable snake device with electric cables hidden inside the arm.

31. Flexible support structure according to any of the preceding claims 16 to 30, characterized in that at least one of the arms is a telescoping two axis pivotable arm.

32. Flexible support structure according to any of the preceding claims 16 to 31, characterized in that the supporting member is fixable to the floor of a surgical room.

33. Flexible support structure according to any of the preceding claims 16 to 32, characterized in that the supporting member is fixable to the ceiling of a surgical room.

34. Flexible support structure according to any of the preceding claims 16 to 33, characterized in that the supporting member is clamped onto a mounting rod on a floor stand with lockable rising and lowering means to be set to achieve stable positioning.

35. Flexible support structure according to claim 34, characterized in that the mounting rod comprises wheels.

36. Flexible support structure according to claim 35, characterized in that the wheels of the mounting rod are lockable.

37. Ultrasound imaging apparatus for ultrasound-guided surgery, comprising a probe (106), a display unit (104), an electronic control unit (100) for driving the probe (106) and processing the received echo signals to form ultrasound images onto the display unit (104), an input unit (107) for inputting data to the electronic control unit (100) , characterized in that is provided in combination with a flexible support structure according to any of the preceding claims 16 to 36.

38. Lay out of an operating room for ultrasound-guided surgery comprising: a) an operating table with side rails; b) a flexible support structure according to any of the preceding claims 16 to 36, the supporting member of which being lockable on said side rails of the operating table; c) an ultrasonic probe held in place close to a surgery region by a first arm of the flexible support structure; d) a display screen held in place close to the surgery region by a second arm of the flexible support structure; e) electronic control means for driving the probe and processing the received echo signals to form ultrasound images onto the display screen.

39. Method for ultrasound-guided surgery in a surgery- region by using a ultrasound imaging apparatus according to any of claims 1 to 15, comprising the following steps: a) imaging the region to be subjected to ultrasound- guided surgery in order to find proper displacement of the probe; b) placing the probe in position and fixing it; c) placing the display unit close to the surgery region; d) adjusting the imaging parameters acting on a control panel interfaced with the control unit; e) starting imaging the region of surgery on the display unit; f) surgically operating on such zone under the guide of such imaging.

40. Method according to claim 39 wherein the ultrasound- guided surgery is a sentinel lymph node resection in the breast.