Transcystic Approach with Micro-incision of the Cystic Duct and Its Confluence Part in Laparoscopic Common Bile Duct Exploration

2013 ◽  
Vol 23 (12) ◽  
pp. 977-981 ◽  
Author(s):  
Xue-Min Chen ◽  
Yue Zhang ◽  
Hui-Hua Cai ◽  
Dong-Lin Sun ◽  
Sheng-Yong Liu ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Cystic Duct ◽  
Common Bile Duct Exploration ◽  
Transcystic Approach

scholarly journals Dilatation of the Cystic Duct Confluence in Laparoscopic Common Bile Duct Exploration and stone extraction for Patients with Secondary Choledocholithiasis

2019 ◽  
Author(s):  
Xiao-Bin Yang ◽  
An-Shu Xu ◽  
Jian-Gang Li ◽  
Yong-Ping Xu ◽  
De-Song Xu ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Cystic Duct ◽  
Common Bile Duct Exploration ◽  
Stone Extraction ◽  
Non Invasive ◽  
Transcystic Approach ◽  
Surgical Modality ◽  
Cbd Exploration

Abstract The advent of endoscopic and laporoscopic techniques changed surgery in many regards. A number of options exist in the management of cholelithiasis and secondary choledocholithiasis. Among them, laparoscopic common bile duct (CBD) exploration with the choledocotomy followed by laparoscopic cholecystectomy (LC) has gained popularity. However, efforts should be made for minimally invasive or non-invasive to the CBD. For this purpose, we modified the surgical modality by laparoscopic transcystic approach with dilatation of the cystic duct confluence in CBD exploration (LTD-CBDE). The aim of this work was to assess the feasibility, safety and effectivity of LTD-CBDE based on our preliminary experience.

scholarly journals Dilatation of the Cystic Duct Confluence in Laparoscopic Common Bile Duct Exploration and stone extraction for Patients with Secondary Choledocholithiasis

2020 ◽  
Author(s):  
Xiao-Bin Yang ◽  
An-Shu Xu ◽  
Jian-Gang Li ◽  
Yong-Ping Xu ◽  
De-Song Xu ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Cystic Duct ◽  
Common Bile Duct Exploration ◽  
Stone Extraction ◽  
Non Invasive ◽  
Transcystic Approach ◽  
Surgical Modality ◽  
Cbd Exploration

Abstract The advent of endoscopic and laporoscopic techniques changed surgery in many regards. A number of options exist in the management of cholelithiasis and secondary choledocholithiasis. Among them, laparoscopic common bile duct (CBD) exploration with the choledocotomy followed by laparoscopic cholecystectomy (LC) has gained popularity. However, efforts should be made for minimally invasive or non-invasive to the CBD. For this purpose, we modified the surgical modality by laparoscopic transcystic approach with dilatation of the cystic duct confluence in CBD exploration (LTD-CBDE). The aim of this work was to assess the feasibility, safety and effectivity of LTD-CBDE based on our preliminary experience.

scholarly journals Dilatation of the Cystic Duct Confluence in Laparoscopic Common Bile Duct Exploration and stone extraction for Patients with Secondary Choledocholithiasis

2020 ◽  
Author(s):  
Xiao-Bin Yang ◽  
An-Shu Xu ◽  
Jian-Gang Li ◽  
Yong-Ping Xu ◽  
De-Song Xu ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Cystic Duct ◽  
Common Bile Duct Exploration ◽  
Stone Extraction ◽  
Non Invasive ◽  
Transcystic Approach ◽  
Surgical Modality ◽  
Cbd Exploration

Abstract The advent of endoscopic and laporoscopic techniques changed surgery in many regards. A number of options exist in the management of cholelithiasis and secondary choledocholithiasis. Among them, laparoscopic common bile duct (CBD) exploration with the choledocotomy followed by laparoscopic cholecystectomy (LC) has gained popularity. However, efforts should be made for minimally invasive or non-invasive to the CBD. For this purpose, we modified the surgical modality by laparoscopic transcystic approach with dilatation of the cystic duct confluence in CBD exploration (LTD-CBDE). The aim of this work was to assess the feasibility, safety and effectivity of LTD-CBDE based on our preliminary experience.

scholarly journals Dilatation of the Cystic Duct Confluence in Laparoscopic Common Bile Duct Exploration and stone extraction for Patients with Secondary Choledocholithiasis

2019 ◽  
Author(s):  
Xiao-Bin Yang ◽  
An-Shu Xu ◽  
Jian-Gang Li ◽  
Yong-Ping Xu ◽  
De-Song Xu ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Cystic Duct ◽  
Common Bile Duct Exploration ◽  
Stone Extraction ◽  
Non Invasive ◽  
Transcystic Approach ◽  
Surgical Modality ◽  
Cbd Exploration

Abstract The advent of endoscopic and laporoscopic techniques changed surgery in many regards. A number of options exist in the management of cholelithiasis and secondary choledocholithiasis. Among them, laparoscopic common bile duct (CBD) exploration with the choledocotomy followed by laparoscopic cholecystectomy (LC) has gained popularity. However, efforts should be made for minimally invasive or non-invasive to the CBD. For this purpose, we modified the surgical modality by laparoscopic transcystic approach with dilatation of the cystic duct confluence in CBD exploration (LTD-CBDE). The aim of this work was to assess the feasibility, safety and effectivity of LTD-CBDE based on our preliminary experience.

scholarly journals The role of choledochoscopy in transductal laparoscopic common bile duct exploration

2021 ◽  
Author(s):  
K. Atstupens ◽  
H. Plaudis ◽  
E. Saukane ◽  
A. Rudzats
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Common Bile Duct Exploration ◽  
Complication Rates ◽  
Time Saving ◽  
Patient Demographics ◽  
Operative Outcomes ◽  
Additional Equipment ◽  
Transcystic Approach ◽  
A Prospective Study

Laparoscopic common bile duct exploration (LCBDE) performed by choledochoscope through the cystic duct or directly through the incision in the common bile duct (CBD) are well established methods for restoring biliary drainage function in patients with choledocholithiasis. Although it plays a crucial role in the transcystic approach, transductal approach can be achieved differently. However, it has restrictions in availability due to its expensiveness. Objective — to report efficacy of transductal LCBDE without laparoscopic choledochoscopy. Materials and methods. This is a prospective study of urgently admitted patients who underwent trans‑ductal LCBDE due to confirmed choledocholithiasis. During laparoscopy, clearance of the CBD was achieved in two ways: by choledochoscopy (group CS+, n = 43) and without it (group CS–, n = 34). The data of patient demographics, comorbidities, operative outcomes, morbidity, mortality and long‑term biliary complications were analysed and compared between the groups. Results. Out of a total of 154 patients with confirmed choledocholithiasis, the trans‑ductal approach of LCBDE was applied to 77 patients. In 43 patients, clearance was done with choledochoscope (group CS+) and in 34 patients without it (group CS–). Gallstone related complications and comorbidities did not differ between the groups. Surgery was done 4 days after admission in both groups. Median duration of the operation was significantly shorter in the group CS–, 93 vs 120 minutes (p = 0.036), without any difference in conversion and complication rates. Clearance rate was markedly high in both groups. Conclusions. Transductal laparoscopic common bile duct exploration without choledochoscopy is a time‑saving, safe and effective way for CBD clearance, without additional equipment.  

scholarly journals Dilation of the Cystic Duct Confluence in Laparoscopic Common Bile Duct Exploration and stone extraction for Patients with Secondary Choledocholithiasis

2020 ◽  
Author(s):  
Xiao-Bin Yang ◽  
An-Shu Xu ◽  
Jian-Gang Li ◽  
Yong-Ping Xu ◽  
De-Song Xu ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Cystic Duct ◽  
Open Cholecystectomy ◽  
Operation Time ◽  
Common Bile Duct Exploration ◽  
Controlled Study ◽  
Stone Extraction ◽  
The Mean ◽  
Cbd Exploration

Abstract Objectives: Many options exist in the management of cholelithiasis and secondary choledocholithiasis. Among them, laparoscopic common bile duct exploration (LCBDE) with the choledocotomy followed by laparoscopic cholecystectomy has gained popularity. However, efforts should be made for minimally invasive or non-invasive to the common bile duct (CBD). For this purpose, we modified the surgical modality of laparoscopic transcystic approach by dilating the cystic duct confluence in CBD exploration (LTD-CBDE). Based on our preliminary experience, the aim of this work was to assess the feasibility, safety and effectivity of LTD-CBDE.Patients and methods: Sixty-eight patients were arbitrarily offered new LTD-CBDE technique from December 2015 to April 2018. During the surgery, we dilated the cystic duct confluence with separation forceps and/or the columnar dilation balloon. Subsequently, the CBD exploration and stone extraction were performed with choledochoscope. The entrance of CBD was covered with cystic duct stump wall and primarily closed at the end of surgery.Results: 49 females and 19 males with cholelithiasis and secondary choledocholithiasis were included. The mean age was 53 years old (18 to 72 yr). Of which, 62 cases (91.2%) were performed with LTD-CBDE techniques successfully, bile leakage was observed in 3 cases (4.4%). The mean operation time was 106 minutes and the mean hospital stay was 5.9 days. As for the other 6 patients, 3 cases were converted to open cholecystectomy due to severe fibrosis, unclear anatomical structure at the Calot’s triangle (n=2) and Mirizze syndrome (n=1); LCBDE were performed in 3 patients due to cystic duct atresia (n=2) and low level of the gallbladder duct into CBD (n=1). These patients had smooth postoperative course. None of the patients presented radiological evidence of retained CBD stone on the postoperative follow-up in 43/68 (40 cases used LTD-CBDE) patients one year later.Conclusion: The current work suggests that LTD-CBDE for the management of cholelithiasis and secondary choledocholithiasis is a feasible, safe and effective technique with a low rate of complications. It offers another alternative for surgeons to treat patients in similar scenarios. However, additional randomized, controlled study is further needed to demonstrate its efficacy, safety, and impact on CBD stenosis.

scholarly journals P-BN27 Novel technique for safe and efficient cannulation of the cystic and common bile duct

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Khurram Khan ◽  
Morag McLellan ◽  
Sajid Mahmud
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Cystic Duct ◽  
Gallstone Disease ◽  
Common Bile Duct Exploration ◽  
Conversion To Open Surgery ◽  
Critical View Of Safety ◽  
Novel Technique ◽  
Increased Risk ◽  
Time Required

Abstract Background Concomitant stones in the common bile duct (CBD) at the time of laparoscopic cholecystectomy (LC) are present in up to 15% of patients.  In conjunction with intra-operative cholangiogram (IOC), transcystic common bile duct exploration (TCBDE) enables diagnosis and management of ductal stones in a single stage procedure.  However, cannulation of the cystic duct (CD) and CBD can be challenging.  With repeated attempts at cannulation, there is increased risk of iatrogenic injury by creating a false passage or perforating the duct.  We propose a novel technique for the safe cannulation of the CD and CBD. Methods Once critical view of safety is achieved, a clip is placed distally in the CD and opened with scissors.  A flexible tip 80cm guidewire is then preloaded into 5-French ureteric catheter. The complex is then passed into the introducer through the lateral port. A grasper placed at Hartmann’s pouch is used to retract the gallbladder and straighting the CD. Only the guidewire is advanced out of the catheter, traversing the CD and CBD. Once safely advanced, the catheter can then be slid over the guidewire and the guidewire can be removed. IOC and TCBDE can then be performed if indicated. Results This technique was performed on 18 patients who failed CD cannulation during elective and emergency LC for symptomatic gallstone disease in a single center performed by the same surgical team.  Median age was 46 years and there was 15 females.  A total of 34 cannulations were attempted (in 18 patients) which 100% success rate.  There was no added time required for the technique.  In majority of cases it decreased the operative time due to quick intubation of CBD.  None of the cases required conversion to open surgery. Conclusions The novel technique described for cannulation of the cystic duct uses a Seldinger ‘like’ approach. This is a safe an effective strategy for cannulation of the CD, making the skills more accessible and more time efficient. This should encourage more surgeons to perform IOC and TCBDE where indicated. 

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