Use of the choledocoscope in the laparoscopic common bile duct exploration for choledocolithiasis resolution

Abstract

Objective: To describe the technique in use of the choledocoscope
for the common bile duct exploration in choledocolithiasis, at
the Servicio de Cirugía Hospital Universitario de Caracas.
Patients and methods: We report the case of a 42 years old
female with abdominal pain for gall bladder lithiasis and probable
choledocolithiasis who underwent an unsuccessful ERCP. We
decided to perform a common bile duct exploration using a choledocoscope.
Results: We successfully performed a common bile duct
exploration through a supraduodenal choledocotomy drawing
several stones from the common bile duct using a choledocoscope
with posterior proximal and distal check of the bile duct
with no anomalies. The patient was discharged with no complications
performing a transkehr cholangiography on the 10th postoperatory
day, with positive results.
Discussion: The use of the choledocoscope in the common
bile duct exploration helps to achieve the highest rates of success
and reduce the residual lithiasis to a minimum. However, we
should not forget that it is a very complicated technique that
demands a complete coordination and team work. Important
issues to take into account are the surgeons experience, skills
and knowledge of the instrumental required.