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Laparoscopic Management of Biliary Stone Disease

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Instruments
Trocars
Informed Consent
Standard Lap-Chole
Routine IOC
LapCBDE:TCD
LapCBDE:Direct
Subtotal Chole
LapChole w CDC

 

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Laparoscopic Management of Biliary Stone Disease
Routine Intra-operative Cholangiogram
 

Additional Instruments:

bullet1 Storz Cholangiograsper 5 mm
bullet1 Ureteral Catheter 4 or 5 F with Adapter
bulletDye Used: Renographin 60

 

 STEP 1: Exposing the Cystic Duct and Artery

The cystic duct is dissected meticulously as close as possible to the gallbladder. The ENDO CLIP* Applier is inserted via the sub-xyphoid trocar and the cystic duct is clipped at its junction with the gallbladder. While maintaining the same exposure, the ENDO CLIP* applier is withdrawn, an ENDO SHEARS* instrument is inserted via the subxyphoid trocar.

An anterior incision is made on the cystic duct.

The ENDO SHEARS* instrument is then withdrawn and a cholangiocatheter grasper with a French #4 catheter is inserted. All the side ports of the catheter have been eliminated by cutting the last 3 cm of the tip. The catheter is inserted into the duct.

In most cases, the intraluminal valves on the cystic duct will make this insertion difficult. However, with the cholangiocatheter only the very tip of the catheter needs to be inserted to ensure the flow of bile enters the common bile duct. The grasper is closed around the duct; the jaws should enclose the entire width of the duct for better performance. The catheter is irrigated, and no leak should be seen around the entry site.

If the injection of dye is difficult and slow, and in most cases it is, use a 10cc syringe to inject the dye.

The cholangiogram is obtained. The following should be visible on the radiogram:
1. The cystic duct
2. The common bile duct with its hepatic bifurcation
3. Renografin in the duodenum
4. Absence of CBD stones

After completing the operative cholangiogram, the cholangiocatheter and grasper are removed.


 

Procedural Videos
> Standard Lapchole -3267

> Standard Lapchole - Acute-789

> Subtotal Lapchole-7897

> IOC -3892

> LapCBDE TC -3670

> LapCBDE-AC -7982

> Lapchole w CDC -32090

> Lapchole with SURGICON Clip Applier - 38003


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