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withdrawn, an ENDO SHEARS* instrument is inserted via the subxyphoid trocar.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The ENDO SHEARS* instrument is then withdrawn and a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.