Donald E. Wenner, MD, FACS
General Surgery
Jason M. Degani
Student, University of New Mexico
Abstract
Laparoscopic Common Bile Duct Exploration has been shown to be as effective or superior to Endoscopic Retrograde Cholangio-Pancreatography/Endoscopic Retrograde Sphincterotomy in terms of complications, cost, and efficacy, with a success rate of 70-95%. However, no generally accepted technique has emerged for the performance of Laparoscopic Common Bile Duct Exploration. Damage to the fragile choledochoscope by passage through laparoscopic port valves and by manipulation with grasping forceps has been problematic. Repair costs for choledochoscope damage typically run around $5,000.00. This problem has inhibited the use of the flexible choledochoscope. Impacted bile duct stones have been the most difficult ones to remedy with present Laparoscopic Common Bile Duct Exploration techniques.
Method: The Multi-channel Instrument Guide is introduced as a solution for difficult cases involving impacted bile duct stones. It also addresses the problem of damage to the fragile choledochoscope. The Multi-channel Instrument Guide lends itself to a logical technique algorithm that progresses from simple to complex.
Results: We have had over 96% success in clearing bile duct stones in difficult cases involving impacted stones. This success comes from applying a technique algorithm that progresses in a logical sequence from simple to complex. The Multi-channel Instrument Guide has been successful in protecting the choledochoscope from damage during the operative procedure.
Conclusion: The Multi-channel Instrument Guide is a valuable addition to the surgeon’s armament in the laparoscopic remediation of bile duct stones. The instrument lends itself to a logical technique algorithm and was successful in preventing damage to the fragile choledochoscope.