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Dictated by Donald E. Wenner, MD FACS
Morbidly obese 50 YO Mexican-American female 5’ 1", 330 pounds presented with acute RUQ pain and jaundice. Lab showed bili of 8.2, Alk. Phos 782, amylase 38, and WBC of 12.8. Ultrasound showed cholelithiasis and nl CBD. Pre op dx, of acute cholecystitis with cholelithiasis, choledocholithiasis and obstructive jaundice was made. Cholangiography demonstrated a single filling defect in a mildly dilated CBD.
The cystic duct was quite large and I elected to use a trans-cystic approach to LCBDE. The MIG was loaded with the 2.8 x 70 cm flexible choledochoscope, and the occlusion plug was used to block the two smaller lumens. A fifth 5 mm port was established in the left abdomen in the anterior axillary line. A retractor placed through this port was used to hold the duodenum and omentum inferiorly. The MIG was placed through the epigastric 10mm port site, and advanced out of it’s sheath and adjusted to the ideal angle for introduction of the choledochoscope through the cystic ductotomy. A 2.4 fr. x 80 cm. Nitenol stone basket was advanced through the working channel of the choledochoscope and the stone engaged into the basket under videoscopic guidance. The stone was removed through the cystic duct. The cystic duct was clipped and the GB removed.
The choledochoscope was protected in the MIG and no manipulation of the choledochoscope with grasping forceps was required. The patient has made an uneventful recovery. This case demonstrates the utility of the MIG when used for a trans-cystic approach to LCBDE.
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