Modified and dynamic intraoperativecholangiography during laparoscopic cholecystectomy in two patients with aberrant right posterior hepatic duct

Navigation by modified and dynamic intraoperative cholangiography during laparoscopic subtotal cholecystectomy for difficult gallbladder

“…In addition, laparoscopic surgery is more difficult in the case of a pericholecystic abscess, as in case 1, because fibrosis develops around the abscess during the healing process. The rate of bile duct injury during laparoscopic cholecystectomy has not decreased despite advances in endoscopic surgery [5] . Severe inflammation has been reported as one of the causes of bile duct injury [12] .…”

“…We have defined an IOC that does not open the cystic duct as a modified IOC, in contrast to the classic IOC. Modified IOC methods include the PTGBD tube method, the infundibulum puncture method, the infundibulum cannulation method, and IOC using endoscopic nasobiliary drainage tube [ 5 , 20 ]. Modified IOC is applicable not only to mild cases of inflammation but also to severe cases.…”

“…Laparoscopic subtotal cholecystectomy (LSC) is an effective surgical technique to avoid biliary and vascular injuries when one cannot safely dissect and identify the structures in the Calot's triangle [4] . We have reported the usefulness of modified and dynamic intraoperative cholangiography (IOC) during laparoscopic cholecystectomy to avoid biliary injury [ 1 , 5 ]. Here we report the navigation by modified and dynamic IOC via PTGBD tube or puncture needle that can identify biliary anatomy, incarcerated gallbladder stone, and safe incision line during LSC.…”

Identification and verification of communicating accessory bile duct associated with a biliary circuit by modified and dynamic intraoperative cholangiography during laparoscopic cholecystectomy

“…A modified and dynamic IOC was performed in the same manner as previously reported. 6 Cannulation was performed from the infundibulum after exposure of the gallbladder neck. Initial IOC showed right anterior hepatic duct (RAHD), RPHD, LHD, CHD, and CBD in that order, but a biliary circuit was not visualized ( Figure 3a ).…”

“… 2 Identifying CABD is very difficult during laparoscopic cholecystectomy (LC); without the use of intraoperative cholangiography (IOC). We report modified and dynamic IOC, 6 which enabled accurate imaging of the CABD, biliary circuit, and short cystic duct during LC in a case.…”