Operative choledochoscopy: Experience with a rigid choledochoscope

Abstract

The use of a choledochoscope after exploration of the common bile ducts should minimize the occurrence of retained common bile duct stones. Experience gained at 50 endoscopies with a rigid choledochoscope is reviewed. In 7 cases stones or debris were found remaining in the bile duct. In one case an unsuspected neoplasm was demonstrated and in another a suspected neoplastic stricture was confirmed. In the remaining 41 cases choledochoscopy showed the ducts to be free of stones. Postoperative cholangiography demonstrated a retained stone in 2 cases. There were 2 deaths in the series. The experience of other authors with rigid and flexible scopes is reviewed.

The use of a rigid choledochoscope in exploration of the common bile duct

“…The site of the choledochotomy is also important (2). When using the right-angled Storz instrument, the incision should be placed low down in the supraduodenal portion of the common D. Ernst and C. W .…”

“…Using conventional post-exploratory T-tube cholangiography, retained stones are still encountered in between 4 and 22 per cent of cases (I). Over the past 15 years direct visualization of the common bile duct by means of intraoperative endoscopy has been increasingly used in an attempt to resolve these problems (2)(3)(4)(5)(6)(7)(8)(9)(10).…”

“…They have the advantage of movement of the tip which may be less traumatic in negotiating intrahepatic ducts. By contrast, rigid choledochoscopes are much less expensive (Table f), easier to use the sterilize and therefore perhaps more appropriate for general use, despite the occasional report of duct trauma (2).…”

Modification of a Choledochoscope for Extraction of Difficult Biliary Stones

“…Rigid and flexible choledochoscopes have been used for detection and treatment of bile duct stones with good results. [11][12][13][14] In a comparison of the two modalities it was believed that the rigid instrument has practical advantages for general use, whereas the flexible instrument may offer some additional benefits but requires more skill and care in its use.l" In our institution at the time of the patient's operation a flexible choledochoscope was not available. Clearly the method of therapy needs to be tailored to the cause of the individual patient's problem, mode of presentation, skill and experience of the surgeon, and institution's available equipment.…”

A New Improved Flexible Choledochoscope: Preliminary Experience

“…The technological progress which has enabled the in troduction of new and improved rigid and flexible choledochoscopes is reflected in the encouraging results and the obvious widespread acceptance of choledochoscopy as a peroperative diagnostic procedure in the last decade [1][2][3][4][5][6][7][8].…”