Our Experience of Laparoscopic Bile Duct Exploration from Nearly 500 Cases: Leveraging Access to Technology and Enhanced Surgical Technique (LATEST) and the Biliary Surgery 2.0 Concept

Martínez‐Isla, Alberto; Navaratne, Lalin; Acosta-Mérida, María Asunción

doi:10.1007/978-3-030-93203-9_7

Cited by 3 publications

(3 citation statements)

References 99 publications

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“…During the evolution of LBDE at our institution over that last 23 years, we have changed practice and adapted the technique in order to increase the transcystic exploration rate. We recently proposed the concepts of Biliary Surgery 2.0 and Leveraging Access to Technology and Enhanced Surgical Technique (LATEST) in LBDE [16,17,28]. Leveraging access to technology includes using thinner and more flexible choledochoscopes combined with fragmentation techniques such as laser or electrohydraulic lithotripsy.…”

Section: Discussionmentioning

confidence: 99%

Leveraging access to technology and enhanced surgical technique (LATEST) in laparoscopic bile duct exploration (LBDE)

et al. 2022

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Single-stage management of choledocholithiasis with concomitant gallstones consists of performing either laparoscopic bile duct exploration (LBDE) or intra-operative endoscopic retrograde cholangiopancreatography at the same time as laparoscopic cholecystectomy. Transductal LBDE is associated with significantly higher post-operative morbidity, longer operative times and longer hospital stay when compared to transcystic LBDE. The aim of this study was to report the transcystic exploration rate and post-operative outcomes from LBDE before and after implementation of the LATEST (Leveraging Access to Technology and Enhanced Surgical Technique) principles. Methods: A retrospective review of 481 consecutive patients between February 1998 and July 2021 was performed. Patients were assigned into two groups determined by whether they were operated before or after the implementation of LATEST. Data collected included pre-operative demographic information, medical co-morbidity, pre-operative investigations, and intra-operative findings (including transcystic exploration rate, negative choledochoscopy rate, use of holmium laser lithotripsy and operative time). Outcomes of this study were the transcystic exploration rate, stone clearance rate, conversion to open surgery, post-operative morbidity and mortality, and length of post-operative hospital stay. Results: The pre-LATEST group contained 237 patients and the LATEST group comprised of 244 patients. Ultra-thin choledochoscopes and holmium laser lithotripsy were used more frequently in the LATEST group (41.4% and 18.4%, respectively). Enhanced surgical techniques (correction of the cystic duct-CBD junction and the trans-infundibular approach) were also performed more frequently in the LATEST group. More patients in the LATEST group received transcystic LBDE (86.1% vs 11.0%, p < 0.0001). The LATEST group had significantly higher stone clearance rates (98.8% vs 93.7%, p = 0.0034), reduced post-operative morbidity and shorter post-operative hospital stay (4 days vs 1 day, p < 0.0001). Conclusions: LATEST describes four key factors that can be used when performing LBDE. The adoption of LATEST in LBDE is associated with an increased stone clearance, a higher transcystic exploration rate and reduced post-operative morbidity.

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Section: Discussionmentioning

confidence: 99%

Leveraging access to technology and enhanced surgical technique (LATEST) in laparoscopic bile duct exploration (LBDE)

et al. 2022

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“…The biliary surgery 2.0 9 concept encompasses the overall strategy to enable an acute biliary service for complex gallstone disease. Its focus is on technical or technological aspects necessary to achieve high rates of transcystic exploration 31–33 . In turn, this leads to minimizing the complications associated with the transductal approach and shorter hospital stays 34 .…”

Section: Discussionmentioning

confidence: 99%

“…Its focus is on technical or technological aspects necessary to achieve high rates of transcystic exploration. [31][32][33] In turn, this leads to minimizing the complications associated with the transductal approach and shorter hospital stays. 34 Also, it requires the availability of a theater that effectively runs like an emergency theater, equipment, and staff to perform lithotripsy.…”

Section: F I G U R Ementioning

confidence: 99%

Learning curve for performing laparoscopic common bile duct exploration in biliary surgery 2.0 era

Durán

Silvestre

Hernández

et al. 2022

J Hepato Biliary Pancreat

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Background Recent trials and metanalysis have demonstrated the favorable results of laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) for the treatment of cholecysto‐choledocholithiasis. The aim of this study was to evaluate the LC + LCBDE learning curve including transcystic and transductal approaches and its effect on the outcomes. Methods We identified all unselected patients who underwent LC + LCBDE by a single surgeon between May 2017 and July 2021. Pre‐, intra‐, and postoperative data were analyzed using the cumulative sum (CUSUM) analysis to evaluate the learning curve. Results A total of 110 patients were included. Total postoperative complications rate was 12.7%, including bile leakage in six (5.5%) patients. Mean length of hospital stay was 2.7 (1‐14) days. No patient had conversion to open surgery. The CUSUM graph divided the learning curve into three distinct phases: (1) Learning (1–38), (2) Competence (39–61) and (3) Proficiency (62–110). There was a significant increase in the transcystic approach rate with each phase (44.7% vs 73.9% vs 98%; P < .001). A significant decrease in the operative time (150.9 vs 117.6 vs 99.9 min; P < .001) and complication rate (21.1% vs 21.7% vs 2%; P = .01) were observed across the three phases. Conclusion Our data suggest that the learning curve for complete competence in LC + LCBDE is approximately 60 cases, provided that proper training is available. The initial learning phase can be carried out safely and efficiently with acceptable results.

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Structured learning and mentoring: shortening the learning curve in laparoscopic common bile duct exploration

Durán,

Martínez-Cecilia,

Navaratne

et al. 2024

Surg Endosc

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Our Experience of Laparoscopic Bile Duct Exploration from Nearly 500 Cases: Leveraging Access to Technology and Enhanced Surgical Technique (LATEST) and the Biliary Surgery 2.0 Concept

Cited by 3 publications

References 99 publications

Leveraging access to technology and enhanced surgical technique (LATEST) in laparoscopic bile duct exploration (LBDE)

Leveraging access to technology and enhanced surgical technique (LATEST) in laparoscopic bile duct exploration (LBDE)

Learning curve for performing laparoscopic common bile duct exploration in biliary surgery 2.0 era

Structured learning and mentoring: shortening the learning curve in laparoscopic common bile duct exploration

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