The ABCdE score for PREdicting Lithotripsy Assistance during transcystic Bile duct Exploration by Laparoendoscopy (PRE-LABEL)

Navaratne, Lalin; Cecilia, David Martínez; Isla, Alberto

doi:10.1007/s00464-020-08082-6

Cited by 9 publications

(5 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Since then, we have demonstrated that use of lithotripsy techniques has increased our rate of successful transcystic LBDE from 67% to over 83% 4 . Therefore, without lithotripsy, we estimate that transcystic exploration is limited to around 60%–70%, which is an opinion shared by other authors and also the quoted figure in the current study by Nassar et al 1,5,6 Since the LABEL technique is applicable to all forms of lithotripsy (not just laser), the term has been changed to Lithotripsy-Assisted Bile duct Exploration by Laparoendoscopy, and we recently published the ABCdE (age, bilirubin, CBD diameter, ERCP) score for PREdicting Lithotripsy Assistance during transcystic Bile duct Exploration by Laparoendoscopy (PRE-LABEL) 7 . We found that when using the transcystic approach to the bile duct, the chance of encountering difficult CBD stones (large and/or multiple and/or impacted) was nearly one-fifth of cases (18.1%).…”

supporting

confidence: 68%

Comment on “Conventional Surgical Management of Bile Duct Stones

2021

Self Cite

View full text Add to dashboard Cite

supporting

confidence: 68%

Comment on “Conventional Surgical Management of Bile Duct Stones

2021

Self Cite

View full text Add to dashboard Cite

“…Since then, we have demonstrated that using lithotripsy alone increased the transcystic exploration rate from 67 to 83% [26]. Without lithotripsy, we estimate that the ceiling of transcystic LBDE is somewhere around 60-70% [21,32]. Over the last seven years, we have been routinely using single-use ultra-thin (~ 3 mm) choledochoscopes at our institution to facilitate transcystic LBDE [12].…”

Section: Discussionmentioning

confidence: 99%

“…The surgical approach to the bile duct was either transductal via choledochotomy or transcystic and has previously been described [12,[21][22][23]. In the LATEST group, the transcystic route was the approach of choice and attempted first routinely, whereas in the pre-LATEST group, the transcystic route was attempted only in selected cases (usually when the anatomy was favourable and there was a dilated cystic duct).…”

Section: Surgical Techniquementioning

confidence: 99%

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

et al. 2022

View full text Add to dashboard Cite

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.

show abstract

“…Reasons for failure of standard retrieval techniques included complex bile duct stones impacted in at the duodenal papilla or those too large to be removed through a smaller cystic duct. 14,15 The learning process consisted on an virtual mentoring by an expert surgeon on laparoscopic biliary surgery (AMI) with a long track record in laparoscopic bile duct exploration, 13 helping to assess the patients and discussing the surgical strategy together with review of recorded interventions and complemented by initial hands on practice using the PARA model for the basics of the cystic cannulation and use of the lithotripsy techniques (LABEL). 16 A retrospective review of a prospectively maintained database was performed.…”

Section: Methodsmentioning

confidence: 99%

“…LABEL was employed when standard retrieval techniques failed via the transcystic approach. Reasons for failure of standard retrieval techniques included complex bile duct stones impacted in at the duodenal papilla or those too large to be removed through a smaller cystic duct 14,15 …”

Section: Methodsmentioning

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

View full text Add to dashboard Cite

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.

show abstract

The ABCdE score for PREdicting Lithotripsy Assistance during transcystic Bile duct Exploration by Laparoendoscopy (PRE-LABEL)

Cited by 9 publications

References 21 publications

Comment on “Conventional Surgical Management of Bile Duct Stones

Comment on “Conventional Surgical Management of Bile Duct Stones

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

Contact Info

Product

Resources

About