2023
DOI: 10.1097/sla.0000000000004912
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Utilization of Laparoscopic Choledochoscopy During Bile Duct Exploration and Evaluation of the Wiper Blade Maneuver for Transcystic Intrahepatic Access

Abstract: Objective: This study aims to examine the indications, techniques, and outcomes of choledochoscopy during laparoscopic bile duct exploration and evaluate the results of the wiper blade maneuver (WBM) for transcystic intrahepatic choledochoscopy. Summary of Background Data: Choledochoscopy has traditionally been integral to bile duct explorations. However, laparoscopic era studies have reported wide variations in choledochoscopy availability and use, particularly with the increasing role of transcystic explorat… Show more

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Cited by 9 publications
(8 citation statements)
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“…Our fragmentation techniques depend on whether stone impaction is encountered within the extra or intrahepatic ducts 3 . Repeated manipulations with baskets together with limited stone fracture or balloon catheter dislodgement succeeded in 25% of the current number of 130 impacted stones, balloon dislodgement in 9%, using the choledochoscope to push ampullary stones into the duodenum or from the intramural CD to the CBD to facilitate engaging them in 5% and open conversion in 5% early in the series (choledochoduodenostomy in 3 cases due to failed disimpaction and fragmentation with biopsy forceps in 3) 4 .…”
mentioning
confidence: 99%
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“…Our fragmentation techniques depend on whether stone impaction is encountered within the extra or intrahepatic ducts 3 . Repeated manipulations with baskets together with limited stone fracture or balloon catheter dislodgement succeeded in 25% of the current number of 130 impacted stones, balloon dislodgement in 9%, using the choledochoscope to push ampullary stones into the duodenum or from the intramural CD to the CBD to facilitate engaging them in 5% and open conversion in 5% early in the series (choledochoduodenostomy in 3 cases due to failed disimpaction and fragmentation with biopsy forceps in 3) 4 .…”
mentioning
confidence: 99%
“…In our view this may suggest that TCE lithotripsy is attempted too often when it should have been possible to determine from the intraoperative cholangiography whether a choledochotomy is a better approach. This would avoid the logistic and clinical complications of lithotripsy, particularly that a significant minority of patients will have an anatomical cystic duct/common hepatic duct junction configuration which is totally incompatible with TCE or with performing the Wiper Blade Maneuvre 3 …”
mentioning
confidence: 99%
“…In recent years, the use of levering access technology and enhanced surgical techniques (LATEST) 17 have allowed increased rates of transcystic approach in up to 90% of cases. In the present study, the most experienced centers not surprisingly favored the transcystic approach, using advanced methods to improve transcystic exploration such as ultrathin scopes, the use of lithotripsy, and enhanced surgical techniques including the Wiper Blade Manoeuvre for transcystic proximal choledochoscopic access, 18 although a majority of centers preferred the transcholedochal approach.…”
Section: Discussionmentioning
confidence: 79%
“…Lab‐based hands‐on training on well‐designed models, should be done with training boxes such as the FLS ® (fundamentals of laparoscopic surgery VTI Medical) or pelvitrainers. Many models are available 18 including the PARA model (Porcine Aorto‐Renal Artery that allows a realistic choledochotomy and training in the transcystic access including lithotripsy) 30 . Some follow‐up mentoring with an expert center is necessary and can even be delivered remotely using smart surgery glasses and digital remote assistance platforms.…”
Section: Discussionmentioning
confidence: 99%
“…Its success rate varies greatly among different reports and is influenced by various factors, such as stone diameter, location and angle of the cystic duct entering the CBD. At the same time, TCDE may still require partial incision of the CBD or dilation of the cystic duct, which may lead to cystic duct rupture, laceration or avulsion and may require more special equipment, such as a 3 mm choledochoscope 28 . Therefore, we did not perform TCDE in these patients in our study.…”
Section: Discussionmentioning
confidence: 99%