The progresses made in minimally invasive surgery, make it not only possible to perform isolated cholecystectomy, but also to provide a totally laparoscopic treatment of common bile duct lithiasis. In this approach, the use of choledochoscopy is indispensable for both diagnostic and therapeutic success. In our department, cholecystectomy and laparoscopic exploration of the bile duct is the treatment of choice for cholelithiasis with associated lithiasis of the main bile duct. We describe the use of a flexible and disposable endoscope, designed for bronchofibroscopy and tracheal intubation, on patients who needed to undergo choledochoscopy. We used Ambu's aScope 3Ô, the large version of the device, which is 60 cm long, 5.8 mm in diameter, and has a 2.8 mm ID work channel that allows the passage of Dormia baskets for bile instrumentation. The LED light source is located at the tip of the device, which has a flexing capacity of 140 upwards and 110 downwards. The image is reproduced on an 8.5", TFT/LCD monitor. Using reusable videoendoscopes for that purpose always raises the question of the ergonomy of use, and easy image capture. In that respect, the Ambu Ò aScope 3Ô clearly exceeded the challenge. The image quality is also comparable to that of conventional choledochoscopes. Using these endoscopes has other advantages: no high costs of repair, no decontamination costs, and no cross infection. This endoscope proved to be easy to use and shows promise while performing choledochoscopy for treatment of coledocholithiasis via laparoscopic approach.
included the term "IPMN" (intraductal papillary mucinous neoplasm) from November 2017-June 2018. 57 cases were identified for preliminary review. Cyst characterization was defined by size, nodule, associated main pancreatic duct dilatation, symptoms, type of cross-sectional imaging, and specialty of ordering physician. Results: Of the 57 cases, 26 were female and 31 were male. Cyst size ranged from 0.2 cm to 4.1 cm, evenly distributed throughout the pancreas and multiple in 27%. 22 of 57 (38.5%) were detected incidentally with computed tomography (CT) scan, (72%). The majority of the scans were ordered by primary care physicians, emergency department, and other specialists unrelated to surgery or gastroenterology. When AGA guidelines were applied, 6/ 57 (11%) patients had worrisome features such as a dilated pancreatic duct, jaundice, size >3 cm, or associated mass necessitating further intervention such as endoscopic ultrasound and fine needle aspiration (FNA). Conclusion:The majority of pancreatic cystic neoplasms can be safely observed over time. Current AGA guidelines suggest the need for surveillance to reduce the risk of pancreatic adenocarcinoma related mortality. The role for a cyst surveillance program was demonstrated by our preliminary review of incidentally discovered cysts
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