Cholecystocholangiography During Laparoscopic Cholecystectomy

Abstract

The aim of this study was to assess the efficacy and safety of performing cholecystocholangiography through a central venous pressure catheter during laparoscopic cholecystectomy. Laparoscopic cholecystocholangiography was attempted during laparoscopic cholecystectomy for chronic calculous cholecystitis in 40 patients, and considered successful if the biliary anatomy was clearly defined. The procedure was evaluated as successful in 36 patients (90%). It added an average 13.5 min to the operating time. A unsuspected common bile duct stone was identified by cholecystocholangiography in one patient and there were no cholangiogram-related complications. We concluded that laparoscopic cholecystocholangiography is a safe, simple, and quick procedure that can be used as an alternative to cystic duct cholangiography to identify the biliary anatomy and detect any common bile duct calculi prior to laparoscopic dissection.

Safety and Feasibility of Robotic-Assisted Partial Nephrectomy and Partial Hepatectomy for Soft Tissue Sarcoma

“…IOC is commonly performed by cannulating the cystic duct, which often requires surgical up skilling. In the setting of increased inflammation or when the duct is narrow and short, cystic duct cholangiography can become challenging because of the difficulties involved in cannulating the cystic duct, which can result in complications, such as bile duct injuries [3]. In light of this fact, routine intra-operative cholangiography (IOC) is often declined by surgeons and a policy of selective cholangiography is adopted [1,2].…”

“…An alternative to performing cholangiography is cholecysto-cholangiography. It is a simple technique that requires puncture of the gallbladder compared with cannulation of the cystic duct [3,4]. This procedure takes place at the beginning of the operation and therefore, unlike cystic duct cholangiography, anatomical variations such as a short cystic duct or a thin common bile duct can be seen prior to dissection, whereby possible iatrogenic injury to the hepatic or common bile duct can be avoided.…”

“…The advantage of IOCC is that it shows the length of the cystic duct and the presence or absence of anatomical variants before Calot's triangle is even approached [7]. Additionally, unsuccessful cholecysto-cholangiography does not preclude the use of cystic duct cholangiography later in the operation [3,[6][7].…”

“…Different methods of performing laparoscopic cholangiography, either through the gallbladder or via cannulation of the cystic duct, have been described [1][2][3][4][5][6][7][8][9][10][11]. Most surgeons use a variation of cystic duct cholangiography, which can be time-consuming, especially when experience is limited, and bile duct injury may be caused during attempts to cannulate the cystic duct [2,5,7,8,11].…”