Operative choledochoscopy

Abstract

We have reported the results of 121 examinations with the rigid choledochoscope performed by 13 different surgeons between 1969 and 1977. Pre-exploratory choledochoscopy was performed in 48 patients with a diagnostic accuracy of 94 per cent. Post-exploratory choledochoscopy was used in 73 patients to define whether the common bile duct had been adequately cleared of stones. Fifty-one patients were correctly assessed as having a clear duct and unsuspected residual calculi were demonstrated by choledochoscopy in 13 patients. However, choledochoscopy failed to identify 9 patients with retained stones. The accuracy of post-exploratory choledochoscopy alone was 87 per cent and the accuracy of post-exploratory cholangiography was 82 per cent, but when choledochoscopy was combined with post-exploratory cholangiography there were no errors. We conclude that the addition of choledochoscopy to conventional radiological techniques is likely to reduce the incidence of residual calculi after choledochotomy.

Modification of a Choledochoscope for Extraction of Difficult Biliary Stones

“…Rigid and flexible choledochoscopes have been used for detection and treatment of bile duct stones with good results. [11][12][13][14] In a comparison of the two modalities it was believed that the rigid instrument has practical advantages for general use, whereas the flexible instrument may offer some additional benefits but requires more skill and care in its use.l" In our institution at the time of the patient's operation a flexible choledochoscope was not available. Clearly the method of therapy needs to be tailored to the cause of the individual patient's problem, mode of presentation, skill and experience of the surgeon, and institution's available equipment.…”

Retained Stones in the Common Bile Duct

“…An incidence of retained stone of less than 2% has been reported in two studies in which a combination of choledochoscopy with the rigid instrument and post-exploratory cholangiography was used. (Nora et al , 1977;Kappas et al, 1979).…”

Operative choledochoscopy: Experience with a rigid choledochoscope

“…One of us (R. W. M.) has subsequently used the Storz rigid choledochoscope (27), in which the viewing limb is at 90" to the main shaft rather than at the 120" of our Wolf choledochoscope, and this was easier to introduce into the distal common bile duct. However, it was this choledochoscope that was used in a series recently reported by Kappas and co-workers in which the incidence of retained stones was higher than average (26). This was surprising in view of the acknowledged superiority of the Hopkins rod lens system used in the Storz choledochoscope.…”