Video-assisted liver abscess debridement

Abstract

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.