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laparoscopic left hepatectomy with direct glissonian approach

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Fluoroscopically-guided Laparoscopic Choledochotomy For Impacted Cbd Stone

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Elgeidy Ahmed,
Mansoura Gastroenterology Surgical Center,
Mansoura

PERSONAL COMMENTS:
We can see that even impacted CBD stones could be safely removed by laparoscopic choledochotomy using fluoroscopic guidance when laparoscopic suturing skill exists.

ABSTRACT:
Laparoscopic choledochotomy is a recent technique that started to gain widespread acceptance as an effective and safe alternative to ERCP for removal of common bile duct stones. This video demonstrates the technique of removal of an impacted stone in the lower end of the CBD under fluoroscopy without the use of choledochoscope. Our patient was a female aged 33 years presented by jaundice (total serum bilirubin was 3.6 mg/dl) and abdominal pain. Her abdominal ultrasound revealed a distended gallbladder with multiple stones and a dilated CBD 1.4 cm with no definite cause of obstruction. On exploration the gallbladder was thick-walled and distended, the cystic duct was dilated and the CBD was significantly dilated, as well. We performed laparoscopic choledochotomy and succeeded to remove the stone using a biliary balloon over a guide wire under fluoroscopic guidance without the use of choledochoscope. T tube was the method of drainage. We verified clearance of the CBD by intraoperative T tube cholangiography. The patient passed a smooth postoperative course. She started oral intake next morning and was discharged on the third postoperative day. T tube cholangiography was performed on the seventh postoperative day revealing no residual stones, so the T tube was removed.
Mediastinal parathyroidectomy performed by videoassisted mediastinal surgery through an intercostal window (IVAMS)
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