Utilisation of laparoscopic choledochoscopy during bile duct exploration and evaluation of the wiper blade manoeuvre for transcystic intrahepatic access

Nassar, A. H.M., Gough, V., Ng, H. J., Katbeh, T. and Khan, K. (2023) Utilisation of laparoscopic choledochoscopy during bile duct exploration and evaluation of the wiper blade manoeuvre for transcystic intrahepatic access. Annals of Surgery, 277(2), e376-e383. (doi: 10.1097/SLA.0000000000004912) (PMID:33856382) (PMCID:PMC9831050)

Abstract

Objective: This study aims to examine the indications, techniques and outcomes of choledochoscopy during laparoscopic bile duct exploration and evaluate the results of the Wiper Blade Manoeuvre (WBM) for transcystic intrahepatic choledochoscopy. Summary Background Data: Choledochoscopy has traditionally been integral to bile duct explorations. However, laparoscopic era studies have reported wide variations in choledochoscopy availability and use, particulary with the increasing role of transcystic exploration. Methods: The indications, techniques and operative and postoperative data on choledeochoscopy collected prospectively during 1320 transcystic and choledochotomy explorations were analysed. The success rates of the WBM were evaluated for the 3 mm and 5 mm choledochocoscopes. Results: Of 935 choledochoscopies, 4 were performed during laparoscopic cholecystectomies and 931 during bile duct explorations (70.5%); 486 transcystic choledochoscopies (52%) and 445 through choledochotomies (48%). Transcystic choledochoscopy was utilised more often than blind exploration (55.7%% vs 44.3%) in patients with emergency admissions, jaundice, dilated bile ducts on preoperative imaging, wide cystic ducts and large, numerous or impacted bile duct stones. Intrahepatic choledochoscopy was successful in 70% using the 3 mm scope and 81% with the 5 mm scope. Choledochoscopy was necessary in all 124 explorations for impacted stones. 20 retained stones (2.1%) were encountered but no choledochoscopy related complications. Conclusions: Choledochoscopy should always be performed during a choledochotomy, particularly with multiple and intrahepatic stones, reducing the incidence of retained stones. Transcystic choledochoscopy was utilised in over 50% of explorations, increasing their rate of success. When attempted, the transcystic Wiper Blade Manoeuvre achieves intrahepatic access in 70–80%. It should be part of the training curriculum.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Khan, Mr Khurram and Nassar, Mr Ahmad and Katbeh, Mr Tarek
• Authors: Nassar, A. H.M., Gough, V., Ng, H. J., Katbeh, T., and Khan, K.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Annals of Surgery
• Publisher: Lippincott, Williams and Wilkins
• ISSN: 0003-4932
• ISSN (Online): 1528-1140
• Published Online: 14 April 2021
• Copyright Holders: Copyright © 2021 The Authors
• First Published: First published in Annals of Surgery 277(2): e376-e383
• Publisher Policy: Reproduced under a Creative Commons License