The “Basket in Catheter” technique: Facilitating transcystic bile duct exploration and optimising the management of suspected ductal stones

Nassar, A. H., Qandeel, H., Khan, K. S. , Ng, H. J., Hasanat, S. and Ashour, H. (2023) The “Basket in Catheter” technique: Facilitating transcystic bile duct exploration and optimising the management of suspected ductal stones. Updates in Surgery, 75(7), pp. 1893-1902. (doi: 10.1007/s13304-023-01610-8) (PMID:37537316)

Abstract

The 'Basket-in-Catheter' (BIC) technique facilitates basket-only laparoscopic transcystic exploration (LTCE), increasing its success rate. Using the cholangiography catheter as a sheath is easier and safer than inserting the wire basket-alone. This study evaluates its benefits in confirmed and suspected ductal stones. Retrospective analysis of prospectively collected data on patients with pre-operative or operative suspicion of bile duct stones or with positive and equivocal intraoperative cholangiographies (IOC) who had LTCE attempted using blind basket trawling, without choledochoscopy, were reviewed. The incidence and outcomes of blind basket LTCEs attempted before and after introducing the BIC technique, whether or not stones were retrieved, were analysed. Blind basket LTCE was attempted in 732 patients. Of 377 (51.5%) patients undergoing successful stone retrieval, only 62% had pre-operative clinical and radiological risk factors for ductal stones, 25% had operative risk factors and 13% had silent stones discovered on IOC. Another 355 patients (48.5%) had negative trawling, although one half had pre-operative risk factors for ductal stones and 47.6% had operative risk factors, e.g. cystic duct stones or dilatation. This cohort had equivocal cholangiography in 25.9%. Following basket trawling, repeat IOC confirmed resolution of abnormalities. As no stones were retrieved, these were not considered duct explorations. The BIC technique facilitates safe and speedy bile duct clearance when stones are confirmed, avoiding choledochotomies, without significant complications. BIC duct trawling is also beneficial in patients with suspected ductal stones, helping to resolve equivocal IOCs. It helps surgeons to acquire and consolidate ductal exploration skills.

• Item Type: Articles
• Keywords: Laparoscopic cholecystectomy, Basket in catheter technique, Intraoperative 17 cholangiography, Transcystic bile duct exploration, bile duct stones
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: QANDEEL, Haitham and Ng, Hwei Jene and Khan, Mr Khurram
• Authors: Nassar, A. H., Qandeel, H., Khan, K. S., Ng, H. J., Hasanat, S., and Ashour, H.
• College/School: College of Medical Veterinary and Life Sciences; College of Medical Veterinary and Life Sciences > School of Cancer Sciences
• Journal Name: Updates in Surgery
• Publisher: Springer
• ISSN: 2038-131X
• ISSN (Online): 2038-3312
• Published Online: 04 August 2023
• Copyright Holders: Copyright © Italian Society of Surgery (SIC) 2023
• First Published: First published in Updates in Surgery 75(7): 1893–1902
• Publisher Policy: Reproduced in accordance with the publisher copyright policy