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Scope of a (uretero)scope within a (laparo)scope: ureteroscope assisted CBD stone retrieval in laparoscopic CBD exploration , a limited single center case series in South India

Ahmed Pervez, Sampathi Rao Gopal Krishna, Anirudh Venkatesan, Cunnigaiper Dhanasekar Narayanan.

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Choledocholithiasis poses challenges to surgeons. Open CBD exploration with T tube has given way to ERCP and Laparoscopic CBD Exploration(LCBDE). Failure rate is high for large impacted stones. Improvisation in technique reduces failure rate. We publish our experience in the use of rigid ureteroscope in laparoscopic CBD exploration and assess feasibility and safety in complete clearance of CBD stones.
This procedure was conducted by Unit 4 of Department of General Surgery in Sri Ramachandra Medical University,Chennai(Tamil Nadu) during 2017. Rigid Ureteroscope was used in 5 patients of choledocholithiasis for LCBDE, which was passed into CBD both proximally and distally visualising the CBD for clearance of stones. Intraoperative finding, operative time, hospital stay and complications were recorded. As per literature search this is the first series from South India using this technique.
5 patients underwent laparoscopic common bile duct exploration. Minimum duct diameter was 10 mm. All had failed ERCP. Primary laparoscopic closure with placement of 10F biliary stent was done in all patients. Complete stone clearance achieved. Average hospital stay was 5 days. No complications occurred.
Use of rigid ureteroscope in LCBDE is feasible and efficacious in dealing with unsuccessful endoscopic stone extraction.

Key words: Choledocholithiasis, Laparoscopic CBD Exploration, Rigid Ureteroscope

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