Abstract
Despite progress in instrumentation of flexible Choledochoscope, many problems still remain to examine the interior of the bile duct, probably because of complicated operation and mechanical troubles. The reason for this is considered that conventional choledochof iberscope was originally developed as a bronchoscope, in principle, a miniature of gastrof iberscope. Improved Choledochoscope Medel I, II, III, were develped with a close co-operation of Olympus Optical Company to eliminate the disadvantage of conventional choledochofiberscope by permiting more easier exploration. Choledochoscope Model I has a flexible working length of 165mm at distal end and a diameter of 5.4mm. This instrument does not provide a means of recording and angulation of the tip. It was designed for only examination of the interior or the biliary duct at the time of surgery. This instrument is very light and very easy to handle. Choledochoscpe Model II has a flexible working length of 150mm at distal end and a diamter of 6.6mm. It has a large channel of 2.6mm which allows the use of balloontipped catheter, stone grasping forceps and biopsy forceps. This instrument provides a means of recording and the short distal tip deflects to 60 degree in two derctins. This instrument was designed for operative or post-operative choledoscopy. Dis advantage of this instrument is that observation of distal portion of common bile duct has been missed in some cases. Choledochoscope Model III has a 180mm flexible part at distal end and a diameter of 4.5mm. The short distal tip deflects to 90 degree in two derections, but it does not provide a means of treatment for residual stones. This Model III made it possible to observe the distal portion of common bille duct. In our department, post-operative choledochoscopy as well as operative choledochoscopy has been done routinely at the time T-tube was removed to avoid residual stone preblem by using these instrument. In this paper, these improved choledochoscopes were introduced. Moreover importance of employing operative and post-operative choledochoscopy adjunctively with cholangiography was strongly emphasized.
