Abstract
Laparoscopic cholecystectomy (LC) has become an accepted standard operation for gallstone in the world. On the other hand, complications accompanied by bile duct injuries were recently reported with extended indication of the LC. Intraoperative cholangiogram is essential for the safe LC to minimize the risk of bile duct injury. The disadvantages of intraoperative cholangiogram include increased operating time and the possibility of bile duct injury by its use, because of the difficulty of the maneuver.
We have achieved a method for real-time fluoroscopic cholangiogram by using a new instrument which was made by us. It is a kind of sheath by which firstly a round-tip stylet is inserted to coax gently through the spiral valves of the cystic duct. Secondly, this stylet is removed and the cholangiogram catheter is smoothly inserted. Digital Carm fluoroscopy provides “real-time” imaging of the biliary tree. As a result, we can now get a clear cholangiogram easily in a short time. In the first 86 patients, direct cholangiogram were attempted in 59 cases and were successfully completed in 55 cases (93.2%).
Now, we are able to cope with bile duct injuries and anomalies, and unsuspected bile duct stone, owing to our method of real-time fluoroscopic intraoperative direct cholangiogram.
