Transdochal CBD exploration

1
Transdochal CBD exploration

• Prof Rajeev Sinha
• HOD
• MLB Medical College
• JHANSI

2
Aim

• Feasibility study
• Assessment of operative parameters
• Assessment of postoperative parameters
• Methodology
• 32pts
• 4mm-0deg-urethroscope OR 17FG-6deg-nephroscope
• 5 ports

3
Ligated Cystic duct
Dissected CBD - Incision with endoknife /
harmonic / cautery
4
Nephroscopic view
Stone in distal CBD
CHD and Intrahepatic
biliary channels
5
4 mm Stone crusher in use
Fragmented stone
6
Post stone removal Normal Ampullary opening seen
Intact stone removal using grasper
7
T- tube in place - optional
8
Closure without T tube
9

• 45 -105 min
• T tube in -7 pts
• Morrisons pouch drain- ALL pts
• Discharge 4 d
• Results
• Bile drainage gt 4days
  (1)pt
• Port site infection (2)
• Retained stones (2)
• Conversion (5)
• COMPARABLE TO OPEN CBD EXPLORATION RESULTS

10
CONCLUSIONS

• Requires advanced Lap expertise
• Significant increase in operating time
• BUT
• Marked reduction in morbidity
• THANK
  YOU