Choledochal Biliary Stones and Laser Lithotripsy: The Laparoscopic Approach

Abstract

Currently, the development of endoscopic procedures has highly modified the management of cholecystocholedochal lithiasis. The laparoscopic approach of surgical procedures and the endoscopic cholangiopancreatography (ERCP) with sphincterotomy are highly effective. ^1,2 Yet, no protocol has been demonstrated as being obviously superior. ^{2 –6} Therefore, the choice depends on the availability and feasibility of techniques and devices. In this video, we show a single-stage mini-invasive treatment: in a 75-year-old patient presenting with acute cholangitis, we removed through a choledocotomy a large blocked choledochal biliary stone after shattering it with a Yag laser probe used for lithotripsy purposes. We also performed the laparoscopic cholecystectomy. Outcomes were unremarkable. The reported technique is interesting because it is feasible (1) with common urologic devices, (2) in patients who cannot undergo ERCP (after gastrectomy, bypass procedure, etc.) or when the endoscopy is unavailable, and (3) when the physicians opt for a single-stage laparoscopic procedure in stable patients. Currently, this technique has been used to treat 11 patients with good results and no complications.

No funding has been received for this work from any of the following organizations: National Institutes of Health (NIH); Wellcome Trust; Howard Hughes Medical Institute (HHMI); and other(s).

Runtime of video: 5 mins 34 secs