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Transdochal CBD exploration

Prof Rajeev Sinha HOD MLB Medical College JHANSI. Transdochal CBD exploration. Aim. Feasibility study Assessment of operative parameters Assessment of postoperative parameters Methodology 32pts 4mm-0deg-urethroscope OR 17FG-6deg-nephroscope 5 ports . Ligated Cystic duct.

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Transdochal CBD exploration

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  1. Prof Rajeev Sinha HOD MLB Medical College JHANSI Transdochal CBD exploration

  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 • Morrison’s pouch drain- ALL pts • Discharge – 4 d • Results • Bile drainage > 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

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