prof rajeev sinha hod mlb medical college jhansi l.
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Transdochal CBD exploration - PowerPoint PPT Presentation


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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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Presentation Transcript
slide2
Aim
  • Feasibility study
  • Assessment of operative parameters
  • Assessment of postoperative parameters

Methodology

  • 32pts
  • 4mm-0deg-urethroscope OR 17FG-6deg-nephroscope
  • 5 ports
slide3

Ligated Cystic duct

Dissected CBD - Incision with endoknife / harmonic / cautery

slide4

Nephroscopic view

Stone in distal CBD

CHD and Intrahepatic

biliary channels

slide6

Post stone removal Normal Ampullary opening seen

Intact stone removal

–using grasper

slide9
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

conclusions
CONCLUSIONS
  • Requires advanced Lap expertise
  • Significant increase in operating time

BUT

  • Marked reduction in morbidity

THANK YOU