Stone removal method in LCBDE
- Oct 22, 2018 -

01

Extrusion method

Try to squeeze the lower end of the common bile duct with the suction head. Sometimes the common bile duct stones can be easily squeezed into the bile duct incision, then the stone is taken by the stone cutter to put the stone into the specimen bag, or the bile duct stone is taken by the stone tube clamp.

02

Laparoscopic instrument

The application of laparoscopic non-invasive intestinal clamp with Wandu can be performed through the bile duct incision into the common bile duct or common hepatic duct. It is also easier to remove the common hepatic duct or common bile duct, especially large stones.


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03

Open device method

Pull out the cannula under the xiphoid process, extend the biliary stone-cutting forceps for laparotomy from the hole into the abdominal cavity, and extend into the lower end of the common hepatic duct or common bile duct under laparoscopic direct vision. This method is suitable for those with thin body.

04

Large water washing method

Attach a soft hose to the suction head. The hose should close all the side holes at the head end of the suction device, extend the rubber tube into the lower end of the common bile duct or the common hepatic duct, or even the intrahepatic bile duct. Apply 50ml syringe to extract the physiological saline from the end of the suction device. The biliary tube is flushed by the vortex formed by the water pressure, and the hose is repeatedly pushed to flush the stone outside the bile duct incision. This method is very useful for <2cm bile duct multiple stones, and is often used as the first choice. About 80% of bile duct stones can be removed by this method.

05

Small water washing method

The laparoscopic contrast tongs and the contrast tube are used for rinsing and stone removal, and the contrast tube is inserted into the lowermost end of the common bile duct or the common hepatic duct and the intrahepatic bile duct through the contrast tongs. Rinse with saline and use water pressure to remove stones. However, the disadvantage is that the contrast tube is too thin, the water pressure is small, and no large water rinse method is effective.

06

Cholangioscopic stone removal

If the above method is still unable to remove the stone, the choledochoscope can be applied to the lower end of the common hepatic duct or common bile duct under laparoscopic direct vision, and the basket is used for stone removal.

07

Intraoperative choledochoscopy

If the bile duct stones are too large or the incarcerated stones that the stone basket cannot pass, the liquid-electric lithotripsy can be applied, that is, the liquid-electric lithotripsy is used to crush the stones and then the bile ducts are taken out or washed out.

08

Catheter expansion

The catheter dilatation method can also be applied to the stenosis of the lower common bile duct or obstructive stones. The specific method uses the zebra guide wire to enter the abdominal cavity, and the laparoscopic forceps clamps the dilatation catheter into the lower bile duct stricture of the common bile duct. Under the monitoring of choledochoscopy, the assistant repeatedly pushes or shakes the zebra guide wire downward, and enters the intestinal cavity more than 20cm through the stenosis. The inner catheter enters the duodenal cavity along the zebra guide wire for about 5cm, and the outer catheter repeatedly shakes along the inner catheter to cause stones. Loose, causing the stone to return to the dilated segment of the bile duct or crushing some cancellous stones, pushing out the dilatation catheter, and then using the above method to remove the stone.

09

EST/ERCP joint method

For those who still can not remove stones, combined with intraoperative ERCP and EST stone.

10

Small incision assisted method

The duodenal side peritoneum can be incision under the microscope, and a small incision is made in the right upper abdomen. The incision is deep into the auxiliary hand. Like the open surgery, the duodenum descending is lifted and the lower end of the bile duct is squeezed. Combine method 3 to remove stone.

11

Not the way

The first ten methods are used up, the stones are still stubborn, then turn to open surgery. . .


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