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𝙋𝙤𝙨𝙩 𝘾𝙝𝙤𝙡𝙚𝙘𝙮𝙨𝙩𝙚𝙘𝙩𝙤𝙢𝙮 𝙇𝙖𝙥𝙖𝙧𝙤𝙨𝙘𝙤𝙥𝙞𝙘 𝘾𝘽𝘿 𝙀𝙭𝙥𝙡𝙤𝙧𝙖𝙩𝙞𝙤𝙣 𝙬𝙞𝙩𝙝 𝙄𝘾𝙂 & 𝙇𝙖𝙨𝙚𝙧 𝙇𝙞𝙩𝙝𝙤𝙩𝙧𝙞𝙥𝙨𝙮 Patient Presentation: 🔵Previous lap cholecystectomy 🔵Presents with cholangitis 🔵Spinal deformity 🔵Ampullary diverticulum with anatomical distortion of ampulla precluded ERCP 🔵Large CBD stone >15mm 🔵Emergency PTC to treat biliary sepsis 🔵Referred to our unit for definitive intervention 🔵Undertook LCBDE 4... weeks post PTC Surgical Approach: 🔴ICG administered via PTC tube ➡️Key to identify CBD ➡️Invaluable in post cholecystectomy LCBDE ➡️Limitations are dissection of adipose tissue anterior to CBD required for ICG scope to detect fluoresence from CBD 🔴Vertical choledochotomy ➡️Preserves "3" and "9" O'clock axial vessels 🔴Choledochoscopy and laser lithotripsy to break down large and impacted CBDS ➡️Alternative is EHL 🔴PTC tube removed 8 weeks post-op #FOAMed #GITwitter #surgery #SoMe4Surgery #MedEd #SurgEd #SoMe4HPB #HPBshow more

Derby Pancreaticobiliary & Robotic AWR Unit

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Tips for Transcystic Laparoscopic CBD Exploration 🔴3mm choledochoscope ➡️Direct visualisation of duct 🔴Cephalad retraction 🔴Incise cystic duct parallel to CBD stone 🔴If large CBD stone ➡️withdraw scope over wire and provide gentle traction 🔴Milk backwards 🔴Keep CBD in view 🔴Reduce speed of irrigation to trap CBDS What are your tips and tricks for transcystic LCBDE? #FOAMed #GITwitter #surgery #hpb #MedEd #SoMe4Surgery

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