Initial Experience with Disposable Single-Use Cholangioscope During Laparoscopic Common Bile Duct Exploration.

Introduction

For patients with choledocholithiasis, laparoscopic common bile duct exploration (LCBDE) is more cost effective than endoscopic retrograde cholangiopancreatography (ERCP) and results in shorter hospital length of stay. As LCBDE can be technically challenging to perform, utilizing a disposable single-use cholangioscope (DSUC) for LCBDE through a cystic ductotomy has several advantages, such as potentially avoiding a choledochotomy and expanding access to cholangioscopes as a DSUC is disposable and does not require infrastructure for cleaning or maintenance.

Methods

An IRB-approved, retrospective chart review from 2021 to 2023 was conducted for patients who underwent concurrent laparoscopic cholecystectomy (LC) and LCBDE with a DSUC (SpyGlass™ Discover, Boston Scientific, Natick, MA) for the management of choledocholithiasis diagnosed either preoperatively or during intraoperative cholangiogram (IOC). Primary endpoint was successful clearance of biliary duct stones.

Results

Twelve patients with a mean age of 55.3 years (SD ±13.9) and mean body mass index of 33.8 (SD ±10.8) were found to have filling defects on IOC for LC and underwent LCBDE with DSUC. Of these, 10 patients had stones. Complete stone clearance was achieved in all 10 patients with various stone extraction maneuvers. The mean operative time was 189 minutes (SD ±63.6) and mean hospital length of stay postoperatively was 1 day (SD ±.8). Mean length of follow-up postoperatively was 26.9 (SD ±16.0) days. There were no intraoperative complications, no need for repeat procedures, and only one postoperative complication involving a superficial surgical site infection requiring oral antibiotics.

Conclusions

LCBDE with a DSUC is safe and efficacious for clearing stones and identifying pathology of the CBD. Familiarity with this device is especially useful for surgeons who want to simultaneously manage choledocholithiasis at the same time as cholecystectomy to reduce hospital stay and overall cost.