Diagnostic and therapeutic choledochoscopy

Laparoscopic cholecystectomy and common bile duct exploration are common surgical procedures for the general surgeon. To successfully remove common bile duct stones, choledochoscopy is an important technique for efficient and effective management. The choledochoscope can be introduced intraoperatively through the cystic duct or directly into the common bile duct and it also can be inserted transhepatically through a T-tube tract and per orally using a therapeutic duodenoscope. All of these methods allow for many options for the surgeon to consider, and one must be familiar with each of these techniques to maximize care. Successful stone extraction with the choledochoscope can be achieved in 75% to 95% of the cases with a morbidity less than 5%. Using this technique, the surgeon can improve the cost benefit of bile duct exploration.