A stone extraction facilitation device to achieve an improved technique for performing LCBDE

Area of Science:

• Gastroenterology
• Minimally Invasive Surgery
• Surgical Technology

Background:

• Laparoscopic common bile duct exploration (LCBDE) is effective for common bile duct (CBD) stones but faces challenges in adoption.
• Difficulties include mastering the technique and protecting fragile choledochoscopes from damage.
• Complex cases with large, impacted, or multiple stones often necessitate conversion to open surgery.

Purpose of the Study:

• To introduce the Multichannel Instrument Guide (MIG) as a solution to enhance LCBDE procedures.
• To evaluate the initial clinical experience and effectiveness of the MIG in managing CBD stones.

Main Methods:

• The MIG, a J-shaped, three-lumen device, facilitates flexible choledochoscope insertion and simultaneous use of additional instruments.
• Procedural multitasking under video guidance is enabled through the MIG.
• Initial experience with the MIG was assessed in 23 patients undergoing LCBDE.

Main Results:

• Twenty of 23 patients had CBD stones, with complex cases (multiple, impacted, large stones) being common.
• The MIG facilitated successful management of difficult stone presentations.
• A high stone clearance rate of 95% was achieved with the MIG.

Conclusions:

• The MIG offers significant advantages by securing biliary access and enabling multitasking while protecting equipment.
• This device simplifies the LCBDE technique, potentially encouraging wider surgeon adoption.
• The MIG represents a valuable advancement for routine LCBDE performance.