Technique and result of intraoperative choledochoscopy

The use of intraoperative choledochoscopy represents a significant advance in biliary surgery. Flexible instruments are ideal for examining the intrahepatic bile ducts, while rigid instruments are best suited for the extrahepatic ductal system. The cystic duct stump may be occasionally used for access, but, as a rule, a supraduodenal choledochotomy is necessary. Our experience with 776 examinations is reported. A total of 348 patients (44.8%) had ductal stones. In 10 patients (2.8%), a stone was overlooked. Equivocal cholangiograms, ductal stones, and obstructive tumors constitute the most important indications for endoscopic examination.