An easy approach to laparoscopic cholangiography

Laparoscopic cholecystectomy has become the procedure of choice for surgical removal of the gallbladder. Intraoperative cholangiography is often needed to define ductal anatomy and to detect choledocholithiasis, a procedure which often proves more difficult than its open counterpart. Several newer cholangiocatheters have been introduced which have made laparoscopic cholangiography easier, however, the standard approach through an existing operating port will usually place the catheter at an odd angle, making catheterization of the cystic duct all but impossible in some cases. To avoid this acute angle between the catheter and the cystic duct, the authors have begun using a standard central line introducer as the port through which the catheter is inserted. When placed in the proper position through the lateral abdominal wall, this approach allows the catheter to be inserted parallel and in line with the cystic duct for much easier and faster cannulation.