Related Experiment Video
Updated: Aug 8, 2026
Application of Laparoscopic Ultrasonography in Primary Choledochal Suture during Combined Two-lens Surgery
Published on: March 28, 2025
Unsuspected choledochal cyst during laparoscopic cholecystectomy
A Pietrabissa1, U Boggi, G Di Candio
1Istituto di Chirurgia Generale e Sperimentale, Università di Pisa, Ospedale di Cisanello, Italy.
Insights
Intraoperative imaging during routine biliary surgery unexpectedly revealed a type I choledochal cyst with a large stone. This highlights the value of advanced imaging in detecting unforeseen biliary pathology during surgery.
Area of Science:
- Gastroenterology and Hepatobiliary Surgery
- Diagnostic Imaging in Surgery
- Abdominal Surgery
Background:
- Elective biliary surgery typically involves planned procedures for known indications.
- Extrahepatic bile duct cystic dilation is an uncommon finding during such elective operations.
- Preoperative assessments and standard intraoperative anatomy may not reveal associated biliary anomalies.
Observation:
- A patient undergoing elective biliary surgery presented with normal preoperative findings and cystic pedicle anatomy.
- Laparoscopic contact ultrasonography and intraoperative cholangiography were employed during the procedure.
- These imaging techniques led to the unexpected detection of a type I choledochal cyst containing a large gallstone.
Findings:
- The combined use of intraoperative ultrasonography and cholangiography successfully identified a type I choledochal cyst.
- A significant gallstone was found within the dilated extrahepatic bile duct.
- The intraoperative imaging findings altered the planned surgical management.
Implications:
- Intraoperative imaging of the biliary system is crucial for preventing iatrogenic injuries.
- These modalities are vital for detecting unsuspected biliary pathologies, such as choledochal cysts.
- Early detection of associated biliary pathology can significantly modify surgical strategy and improve patient outcomes.
Abstract:
Cystic dilation of the extrahepatic bile ducts is rarely encountered during elective biliary surgery planned for different indications. We report here on a patient with unremarkable preoperative workup and normal intraoperative anatomy of the cystic pedicle in whom a type I choledochal cyst containing a large stone was detected by the combined use of laparoscopic contact ultrasonography and intraoperative cholangiography. This case report highlights the importance of intraoperative imaging modalities of the ductal system not only in preventing iatrogenic injuries and their related complications, but also in detecting unsuspected associated biliary pathology which might significantly change the course of surgical intervention.
