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TAVAC: choledochoscopy disposable scopes, and the single-stage vs. two-stage approach to choledocholithiasis

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Abstract

Background

Previous studies have been published evaluating the benefits and drawbacks of clearing the common bile duct of stones using a single-stage approach (LCBDE + LC) versus a two-stage approach (ERCP followed by LC). These studies have demonstrated that a single-stage approach offers similar outcomes and morbidities as a two-stage approach, with the added benefit of a lower cost and shorter length of stays. However, it is significant we understand why LCBDE is not commonly performed currently and also the lapse in surgical trainee exposure and competence in LCBDE. This paper aims to address the lapse in surgical trainee exposure to LCBDE, evaluate the scopes currently available to perform LCBDE, and review current data evaluating the risks and benefits of single-stage versus two-stage approaches to.

Methods

We utilized PubMed to analyze all publications related to the various disposable scopes utilized to perform choledochoscopy. We also discuss the need for disposable scopes and how this new market niche is transforming the choledochoscopy space.

Results

We analyzed the data related to single-stage and two-stage approach to choledocholithiasis. We noted an overall shorter length of stay and also decreased costs in favor of a single-stage approach.

Conclusion

A single-stage LCBDE is the most cost-effective treatment option for choledocholithiasis in patients with choledocholithiasis undergoing a cholecystectomy. In addition, single-stage approach is associated with shorter length of stay. Knowledge of the available choledochoscopes and tools available to surgeons to perform choledochoscopy is significant. The evidence does support the use of disposable choledochoscope from a cost and cross-contamination perspective. Additionally, efforts should be made to incorporate LCBDE into the teaching paradigm of surgical training programs.

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Authors and Affiliations

  1. Department of Surgery, University of South Florida, Tampa, USA

    Salvatore Docimo Jr.

  2. Digestive Health Institute at AdventHealth Tampa, Tampa, USA

    Iswanto Sucandy

  3. Department of Surgery, Warren Alpert Medical School of Brown University, Providence, USA

    Andrew Luhrs

  4. Sentara Martha Jefferson Hospital, Charlottesville, USA

    Tim Snow

  5. Zucker School of Medicine at Hofstra, Northwell Health, Hempstead, USA

    David Pechman

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  1. Salvatore Docimo Jr.
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  2. Iswanto Sucandy
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Correspondence to Salvatore Docimo Jr..

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Disclosures

Dr. Salvatore Docimo, Jr. receives honorarium from Boston Scientific, Medtronic, and BD. Dr. David Pechman receives honorarium from Intuitive. Dr’s Andrew Luhrs, Iswanto Sucandy and Tim Snow have no conflicts of interest to disclose.

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Docimo, S., Sucandy, I., Luhrs, A. et al. TAVAC: choledochoscopy disposable scopes, and the single-stage vs. two-stage approach to choledocholithiasis. Surg Endosc 37, 6611–6618 (2023). https://doi.org/10.1007/s00464-023-10267-8

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