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The “Basket-in-Catheter” technique: facilitating transcystic bile duct exploration and optimising the management of suspected ductal stones

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Abstract

The ‘Basket-in-Catheter’ (BIC) technique facilitates basket-only laparoscopic transcystic exploration (LTCE), increasing its success rate. Using the cholangiography catheter as a sheath is easier and safer than inserting the wire basket-alone. This study evaluates its benefits in confirmed and suspected ductal stones. Retrospective analysis of prospectively collected data on patients with pre-operative or operative suspicion of bile duct stones or with positive and equivocal intraoperative cholangiographies (IOC) who had LTCE attempted using blind basket trawling, without choledochoscopy, were reviewed. The incidence and outcomes of blind basket LTCEs attempted before and after introducing the BIC technique, whether or not stones were retrieved, were analysed. Blind basket LTCE was attempted in 732 patients. Of 377 (51.5%) patients undergoing successful stone retrieval, only 62% had pre-operative clinical and radiological risk factors for ductal stones, 25% had operative risk factors and 13% had silent stones discovered on IOC. Another 355 patients (48.5%) had negative trawling, although one half had pre-operative risk factors for ductal stones and 47.6% had operative risk factors, e.g. cystic duct stones or dilatation. This cohort had equivocal cholangiography in 25.9%. Following basket trawling, repeat IOC confirmed resolution of abnormalities. As no stones were retrieved, these were not considered duct explorations. The BIC technique facilitates safe and speedy bile duct clearance when stones are confirmed, avoiding choledochotomies, without significant complications. BIC duct trawling is also beneficial in patients with suspected ductal stones, helping to resolve equivocal IOCs. It helps surgeons to acquire and consolidate ductal exploration skills.

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Data is available from the corresponding author.

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Authors and Affiliations

  1. Laparoscopic Biliary Service, University Hospital Monklands, Lanarkshire, Scotland, UK

    Ahmad H. M. Nassar, Haitham Qandeel, Khurram S. Khan, Hwei J. Ng, Subreen Hasanat & Haneen Ashour

  2. School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, Scotland

    Ahmad H. M. Nassar & Khurram S. Khan

  3. The Hashemite University, Zarqa, Jordan

    Haitham Qandeel, Subreen Hasanat & Haneen Ashour

  4. University Hospital Hairmyres, Lanarkshire, Scotland, UK

    Khurram S. Khan

  5. Royal Alexandra Hospital, Paisley, Scotland, UK

    Hwei J. Ng

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  4. Hwei J. Ng
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  5. Subreen Hasanat
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Contributions

Study concept and design: AHMN, HQ. Acquisition of data: AHMN, HQ. Analysis and interpretation of data: HQ, KSK, SH, HA. Drafting of manuscript: HQ, AHMN, KSK, HJN. Critical revision of manuscript: AHMN, HJN, KSK. Final approval: AHMN, HQ, KSK, HJN, SH, HA.

Corresponding author

Correspondence to Ahmad H. M. Nassar.

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Conflict of interest

Drs. Ahmad H. M. Nassar, Haitham Qandeel, Khurram S Khan, Hwei J Ng, Ms Subreen Hasanat and Ms Haneen Ashour have no conflicts of interest or financial ties to disclose.

Research involving human participants and/or animals, and Informed consent

Informed consent was obtained from all patients throughout the period of data collection with explanation of the rationale for one-session management of bile duct stones. The management was in line with the approved hospital protocols and not contrary to the guidelines of national and international societies. Ethical approval was not required for anonymised retrospective analysis of data that was registered with local audit departments according to their requirements.

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Supplementary Information

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Supplementary media file 1: The potential difficulty in inserting “naked” disposable baskets into the cystic duct is resolved by using the BIC technique, allowing the basket to reach the common bile duct. Supplementary file1 (MOV 31228 KB)

Supplementary media file 2: The basket in catheter technique allows the trawling of the common bile duct and extraction of stones. A grasper is used to prevent stones from travelling into the common hepatic duct. As the basket emerges from the cystic duct opening the introducer tip is advanced to control the stones as they are removed. Supplementary file2 (MOV 51039 KB)

Supplementary Figure 1A: Transcystic exploration using BIC under X Ray control. Supplementary file3 (TIFF 1608 KB)

13304_2023_1610_MOESM4_ESM.tiff

Supplementary Figure 1 B: Transcystic exploration, stone engaged in basket under X Ray control prior to removal. Supplementary file4 (TIFF 1646 KB)

13304_2023_1610_MOESM5_ESM.tiff

Supplementary Figure 2: Cholangiography showing two stones in the intramural cystic duct. Low medial entery of the cystic duct indicates exploration under choledochoscopic vision rather than blind basket exploration. Supplementary file5 (TIFF 2085 KB)

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Nassar, A.H.M., Qandeel, H., Khan, K.S. et al. The “Basket-in-Catheter” technique: facilitating transcystic bile duct exploration and optimising the management of suspected ductal stones. Updates Surg 75, 1893–1902 (2023). https://doi.org/10.1007/s13304-023-01610-8

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