Begin the operation in the same manner as a standard laparoscopic cholecystectomy, with trocar insertion and dissection of the triangle of Calot to a “critical view of safety.” Then perform a cholangiogram to confirm the presence of choledocholithiasis. Attempt to flush the common duct stones using saline, aided by intravenous glucagon. If flushing is unsuccessful, determine the optimal approach method for LCBDE (transcystic versus transcholedochal). If a transcystic approach is possible, introduce a guide wire through the cholangiogram catheter and then perform a balloon dilation of the cystic duct. Advance the choledochoscope through the cystic ductotomy and capture the common duct stone using an endoscopic wire basket. If a transcholedochal approach is indicated, dissect the common bile duct clear and make a longitudinal choledochotomy to allow for direct introduction of the choledochoscope. After stone removal, determine the need for t-tube insertion and then close the choledochotomy using intracorporeal suturing.
Common Bile Duct Cystic Duct Guide Wire Common Duct Common Hepatic Duct
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