Laparoscopic Intraoperative Cholangiography

Abstract

Since its introduction by Mirizzi in 1932 intraoperative cholangiography has come to play an integral role in the surgical management of cholelithiasis and choledocholithiasis. The technique not only allows the surgeon a means of evaluating the common duct prior to exploration but also provides an objective means of identifying the ductal anatomy. This should lead to a safer dissection and an accurate placement of clips on the cystic duct. It also allows for immediate identification of ductal injuries when they can best be managed. Although the routine use of intraoperative cholangiography has been advocated, many argue that routine cholangiography is not cost-effective. Every surgeon, however, would agree that cholangiography does play a role in the operative management of gallbladder disease. It is therefore a technique that every biliary tract surgeon needs to be able to perform effectively.