Techniques and Equipment for Percutaneous Cholecystostomy

Abstract

A standard undercouch fluoroscopic tilting table with single-plane screening that is generally available in all radiology departments in hospitals and clinics is the only X-ray equipment necessary for percutaneous cholecystostomy. For all types of percutaneous cholecystostomy the patient lies supine on the fluoroscopy table with one or two pillows under the head. Two pillows may make the elderly of ill patient more comfortable. Both arms are placed at the patient’s side, since the site for transhepatic or subcostal puncture of the gallbladder lies more anteriorly than the axillary puncture site used for PTHC. When percutaneous cholecystostomy is carried out for cholecystolithotomy the patient and X-ray table are covered in waterproof sterile surgical sheets which are available commercially. These are not necessary when percutaneous cholecystostomy is used for gallbladder or biliary drainage or access, or for gallbladder stone lysis. We find it best to remove the lead-rubber protection from the right side of the fluoroscopy table to prevent needle and guide-wire accidents during cholecystostomy catheter insertion [1]. Minimum fluoroscopy time screening is used, with the X-ray beam coned to the smallest area necessary for visualisation of the puncture track to the gallbladder during the manoeuvres necessary to catheterise the gallbladder. Using a transhepatic approach, the operator’s hands should never lie within the X-ray beam. With the subcostal approach to the gallbladder, fluoroscopy should be strictly limited to assessing needle or dilator or catheter positions between manual manoeuvres.