A NEW T-TUBE APPLIER IN LAPAROSCOPIC SURGERY

In the majority of patients undergoing laparoscopic choledochotomy, it is advisable to insert a T-tube into the duct after ductal exploratio n, as bile sludge or fibrin deposits may obstruct the papilla and caus e postoperative cholangitis. Based on our experience in open surgery, a limited transverse choledochotomy is preferred, which reduces the po ssibility of damaging the common bile duct blood supply. Such a techni que can complicate laparoscopic T-tube positioning, however. After exp erimenting with the method described by Kitano et al. [Surg Endosc 7:1 04-105 (1993)], which was abandoned because it was difficult to carry out with the type of soft silicone rubber tubes that we normally use, two subsequent techniques were developed and are described. They were employed in 3 and 10 patients, respectively, out of 21 who underwent l aparoscopic transverse choledochotomy. The most satisfying results wer e obtained using a system employing two sets of telescopic cannulae of different diameters. Laparoscopic T-tube introduction through a trans verse choledochotomy using two telescopic cannulae was rapid and safe and allowed to precisely guide T-tube positioning inside the common du ct.