THE IMPORTANCE OF THE REAL-TIME FLUOROSCOPIC INTRAOPERATIVE DIRECT CHOLANGIOGRAM IN THE LAPAROSCOPIC CHOLECYSTECTOMY USING A NEW INSTRUMENT

Background/Aims: Laparoscopic cholecystectomy (LC) has become an. acce pted standard operative technique for gallstone treatment worldwide. O n the other hand, complications, such as bile duct injuries, have been reported recently with the expansion of indication for LC. Intraopera tive cholangiogram (IOC), to minimize the risk of bile duct injury, is now considered to be essential for safe LC, There are disadvantages t o IOC such as increased operating time, the possibility of bile duct i njury and the difficulties of manipulation. Material and Methods: We h ave developed a method for real-time fluoroscopic cholangiograms using a new instrument designed by our group for safe LC. First, a round-ti p stylet is inserted through a sheath to coax it gently through the sp iral valves of the cystic duct. Secondly, the stylet is removed and th e cholangiogram catheter is inserted smoothly. Digital C-arm fluorosco py provides ''real-time'' imaging of biliary tree. As a result, rue be came abbe to obtain a clear cholangiogram easily in a very short time. Results: In the first 136 patients, direct cholangiograms were attemp ted in 106 cases and successfully completed in 102 cases (96.2%). Conc lusion: With the development of real-time fluoroscopic intraoperative direct cholangiogram, we are able to cope with bile duct injuries and anomalies, and unsuspected bile duct stones.