Laparoscopic Transductal CBD Exploration
- Perform a cholangiogram.
- Forcefully flush through the transcystic catheter to distend the CBD.
- Make a distal, vertical, supraduodenal choledochotomy with sharp scissors or hook cautery on cut mode.
- Use a cholangiogram catheter to flush the stones.
- Perform a choledochoscopy with a flexible scope.
- Retrieve the stones using a basket retrieval device through the working port of the choledochoscope.
- In cases of stone impaction, use Fogarty balloon catheters to help free stones.
- Close the choledochotomy primarily or over a T tube at least 14F in size using absorbable monofilament suture.
- Completion cholangiogram.