Laparoscopic cholecystectomy with rendez-vous technique for symptomatic cholelithiasis with occult choledocholithiasis

This video demonstrates a laparoscopic cholecystectomy with a rendez-vous technique for choledocholithiasis. This 75-year-old patient presented with pain at the level of the right hypochondrium, without jaundice. Serum chemistries show a hepatic cytolysis without cholestasis. Medical imaging demonstrated the presence of a cholelithiasis without choledocholithiasis. This was confirmed by bili-MRI and CT-scan images. A rendez-vous technique is decided upon if intraoperative cholangiography proves positive.

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Laparoscopic cholecystectomy with rendez-vous technique for symptomatic cholelithiasis with occult choledocholithiasis

Authors

F Costantino, Gf Donatelli, J Marescaux

Abstract

This video demonstrates a laparoscopic cholecystectomy with a rendez-vous technique for choledocholithiasis. This 75-year-old patient presented with pain at the level of the right hypochondrium, without jaundice. Serum chemistries show a hepatic cytolysis without cholestasis. Medical imaging demonstrated the presence of a cholelithiasis without choledocholithiasis. This was confirmed by bili-MRI and CT-scan images. A rendez-vous technique is decided upon if intraoperative cholangiography proves positive.

Mots-clés

Laparoscopic cholecystectomy, rendez-vous technique, symptomatic cholelithiasis, occult choledocholithiasis

Type de vidéo

Vidéo chirurgicale

Durée

05'02''

Publication

2011-03

Popularité

Favoris

Favorites Media

Audio

Sous-titres

E-publication

WeBSurg.com, Mar 2011;11(03).
URL: http://www.websurg.com/doi-vd01en3224.htm

Laparoscopic cholecystectomy with rendez-vous technique for symptomatic cholelithiasis with occult choledocholithiasis

1. Introduction 00'10''

This video demonstrates a laparoscopic cholecystectomy with a rendez-vous technique for choledocholithiasis. This 75-year-old patient presented with pain at the level of the right hypochondrium, without jaundice. Serum chemistries show a hepatic cytolysis without cholestasis. Medical imaging demonstrated the presence of a cholelithiasis without choledocholithiasis. This was confirmed by bili-MRI and CT-scan images. As can be seen here, there is no major dilatation of the CBD. However, since cholestasis was suspected preoperatively, a rendez-vous technique is decided upon if intraoperative cholangiography proves positive.

2. Calot’s triangle dissection 00'59''

Here the laparoscopic view is shown. Calot’s triangle has been already dissected.

3. Cystic artery control 01'05''

The cystic artery has been isolated between clips.

4. Cystic duct opening 01'09''

The cystic duct is opened using scissors. A cholangiography set is placed by means of a laparoscopic grasper.

5. Intraoperative cholangiography 01'29''

Now an intraoperative cholangiography is carried out.

6. Common bile duct stone identification 01'32''

It demonstrates a completely mobile stone at the level of the common bile duct. As the cystic duct is not dilated, a transcystic extraction seems difficult to carry out, and opening the common bile duct does not seem to be indicated at this time.

7. Duodenojejunal flexure clamping 02'06''

A clamping is then carried out at the level of the duodenojejunal flexure laparoscopically.

8. Endoscopic sphincterotomy with stone removal 02'12''

As can be seen here, the endoscopist performs the papillary cannulation by cutting at the level of the duodenal papilla. This will allow to carry out an intraoperative sphincterotomy. As can be seen here, the cannulation of the papilla is performed fairly easily. A guide is placed. The cholangiography has been performed endoscopically. Once entrance into the cavity has been ascertained, a cut is now performed and a balloon is placed above the stone in order to allow for its extraction. This stone is located beyond the papilla as can be seen here. Control of the common bile duct is performed to ensure that it is completely empty. Once the endoscopic sphincterotomy has been completed and the stone has been extracted, the cholangiography set is removed and cholecystectomy is completed conventionally.

9. Division of cystic duct and artery 04'05''

The cystic duct and the cystic artery are divided once they have been ligated between clips.

10. Cholecystectomy 04'13''

Cholecystectomy is performed routinely with the dissection of the anterior and posterior peritoneum at the level of Calot’s triangle. Traction is exerted in order to help identify the elements of Calot’s triangle. Cholecystectomy is further achieved with monopolar cautery set at 15 Watts. The gallbladder’s bed is controlled and the gallbladder is extracted through a protection bag. As can be seen here, the protection bag is always placed above the liver, which allows to control it. Once the gallbladder has been extracted out of the abdominal cavity, port sites are controlled.