Laparoscopic common bile duct exploration using a disposable fiber-optic bonchoscope (Ambu® aScope™)
Epublication WebSurg.com, Jul 2019;19(07). URL: http://websurg.com/doi/vd01en5570
Background: Laparoscopic common bile duct (CBD) exploration can be performed following choledochotomy or via the trancystic approach. Laparoscopic CBD exploration is limited in some benign upper gastrointestinal units due to the cost of sterilization of the reusable choledochoscope. We have recently published a case series confirming the safety and efficacy of the 5mm reusable bronchoscope for CBD exploration. This case series evaluates a single-use bronchochoscope (Ambu® aScope™) for laparoscopic CBD exploration. Method: A retrospective study was conducted from January 2015 to December 2016. Data was collected from electronic records of the patients. All cases confirmed the presence of CBD stones using USS and MRCP. The disposable bronchoscope is introduced via an epigastric port. Choledochotomy is performed using a choledochotome, and a transcystic approach is used after cystic duct dilatation, if required. The Ambu® aScope™ 2 (Ambu UK Ltd, Cambridgeshire) is a sterile and single-use flexible bronchoscope, which is normally used by anesthesiologists for difficult tracheal intubation. A disposable bronchoscope is available in two sizes (3.8mm and 5mm). It is a one-piece unit with a single dimensional flexible tip manipulated with a handpiece (150-degree flex in the 5mm model and 130-degree flex in the 3.8mm model). There is a single instrument channel with a 2.2mm diameter, which allows for the passage of standard endoscopic baskets for CBD stone retrieval. The image is projected to a high-resolution 6.5” LCD screen with a resolution of 640x480 pixels. The bronchoscope handpiece includes a suction port, which is used as an irrigation source for CBD dilatation. It requires the use of a standard 3-way connector. Results: Twenty nine patients had CBD exploration using the disposable bronchochoscope. There were 10 male and 19 female patients (median age: 42). Ten procedures were performed as emergencies and 19 were performed electively. All cases were managed laparoscopically except one, which was planned as an open procedure due to previous extensive open surgery. Twenty eight patients had their CBD cleared using a disposable bronchoscope and two needed subsequent ERCP. Choledochotomy was performed in 15 patients and a transcystic approach was used in 6 patients. No T-tube was used in the laparoscopic cases. Two cases were performed as day case surgery. Median postoperative hospital stay was 2.5 days. Conclusion: The disposable bronchoscope is a safe and effective instrument for CBD exploration, with results comparable to our previously published case series. It has guaranteed sterility and is cost-effective compared to the reusable bronchoscope, especially when initial capital outlay, sterile processing and maintenance costs are considered.