Use of Ureterorenoscope as Choledochoscope

Abstract

Background: Flexible Choledochoscope is used to remove the stones using accessories during exploration of the common bile duct and its use reduces the incidence of retained stones. The choledochoscope and accessories are expensive and not available in many General Hospitals. In comparison to this, semi-rigid ureterorenoscope is easily available in many minimally invasive centres and accessories are more useful to remove even the impacted stones. We have used this for exploration of the CBD and tried to analyse its efficacy and safety.

 

Methods: All the patients who underwent Ureterorenoscopic intervention by single surgeon for common bile duct stones during 2007-2010 are included. The usefulness, efficacy and safety of the procedure are analysed.

 

Results: There were total 71 patients. Age ranges from 10 years to 69 years. Forty one (57.7%) patients had undergone open procedure where as 30 (42.2%) underwent laparoscopic procedure. Most of them were females (69%) and majority had multiple stones (59%). Twenty five (35%) patients required the use of different accessories like dormia basket, forceps etc. Pneumatic lithotripsy was used in 3 patients to fragment large impacted stones. In one (3%) patient of laparoscopic group scope could not be negotiated. In 4 cases mild common bile duct tear observed and in one patient duodenal laceration occurred. In two patients (2.8%) there were retained small stone fragments which passed spontaneously within two weeks post-operatively.

 

Conclusions: SemirigidUreterorenoscope is easily available, safe and effective instrument. It is useful even for large impacted stones.

 

Key words: semirigidureterorenoscope, common bile duct exploration, retained stones, primary closure.