LCBDE with digital choledochoscopy and electrohydraulic lithotripsy (no narration) скачать в хорошем качестве

LCBDE with digital choledochoscopy and electrohydraulic lithotripsy (no narration)

This video shows choledochoscopy using.the Boston Scientific Spyglass Discover device. In order to clear the common duct stone, an EHL (electrohydraulic lithotripsy) probe is used to fracture the stone into smaller pieces and flush them into the duodenum using foot pedal controlled saline irrigation. Often, the most challenging part of this procedure is advancing the scope through the cystic ductotomy into the common duct. For this reason, I favor routine dilation of the cystic duct / common duct junction over a 0.035 wire with a 6mm diameter x 40mm length balloon followed by the EHL fracture and flush technique as opposed to basket retrieval. The acute angle of the cystic duct / common duct junction and cystic duct tortuosity make basket retrieval difficult in many cases. The EHL fracture and flush technique allow for a single cystic duct cannulation. Completion choledochoscopy (and duodenoscopy if possible) are performed to confirm no residual common duct stones. If you keep the patient in a steep head up position (reverse trendelenburg) throughout the case, the common duct stones and fragments will follow gravity to stay in front of the scope for further fracturing and flushing until the duct is clear.