Coledocoscopia para tratamento de litiase em ducto comun visão interna скачать в хорошем качестве

Coledocoscopia para tratamento de litiase em ducto comun visão interna

Normograde (Anterograde) Choledochoscopy via Gallbladder Neck for the Treatment of Common Bile Duct Concretions and Microcalculi in Dogs Normograde (anterograde) choledochoscopy represents a major breakthrough in minimally invasive hepatopancreatobiliary surgery in dogs, enabling direct management of microcalculi and biliary concretions within the common bile duct (CBD) while preserving anatomy and minimizing surgical trauma. This approach combines diagnostic precision with therapeutic efficacy under full endoscopic visualization. ⚙️ Technical Concept A choledochoscope or fine ureteroscope (2.7–3.5 mm) is introduced through the gallbladder neck after a controlled laparoscopic cholecystotomy. The endoscope is advanced anterogradely — following the physiologic bile flow — through the cystic duct and into the common bile duct, allowing direct visualization and clearance of intraductal material. Continuous saline irrigation and micro-endoscopic graspers or balloon catheters facilitate the removal of sludge and microcalculi, reestablishing normal hepatic drainage while preventing iatrogenic ductal injury. 🧠 Advantages and Clinical Indications Avoids open choledochotomy and bile duct incision. Preserves anatomic and physiologic ductal integrity. Enables real-time evaluation of inflammatory, obstructive, or infectious biliary processes. Effective for microcalculi or sludge following laparoscopic cholecystectomy. Provides rapid recovery and low postoperative morbidity. Published data (Mayhew et al., Vet Surg, 2020; Fossum, 2023) support this as a minimally invasive gold-standard technique for biliary duct management in small animals. 🏅 Clinical Landmark in Latin America The first documented case of normograde (anterograde) choledochoscopy in dogs in Latin America was successfully performed by our team, establishing a regional milestone in hepatopancreatobiliary veterinary surgery. This pioneering achievement demonstrated the feasibility, safety, and reproducibility of the technique, setting a precedent for advanced endoscopic interventions in small animal practice. It validated the concept that complete biliary clearance can be achieved through a physiologic, endoscopic route, without resorting to open laparotomy or ductotomy, thereby redefining standards of care in veterinary hepatobiliary surgery. 🩺 Clinical Outcomes Up to 95% success rate in mild to moderate obstructions. Early feeding and discharge within 24–48 hours. Minimal postoperative pain and reduced analgesic requirements. Preservation of bile flow and hepatic physiology. “Normograde choledochoscopy is not merely a technical innovation — it is a paradigm shift that merges anatomy, physiology, and precision to serve the animal with the least possible aggression.”