The surgical skills of transcystic approach with intra-operative choledochoscope in laparoscopic common bile duct exploration: an analysis of 292 cases        HAN Wei, ZHANG Zhong-tao, II Jian-she, et al.  Department of General Surgery, Beijing Friendship Hospital Affiliated to Capital University of Medical Science, Beijing 100050, China.
Corresponding author：ZHANG  Zhong-tao, zhangzht@medmail.com.cn
Abstract    Objective    To summarize the surgical skills of laparoscope transcystic common bile duct exploration (LTCBDE). Methods    Retrospectively analyze the clinical materials of 292 cases of LTCBDE between Dec 2006 and Apr 2009 in our hospital. Results    We support the flexible choledochoscope with the guide suture on the cystic duct in all cases. 206 cases (70.5%) can retrieval the calculi with wire basket via Tran cystic approach directly, among them 83 cases with a small-caliber choledochoscope. The other 86 cases under the help of cystic duct balloon dilation, mini-incision at the confluence of CBD and cystic duct, or transcystic lithotripsy. The mean operative time and post-operative hospital stay were (92.00±37.24) minutes and (2.52±1.91) days, without severe procedure-related complication. Conclusion    Support of the flexible choledochoscope on axial direction is prerequisite for the transcystic approach. Integrative use of variety skills is helpful to more transcystic approach and eventually benefit for the clinical effect.