Use of the ultrathin choledochoscope in cholecystectomy
Use of the ultrathin choledochoscope (2 mm) was evaluated in 80patients undergoing routine cholecystectomy. It was used successfully in 67 (84 per cent) patients. There were eight (12 per cent) explorations of the common bile duct and no negative explorations. The instrument was helpful in determining the nature of an equivocal on-table cholangiogram. The ultrathin choledochoscope may be useful in reducing the rate of negative common bile duct exploration.
Despite the use of routine operative cholangiography, the rate of negative common bile duct exploration remains at a level of 22-33 per cent'.*. Common bile duct exploration has an associated morbidity rate of the order of 45 per cent and a mortality rate of 7.4 per cent in older p a t j e n t ~" ~. The mortality rate is especially high when patients present with jaundice, pancreatitis and c h ~l a n g i t i s ' ~~~~, but even after negative common bile duct exploration the mortality rate is at least double that of cholecystectomy alone4. In this latter group Sheridan et a/. found a mortality rate of 3.6 per cent directly attributable to complications arising from opening the bile duct. They also found that the morbidity rate from negative duct exploration was 39.3 per cent'.
It follows therefore that any method that could safely reduce the rate of common bile duct exploration would be important. We evaluated the ultrathin choledochoscope to provide choledochoscopy via the cystic duct.