Laparoscopic Cholecystectomy with Intraoperative Cholangiogram

We have performed more than 4,000 laparoscopic cholecystectomies, and we were the first performing this procedure in San Antonio, Texas in 1990. Now a worldwide standard of care for the treatment of cholelithiasis (stones inside the gallbladder), we use this technique for treatment of other conditions such as biliary diskynesia and acute cholecystitis. We routinely perform an intraoperative cholangiogram (IOC), a contrasted X-ray test which allows us to exactly identify the anatomy of the biliary system, as well as to identify any stones (sometimes totally unexpected) inside the common bile duct. The use of routine IOC is the reason why our complication rate is very low. Most of our patients do not stay in the hospital longer than 23 hours.

 

Laparoscopic/Endoscopic Exploration of the Common bile duct

When stones are found inside the Common bile duct during a laparoscopic cholecystectomy, it is imperative to take them out. We, at the Texas Endosurgery Institute, prefer to use a laparoscopic approach instead of ERCP (Endoscopic Retrograde CholangioPancreatography) to treat this condition. We perform an intraoperative choledochoscopy (endoscopic exploration of the biliary system) and extract all the stones. So the problem is solved in one procedure, and the patient normally can leave the hospital the following day.

Laparoscopic treatment of benign liver diseases

We have used the laparoscopic approach for the treatment of benign liver cysts, both solitary and multiple. We have found this technique to be safe and patient-friendly. We can also perform liver biopsies when needed.