Laparoscopic Bile Duct Techniques

The debate over selective versus routine cholangiography during cholecystectomy has been refueled since the advent of laparoscopic cholecystectomy. Regardless of whether routine or selective cholangiography is performed, if the need for common bile duct (CBD) exploration arises, it can be conducted laparoscopically in more than 80% of cases. The techniques of fluoroscopically guided CBD stone removal, transcystic choledochoscopy, and choledochotomy are described. Each technique has specific indications and advantages. It behooves the surgeon to become familiar with the various techniques of laparoscopic CBD exploration. This allows the treatment of cholelithiasis and CBD stones to become a single-stage procedure.