Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 16, 2023; 11(29): 7193-7199
Published online Oct 16, 2023. doi: 10.12998/wjcc.v11.i29.7193
Laparoscopic choledocholithotomy and transductal T-tube insertion with indocyanine green fluorescence imaging and laparoscopic ultrasound: A case report
Daegwang Yoo
Daegwang Yoo, Department of Surgery, Seoul Soonchunhyang University Hospital, Seoul 04401, South Korea
Author contributions: Yoo D wrote the case report, performed the conceptualization and patient information acquisition, and drafted and critically revised the article for important intellectual content.
Supported by the Soonchunhyang University Research Fund, No. 2023-0060.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The author has no conflicts of interest to declare.
CARE Checklist (2016) statement: The author read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Daegwang Yoo, MD, PhD, Assistant Professor, Department of Surgery, Seoul Soonchunhyang University Hospital, 59, Daesagwan-ro, Yongsan-gu, Seoul 04401, South Korea. yoodaegwang@naver.com
Received: July 6, 2023
Peer-review started: July 6, 2023
First decision: July 18, 2023
Revised: July 28, 2023
Accepted: September 18, 2023
Article in press: September 18, 2023
Published online: October 16, 2023
Processing time: 99 Days and 13.2 Hours
Abstract
BACKGROUND

Laparoscopic choledocholithotomy for a large impacted common bile duct (CBD) stone is a challenging procedure because of the technical difficulty and the possibility of postoperative complications, even in this era of minimally invasive surgery. Herein, we present a case of large impacted CBD stones.

CASE SUMMARY

A 71-year-old man showed a distal CBD stone (45 mm × 20 mm) and a middle CBD stone (20 mm × 15 mm) on computed tomography. Endoscopic retrograde cholangiopancreatography failed due to the large size of the impacted stone and the presence of a large duodenal diverticulum. Laparoscopic choledocholithotomy was decided, and we used a near-infrared indocyanine green fluorescence scope to detect and expose the supraduodenal CBD more accurately. Then, the location, size, and shape of the stones were detected using a laparoscopic intraoperative ultrasound. The CBD was opened with a 2-cm-sized vertical incision. After irrigating several times, two CBD stones were removed with the Endo BabcockTM. T-tube insertion was done for postoperative cholangiography and delayed the removal of remnant sludge. The patient had no postoperative complications.

CONCLUSION

Laparoscopic choledocholithotomy by transcholedochal approach and transductal T-tube insertion is a safe and feasible option for large-sized impacted CBD stones.

Keywords: Gallstones; Indocyanine green; Choledocholithotomy; Laparoscopy; Endoscopic retrograde cholangiopancreatography; Case report

Core Tip: Laparoscopic choledocholithotomy for a large impacted common bile duct (CBD) stone is a challenging procedure, even in this era of minimally invasive surgery. A 71-year-old man showed a distal CBD stone (45 mm) and a middle CBD stone (20 mm). Laparoscopic choledocholithotomy was performed with a near-infrared indocyanine green fluorescence scope and laparoscopic intraoperative ultrasound. Two CBD stones were successfully removed with the Endo BabcockTM, and T-tube insertion was done. This case shows that laparoscopic choledocholithotomy by the transcholedochal approach and transductal T-tube insertion is a safe and feasible option for large-sized impacted CBD stones.