Intraoperative flexible videocholedochoscopy. An improved technique for evaluating the common duct.

At the conclusion of common duct exploration, a T-tube cholangiogram is usually performed. Recently, flexible choledochoscopy has become available to evaluate the interior of the common duct. We compared four cases, using the videocholedochoscope with completion T-tube cholangiography, both in our four patients and historically. We used the Olympus CHF-P20 flexible choledochoscope, which is 4.8 mm in diameter, hooked to an Olympus S-4 videoadapter. We found that flexible choledochoscopy enabled us to evaluate the biliary tree directly from the ampulla to the third branch radicle within the liver. In all cases, the common ducts were normal after stone removal. Both the preexploration and completion T-tube cholangiograms yielded less information. We conclude that flexible choledochoscopy is an improved technique that allows a more thorough evaluation of the common duct, obviates more extensive procedures, i.e., sphincteroplasty, by removing stones through the scope, and negates the need for a completion T-tube cholangiogram. We encourage all biliary tract surgeons to consider this technique for their own use.