Intra-operative and postoperative biliary endoscopy (choledochoscopy). The role of the surgeons.

Intra-operative and postoperative choledochoscopy is an important adjunct to biliary surgery. In the last two decades, the necessity of this examination became obvious but two surveys clearly indicated that despite the availability of instruments surgeons do not use it routinely. One of the reasons is the long learning curve and the limited experience. The introduction of the video choledochoscope opened a new chapter because the surgeon could learn it faster and the technique is easier to use. Choledochoscopy is a "two man" job, requiring four hands. Using video choledochoscopy, the assistant and the operator can observe the situation together, therefore coordination of movement is easier. The actual endoscopic procedure is faster and the location of the stone, its removal, and the sphincter function are recorded on tape. This is a great step forward in analyzing sphincter function. It became the method of choice in teaching. It is assumed that, with the introduction of video choledochoscopy, the incidence of missed stones will be decreased significantly.