Torres Guaicha Máximo Vicente, Tinoco Ortiz Tábata Lissette, Borja Villacres Santiago, Troya Francisco, Muñoz-Palomeque Santiago Andrés
Faculty of Medicine, Central University of Ecuador, Quito, 170521, Ecuador.
Department of Surgery, Division of General Surgery, Hospital Metropolitano, Av. Mariana de Jesús Oe 7/47, Quito,170521, Ecuador.
J Surg Case Rep. 2025 Jul 13;2025(7):rjaf495. doi: 10.1093/jscr/rjaf495. eCollection 2025 Jul.
Choledocholithiasis is traditionally managed via a two-stage approach involving endoscopic retrograde cholangiopancreatography followed by laparoscopic cholecystectomy. However, this method carries significant morbidity and logistical challenges. We report a case of a 70-year-old woman with symptomatic choledocholithiasis and mild pancreatitis successfully treated with a single-stage laparoscopic cholecystectomy and transcystic bile duct exploration using the SpyGlass DS II system. This technique enabled direct stone visualization, electrohydraulic lithotripsy, and successful ductal clearance without the need for choledochotomy or papillary trauma. The patient experienced an uneventful recovery, resuming oral intake within 6 hours and being discharged within 36 hours postoperatively. SpyGlass-assisted transcystic exploration offers important advantages over endoscopic retrograde cholangiopancreatography, including reduced complication rates, shorter hospital stays, and cost-effectiveness in experienced centers. This case supports the integration of SpyGlass technology into surgical algorithms for choledocholithiasis management, especially in high-risk or anatomically challenging patients. Further studies are warranted to confirm its role in broader clinical practice.
传统上，胆总管结石的治疗采用两阶段方法，即先进行内镜逆行胰胆管造影术，然后进行腹腔镜胆囊切除术。然而，这种方法存在显著的发病率和后勤挑战。我们报告了一例70岁有症状胆总管结石和轻度胰腺炎的女性患者，通过单阶段腹腔镜胆囊切除术和使用SpyGlass DS II系统经胆囊管胆管探查成功治疗。该技术能够直接观察结石、进行电液压碎石术，并成功清除胆管结石，无需进行胆总管切开术或乳头创伤。患者恢复顺利，术后6小时内恢复经口进食，36小时内出院。与内镜逆行胰胆管造影术相比，SpyGlass辅助经胆囊管探查具有重要优势，包括降低并发症发生率、缩短住院时间以及在经验丰富的中心具有成本效益。该病例支持将SpyGlass技术纳入胆总管结石治疗的手术方案中，尤其是在高危或解剖结构复杂的患者中。有必要进行进一步研究以证实其在更广泛临床实践中的作用。
