Application of choledochoscope assisted Glission pedicle transection in laparoscopic left hepatectomy for left intrahepatic bile duct stones

Abstract:

Objective: To investigate the feasibility of choledochoscope assisted Glisson pedicle transection in laparoscopic left hepatectomy for left intrahepatic bile duct stones. Methods: The clinical data of 10 patients with left intrahepatic bile duct stones treated by laparoscopic choledochoscopy assisted Glisson pedicle anatomical left hepatectomy in the General Surgery Center of the PLA Western Theater General Hospital from December 2016 to February 2020 were retrospectively analyzed. Results: Among the 10 patients，there were 4 males and 6 females，aged 45-68. The operation was successful among all the 10 patients. The operation time was 245（200，320） min，and the intraoperative blood loss was 300（200，650） mL. During the operation，the left hepatic pedicle was cut off with a disposable cutting stapler under the guidance of choledochoscope，and the position of the cut-off was good，without injury of the reserved bile duct，no massive hemorrhage and bile leakage，no conversion to laparotomy. And the postoperative adverse events were mild，including slight bile leakage in 1 patient and a small amount of pleural effusion in 1 patient. The Clavien-Dindo complication grade was Ⅱ，which was treated conservatively. The recovery time of liquid diet was 90-102 h，the postoperative hospital stay was 8-13 d，and the cost of hospitalization was（4.02 ± 0.36） ten thousand yuan. Conclusion: The application of choledochoscope assisted with Glisson pedicle transection in the treatment of left hepatolithiasis by laparoscopic left hepatectomy is safe and feasible under the protection of instruments and techniques，and it will not increase the hospitalization expenses of patients.