Facebook
X
LinkedIn
ForwardJournal Review in Minimally Invasive Surgery Common Bile Duct Exploration
In this episode of Behind the Knife, the minimally invasive surgery (MIS) team dives deep into the evolving field of common bile duct exploration (CBDE). From the historical context of laparoscopic approaches to the latest advances including robotic-assisted techniques, Drs. Shaina Eckhouse, James Jung, Zachary Weitzner, and Joey Lew discuss key evidence shaping modern practice. Listeners will learn about indications and anatomy guiding trans-cystic versus trans-choledochal approaches, practical tips for safe stone clearance, and critical considerations around learning curves and team coordination for robotic procedures. The episode also highlights important studies comparing single-stage laparoscopic CBDE with staged ERCP and cholecystectomy, emphasizing outcomes such as stone clearance, pancreatitis rates, and hospital length of stay. This comprehensive overview is a must-listen for MIS and acute care surgeons interested in optimizing the management of choledocholithiasis and streamlining patient care with minimally invasive techniques.
Target Audience
- Nurses
- Nurse Practitioners
- Physicians
- Physician Assistants
Learning Objectives
- Describing the historical approaches to managing choledocholithiasis, including staged interventions and the evolution toward single-stage laparoscopic common bile duct exploration (CBDE).
- Summarizing key clinical evidence comparing CBDE and ERCP, including landmark studies and meta-analyses evaluating outcomes, complications, and trends over time.
- Distinguishing between transcystic and transcholedochal approaches to CBDE, explaining indications, contraindications, and technical nuances for each technique.
- Identifying appropriate candidates for transcystic exploration based on cystic duct anatomy and stone characteristics.
- Recognizing the impact of newer surgical technologies—such as digital choledochoscopy, Spyglass, and robotic platforms—on CBDE practice, efficiency, and safety.
- Discussing the importance of multidisciplinary teamwork, preparation, and perioperative planning for successful CBDE, particularly in complex or altered anatomy cases.
- Appraising the learning curve and quality of evidence for new CBDE procedures, outlining the need for mentorship, ongoing training, and knowing when to collaborate with GI or hepatopancreaticobiliary (HPB) surgery.
- Outlining approaches and bailout strategies for challenging cases, including patients with surgically altered anatomy and use of adjuncts such as intraoperative cholangiography (IOC), feeding tube placement, and Fanelli stents.
- Evaluating safety outcomes and limitations associated with robotic-assisted CBDE and single-stage management, incorporating recent data from population-based studies.
- Reflecting on strategies for tailoring CBDE techniques to individual patient anatomy, surgeon experience, and available resources, advocating for evidence-based practice and continuous learning.
- Shaina Eckhouse
- James Jung
- Zachary Weitzner
- Joey Lew
- AMA PRA Category 1 Credit(s)
- ANCC
- Attendance
- JA Credit - AH
Available Credit
- 0.50 AMA PRA Category 1 Credit(s)™
- 0.50 ANCC
- 0.50 Attendance
- 0.05 IACET CEU