A Two-Step Method for Percutaneous Transhepatic Choledochoscopic Lithotomy
September 13th, 2022
This "two-step method" significantly improved the success rate of percutaneous transhepatic choledochoscopy and achieved a better prognosis of intrahepatic and extrahepatic choledocholithiasis.
This protocol significantly improves the success rate of percutaneous transhepatic choledochoscopy and achieves a better prognosis of intrahepatic and extrahepatic choledocholithiasis. This technique reduces the recurrence of intrahepatic and extrahepatic choledocholithiasis and shortens the whole lithotripsy period, operation time, and the distance between skin entrance sites and targeted biliary ducts. PTCSL can be a better choice for the treatment of complex intrahepatic and extrahepatic choledocholithiasis, such as in patients who had undergone previous complicated abdominal surgery or who had anatomical abnormalities and were unable to undergo an endoscopic examination.
This technique can also be used for percutaneous nephrolithotomy to manage kidney stone problems. The structure of the intrahepatic bile duct is complex and vulnerable to injury, which raises the surgical risk, and the visual demonstration can better avoid these dangerous complications. One week before the operation, perform the procedure for percutaneous transhepatic cholangio drainage, or PTCD.
Insert an indwelling 8F biliary drainage tube to drain and reduce the swelling of the bile duct. Wait for the sinus tract to become stable at one week after this procedure. Inject 20 milliliters of saline into the bile duct along the drainage tube.
After a guide wire is inserted into it, pull out the PTCD tube. To place the fascia dilator in sheath, expand the sinus using a 16F expander and join a 16F belt dilator so that the 16F sheath can reach the bile duct where the stone might have been placed. Locate the stones.
Use clamping forceps to break and remove the stones. Wash out small stones and powdered stones using an adjustable pressure pump. At the end of the procedure, leave a drainage tube inside the patient for one week.
Using PTCSL, all patients had their biliary tract stones cleared successfully. 72%of the patients had the bile duct stones completely removed after the first operation, while 28%of the patients required more than one operation. 56 patients underwent percutaneous liver surgery and 25 patients underwent surgery by indwelling a sinus formed by a T tube.
The number of stones was equal to one in 70 patients. The average hospital stay was 11 days. There was a complication of a small amount of reactive pleural effusion.
Minor intraoperative biliary bleeding was observed in two patients, and one patient had a biliary infection after surgery. However, no massive hemorrhaging of the biliary tract was observed. Preoperative ultrasound was used to accurately locate the stone location and to retain the 8F drain, and the sinus was directly expanded using a 16F expander.
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Overview
This protocol significantly improves the success rate of percutaneous transhepatic choledochoscopy and achieves a better prognosis for intrahepatic and extrahepatic choledocholithiasis. The technique reduces recurrence and shortens the lithotripsy period and operation time.
Key Study Components
Area of Science
- Neuroscience
- Surgery
- Gastroenterology
Background
- Percutaneous transhepatic choledochoscopy (PTCSL) is used for treating choledocholithiasis.
- The procedure is beneficial for patients with complex cases or previous surgeries.
- Intrahepatic bile duct structures are complex and prone to injury.
- Visual demonstration can help avoid complications during surgery.
Purpose of Study
- To improve the success rate of PTCSL.
- To provide a better prognosis for patients with choledocholithiasis.
- To reduce the recurrence of biliary stones.
Methods Used
- Implementation of a two-step method for PTCSL.
- Preoperative percutaneous transhepatic cholangio drainage (PTCD).
- Assessment of operation time and lithotripsy duration.
- Evaluation of patient outcomes post-procedure.
Main Results
- Significant improvement in the success rate of PTCSL.
- Reduction in the recurrence of choledocholithiasis.
- Shortened operation time and lithotripsy period.
- Effective for patients with anatomical abnormalities.
Conclusions
- PTCSL is a viable option for complex choledocholithiasis cases.
- The two-step method enhances surgical outcomes.
- Further studies may solidify its role in biliary surgery.
Frequently Asked Questions
Executive Industry Relevance
This two-step percutaneous transhepatic choledochoscopic lithotomy (PTCSL) method addresses a critical unmet need in biliary surgery by improving stone clearance rates and reducing procedural complexity in patients with complex anatomical challenges or prior surgical history. The technique enhances procedural predictability and shortens intervention timelines, supporting risk-adjusted decision-making in hepatobiliary interventions. Its adaptability to percutaneous nephrolithotomy further demonstrates cross-platform utility in minimally invasive stone management.
Strategic Applications in Biopharma R&D
Early Discovery & Target Validation
- Scientific Value: Enables functional validation of biliary tract models by achieving complete stone clearance in preclinical simulation systems.
- Operational Value: Provides a reproducible interventional workflow for testing device efficacy and safety in biliary access platforms.
Screening & Assay Development
- Scientific Value: Facilitates standardized biliary duct access for evaluating lithotripsy devices and irrigation systems under controlled pressure conditions.
- Operational Value: Supports assay readiness through stable sinus tract formation and consistent drainage tube placement, reducing variability in preclinical models.
Translational & Preclinical Research
- Scientific Value: Bridges discovery to preclinical validation by enabling longitudinal assessment of biliary patency and stone recurrence in disease-relevant models.
- Operational Value: Allows iterative intervention testing through staged procedures, supporting risk-adjusted advancement of biliary therapeutics.
Pipeline & Workflow Integration
The method integrates into the interventional development continuum from early device testing to preclinical validation, particularly for biliary access and stone clearance technologies.
- Discovery Biology: Supports hypothesis testing of biliary duct patency and stone fragmentation efficacy in ex vivo and in vivo models.
- Screening: Enables standardized evaluation of irrigation pressure systems and stone retrieval devices through reproducible tract establishment.
- Analytics: Provides quantitative endpoints such as operation time, stone clearance rate, and recurrence frequency for comparative device assessment.
- Translational Research: Connects early feasibility to preclinical durability by modeling postoperative drainage and tract maturation.
- Enterprise Reuse: Establishes a reusable platform for iterative testing of biliary access sheaths, dilators, and endoscopic tools across multiple intervention cycles.
Operational & Enterprise Impact
- Scientific Value: Increases predictive confidence in biliary device performance by achieving high first-pass stone clearance rates.
- Operational Value: Enhances reproducibility through standardized preoperative drainage and sinus tract maturation steps.
- Strategic Value: Reduces iterative procedure burden, lowering resource consumption and accelerating preclinical timelines.
- Portfolio Impact: Enables risk-stratified advancement of biliary interventions based on procedural success and safety profiles.
Implementation Considerations
- Requires expertise in percutaneous biliary access and tract dilation techniques.
- Dependent on fluoroscopy-guided placement of 16F sheaths and drainage tubes.
- Necessitates coordination between interventional radiology and endoscopic teams for procedural sequencing.
- Adaptation across models requires scalable dilator systems and adjustable pressure irrigation capabilities.
- Limited by patient-specific biliary anatomy and preoperative ductal inflammation affecting tract stability.
