Name: Laparoscopic Common Bile Duct Exploration Followed by Primary Suture Using a Modified Bile Duct Incision (Video) | JoVE Journal
Uploaded: 2025-05-02T13:00:00.000+00:00
Duration: 5 min 36 s
Description: Learn a modified laparoscopic common bile duct exploration technique using a 5-10 mm incision from the cystobiliary junction. This method reduces biliary leakage and stenosis while improving safety for patients with non-dilated cystic ducts.

ai_agent_IP

ai_agent

maintenance

instantTrialDurationMinutes

isBiopharma

enableNewMyJoveSectionDesign

educationFeatures

seoMetaApi

ai_copilot_institution_blacklist

ai_chat_institution_blacklist

freeAccessWindow

ssoRoleCapture

scheduledMaintenanceBanner

joveLabsFeatures

disable_autoplay_for_bots

extended_trial_duration

5 minutes

We are thankful to our colleagues in the operating room.

This protocol was approved by the Ethics Committee of Dongguan Tungwah Hospital, and written informed consent was obtained from all patients who underwent surgery.
1. Operating setting and anesthesia
<ol>
	<li>Position the patient in a supine position with the head elevated at 30&#176;. Administer general anesthesia via a laryngeal mask or tracheal intubation.
	<ol>
		<li>To follow this protocol, for induction of anesthesia, use Sufentanil 0.3-0.5 &#181;g/kg intravenous injection for analgesia, Propofol 1.5-2.5 mg/kg intravenous injection for sedation and loss of consciousness, and Vecuronium 0.1 mg/kg intravenous injection for muscle relaxation before endotracheal intubation. Use Sevoflurane for maintenance of anesthesia: maintain an end-tidal concentration of 1-1.5 MAC. Administer a continuous infusion of Propofol at 4-8 mg/(kg&#183;h) or aTarget-Controlled Infusion (TCI) to maintain a bispectral index value of 40-60.</li>
	</ol>
	</li>
	<li>Position the surgeon and second assistant to the left of the patient, at the head and foot, respectively. Position the first assistant to the right of the patient (Figure 1).</li>
</ol>
2. Surgical technique
<ol>
	<li>Insert the subumbilical trocar for the camera and establish the epigastric port (10 mm), right midclavicular port (5 mm), and right anterior axillary line port (5 mm) under direct vision. The distribution of these four trocars is shown in Figure 1.</li>
	<li>Position the patient in 20&#176; reverse Trendelenburg with left lateral tilt for better visualization. Maintain pneumoperitoneum at 12 mmHg to create working space.</li>
	<li>Grasp the neck of the gallbladder or Hartmann&#39;s pouch with grasping forceps and apply traction in the right upper direction.</li>
	<li>Incise the serosa overlying the cystic duct, clear lymphatic tissue, and skeletonize the cystic artery.</li>
	<li>Ligate the cystic artery; then, completely dissect the cystic duct up to the cystobiliary junction.</li>
	<li>Utilize atraumatic graspers to engage the seromuscular layer of the proximal cystic duct, avoiding full-thickness compression. Apply anterolateral traction to achieve optimal cystic duct-CBD angulation. Maintain sufficient but not excessive tension to prevent ductal avulsion. Use locking clips in the distal cystic duct to temporarily prevent bile flow. 
	NOTE: To ligate the cystic artery, surgeons typically use surgical clips, sutures, or energy devices. We prefer sutures and energy devices to surgical clips because sometimes, clips in the Calot&#39;s triangle may obstruct surgeon&#39;s view and influence the next procedure. The optimal angle between the cystic duct and CBD does not have a fixed degree and usually 45-60&#176; will be easier for a choledochoscope to enter the CBD.</li>
	<li>Make a micro longitudinal incision extended along the cystobiliary junction toward CBD (Figure 2A) using electric hooks or scissors. Ensure that the incision size ranges from 5 mm to 10 mm according to the size of the stones. 
	NOTE: This incision is different from the traditional anterior wall of the CBD (Figure 2B) or transverse transcystic incision (Figure 2C).</li>
	<li>Perform choledochoscopy using a 3 mm or 5 mm choledochoscope depending on the diameter of the cystic duct. Remove CBD stones in the basket; if impacted stones at the papilla level obstruct access to the basket, employ electrohydraulic lithotripsy to fragment the stones and collect them with the basket later.</li>
	<li>Reconfirm the clearance of CBD stones. Make sure the irrigation water flows smoothly through the CBD and the sphincter of Oddi works well.</li>
	<li>Close the incision primarily from the cystobiliary junction to the CBD anterior wall with a 5-0 Polydioxanone suture. 
	NOTE: We prefer continuous sutures to interrupted sutures owing to their time efficiency14. The process of bile duct exploration and primary suture is shown in Figure 3.</li>
	<li>Close the proximal cystic duct using clips and cut the distal cystic duct. Remove the gallbladder completely.</li>
	<li>Confirm the absence of bile leakage and stenosis, then place a drainage tube near the CBD and pull it through the right anterior axillary line port.</li>
</ol>

<ol><li>Cianci, P., Restini, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Management+of+cholelithiasis+with+choledocholithiasis%3A+Endoscopic+and+surgical+approaches%5BTitle%5D)+AND+%22World+J+Gastroenterol%22%5BJournal%5D)">Management of cholelithiasis with choledocholithiasis: Endoscopic and surgical approaches.</a> World J Gastroenterol. 27 (28), 4536-4554 (2021).</li>
<li>Fan, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Laparoscopic+common+bile+duct+exploration+with+primary+closure+could+be+safely+performed+among+elderly+patients+with+choledocholithiasis%5BTitle%5D)+AND+%22BMC+Geriatr%22%5BJournal%5D)">Laparoscopic common bile duct exploration with primary closure could be safely performed among elderly patients with choledocholithiasis.</a> BMC Geriatr. 23 (1), 486(2023).</li>
<li>Wang, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Efficacy+and+safety+of+laparoscopic+common+bile+duct+exploration+via+choledochotomy+with+primary+closure+for+the+management+of+acute+cholangitis+caused+by+common+bile+duct+stones%5BTitle%5D)+AND+%22Surg+Endosc%22%5BJournal%5D)">Efficacy and safety of laparoscopic common bile duct exploration via choledochotomy with primary closure for the management of acute cholangitis caused by common bile duct stones.</a> Surg Endosc. 36 (7), 4869-4877 (2022).</li>
<li>Zhang, W. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Treatment+of+gallbladder+stone+with+common+bile+duct+stones+in+the+laparoscopic+era%5BTitle%5D)+AND+%22BMC+Surg%22%5BJournal%5D)">Treatment of gallbladder stone with common bile duct stones in the laparoscopic era.</a> BMC Surg. 15, 7(2015).</li>
<li>Tinoco, R., Tinoco, A., El-Kadre, L., Peres, L., Sueth, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Laparoscopic+common+bile+duct+exploration%5BTitle%5D)+AND+%22Ann+Surg%22%5BJournal%5D)">Laparoscopic common bile duct exploration.</a> Ann Surg. 247 (4), 674-679 (2008).</li>
<li>Gurusamy, K. S., Koti, R., Davidson, B. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((T-tube+drainage+versus+primary+closure+after+laparoscopic+common+bile+duct+exploration%5BTitle%5D)+AND+%22Cochrane+Database+Syst+Rev%22%5BJournal%5D)">T-tube drainage versus primary closure after laparoscopic common bile duct exploration.</a> Cochrane Database Syst Rev. (6), Cd005641(2013).</li>
<li>Zhang, W. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Laparoscopic+exploration+of+common+bile+duct+with+primary+closure+versus+t-tube+drainage%3A+A+randomized+clinical+trial%5BTitle%5D)+AND+%22J+Surg+Res%22%5BJournal%5D)">Laparoscopic exploration of common bile duct with primary closure versus t-tube drainage: A randomized clinical trial.</a> J Surg Res. 157 (1), e1-e5 (2009).</li>
<li>Rendell, V. R., Pauli, E. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Laparoscopic+common+bile+duct+exploration%5BTitle%5D)+AND+%22JAMA+Surg%22%5BJournal%5D)">Laparoscopic common bile duct exploration.</a> JAMA Surg. 158 (7), 766-767 (2023).</li>
<li>Fang, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Laparoscopic+transcystic+common+bile+duct+exploration%3A+Surgical+indications+and+procedure+strategies%5BTitle%5D)+AND+%22Surg+Endosc%22%5BJournal%5D)">Laparoscopic transcystic common bile duct exploration: Surgical indications and procedure strategies.</a> Surg Endosc. 32 (12), 4742-4748 (2018).</li>
<li>Memon, M. A., Hassaballa, H., Memon, M. I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Laparoscopic+common+bile+duct+exploration%3A+The+past%2C+the+present%2C+and+the+future%5BTitle%5D)+AND+%22Am+J+Surg%22%5BJournal%5D)">Laparoscopic common bile duct exploration: The past, the present, and the future.</a> Am J Surg. 179 (4), 309-315 (2000).</li>
<li>Pang, L., Zhang, Y., Wang, Y., Kong, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Transcystic+versus+traditional+laparoscopic+common+bile+duct+exploration%3A+Its+advantages+and+a+meta-analysis%5BTitle%5D)+AND+%22Surg+Endosc%22%5BJournal%5D)">Transcystic versus traditional laparoscopic common bile duct exploration: Its advantages and a meta-analysis.</a> Surg Endosc. 32 (11), 4363-4376 (2018).</li>
<li>Hajibandeh, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Laparoscopic+transcystic+versus+transductal+common+bile+duct+exploration%3A+A+systematic+review+and+meta-analysis%5BTitle%5D)+AND+%22World+J+Surg%22%5BJournal%5D)">Laparoscopic transcystic versus transductal common bile duct exploration: A systematic review and meta-analysis.</a> World J Surg. 43 (8), 1935-1948 (2019).</li>
<li>Huang, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Laparoscopic+transcystic+common+bile+duct+exploration%3A+8-year+experience+at+a+single+institution%5BTitle%5D)+AND+%22J+Gastrointest+Surg%22%5BJournal%5D)">Laparoscopic transcystic common bile duct exploration: 8-year experience at a single institution.</a> J Gastrointest Surg. 27 (3), 555-564 (2023).</li>
<li>Wu, D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Primary+suture+of+the+common+bile+duct%3A+Continuous+or+interrupted%5BTitle%5D)+AND+%22J+Laparoendosc+Adv+Surg+Tech+A%22%5BJournal%5D)">Primary suture of the common bile duct: Continuous or interrupted.</a> J Laparoendosc Adv Surg Tech A. 32 (4), 390-394 (2022).</li>
<li>Navaratne, L., Martinez Isla, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Transductal+versus+transcystic+laparoscopic+common+bile+duct+exploration%3A+An+institutional+review+of+over+four+hundred+cases%5BTitle%5D)+AND+%22Surg+Endosc%22%5BJournal%5D)">Transductal versus transcystic laparoscopic common bile duct exploration: An institutional review of over four hundred cases.</a> Surg Endosc. 35 (1), 437-448 (2021).</li>
<li>Kim, E. Y., Lee, S. H., Lee, J. S., Hong, T. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Laparoscopic+cbd+exploration+using+a+v-shaped+choledochotomy%5BTitle%5D)+AND+%22BMC+Surg%22%5BJournal%5D)">Laparoscopic cbd exploration using a v-shaped choledochotomy.</a> BMC Surg. 15, 62(2015).</li>
<li>Chen, D., Zhu, A., Zhang, Z. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Laparoscopic+transcystic+choledochotomy+with+primary+suture+for+choledocholith%5BTitle%5D)+AND+%22Jsls%22%5BJournal%5D)">Laparoscopic transcystic choledochotomy with primary suture for choledocholith.</a> Jsls. 19 (1), e2014.00057(2015).</li>
<li>Zhu, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Learning+curve+for+performing+choledochotomy+bile+duct+exploration+with+primary+closure+after+laparoscopic+cholecystectomy%5BTitle%5D)+AND+%22Surg+Endosc%22%5BJournal%5D)">Learning curve for performing choledochotomy bile duct exploration with primary closure after laparoscopic cholecystectomy.</a> Surg Endosc. 32 (10), 4263-4270 (2018).</li>
<li>Chuang, S. H., Hung, M. C., Huang, S. W., Chou, D. A., Wu, H. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Single-incision+laparoscopic+common+bile+duct+exploration+in+101+consecutive+patients%3A+Choledochotomy%2C+transcystic%2C+and+transfistulous+approaches%5BTitle%5D)+AND+%22Surg+Endosc%22%5BJournal%5D)">Single-incision laparoscopic common bile duct exploration in 101 consecutive patients: Choledochotomy, transcystic, and transfistulous approaches.</a> Surg Endosc. 32 (1), 485-497 (2018).</li>
</ol>

The authors have no conflicts of interest to declare.

Currently, the transcystic LCBDE followed by primary closure is deemed the least invasive procedure and has the advantages of preserving the integrity of the major ductal wall and avoiding routine drainage of the CBD, which helps decrease the incidence rate of surgery-related complications (leakage and stenosis)15. In some cases, small-caliber choledochoscope may be the only option when the cystic duct is narrow, which can increase the incidence of residual stones and the rate of secondary surgeri...

Cholelithiasis is among the most common clinical diseases in general surgery, and 10%-15% of patients concurrently experience cholelithiasis and choledocholithiasis1. Common bile duct (CBD) primary closure, a procedure typically performed after biliary exploration or removal of biliary stones involves direct closure of the CBD incision and is performed to maintain the normal anatomical structure and biliary flow2,3. Laparoscopic cholecystectomy (LC) + laparoscopic CBD exploration (LCBDE) is considered an effective treatment option for patients with both gallbladder and CBD stones4, and its safety and efficacy have been previously reported3,5. With the development of laparoscopic techniques and medical devices, surgeons can now perform LCBDE using different approaches, including the transcystic and transductal approaches. Furthermore, in the last decade, significant advances have been made with LCBDE with primary sutures, which is gradually replacing the T-tube drainage procedure6,7.
However, complications are unavoidable in LCBDE and are primarily related to CBD resection (biliary leakage and stenosis). Postoperative bile leakage and bile duct stenosis can occur due to insufficient suturing or inadequate closure of the CBD8; these complications may cause abdominal infection and liver function damage, which can significantly delay recovery, increase the length of hospital stay, and lead to higher morbidity and mortality rates. Hence, to reduce the incidence rate of bile leakage, some surgeons tend to use T-tube drainage after LCBDE. However, carrying a T-tube for several weeks is uncomfortable for the patients. Furthermore, biliary leakage may occur if the T-tube is displaced. Therefore, it is vital to choose the appropriate incision and drainage process.
A transcystic approach to CBD exploration has been proposed to avoid CBD damage and eliminate the subsequent need for a T tube9,10. Nevertheless, the transcystic procedure is sometimes limited to patients presenting with a dilated cystic duct and poses challenges when addressing large stones11,12. Hence, the generalization of transcystic LCBDE with primary closure is currently restricted13.
To minimize CBD damage and optimize the use of the cystic duct, we propose a modified micro incision starting from the cystobiliary junction to the CBD. This technique is deemed suitable for patients with a non-dilated cystic duct because the incision contains both the cystobiliary junction and CBD. Furthermore, the technique allows surgeons to perform cholangioscopy and the primary sutures after LCBDE more easily. Further, a shorter incision on the CBD means less damage to the CBD, which can lead to lower postoperative biliary leakage and stenosis rates.

<table><tbody><tr><td>Drainage tube (5 mm x 1100 mm)</td><td>Jiangsu Yangtze River</td><td></td><td>for draining fluid accumulations and blood</td></tr><tr><td>Electronic choledochoscope</td><td>OLYMPUS</td><td></td><td>for bile duct exploration</td></tr><tr><td>Electrosurgical Unit</td><td>Shanghai Hutong</td><td></td><td>for cutting and coagulating tissues</td></tr><tr><td>Hem-o-lok</td><td>Teleflex</td><td></td><td>for the ligation and anastomosis of blood vessels and tissues</td></tr><tr><td>&amp;zwnj;Insuffator for laparoscopy&amp;zwnj;</td><td>OLYMPUS</td><td></td><td>for&amp;nbsp;insufflating carbon dioxide gas</td></tr><tr><td>Laparoscope</td><td>STORZ</td><td></td><td>for laparoscopic surgery</td></tr><tr><td>Laparoscopic Dissecting Forceps</td><td>Richard Wolf</td><td></td><td>for dissecting and grasping tissue</td></tr><tr><td>Laparoscopic Grasping Forceps</td><td>Richard Wolf</td><td></td><td>for clamping tissue&amp;nbsp;</td></tr><tr><td>Laparoscopic Needle Holder</td><td>Kanger</td><td></td><td>for grasping and manipulating suturing needles</td></tr><tr><td>Laparoscopic Scissors</td><td>Richard Wolf</td><td></td><td>for cutting various tissues&amp;nbsp;</td></tr><tr><td>Polydioxanone suture</td><td>Johnson &amp;amp; Johnson</td><td></td><td>for incision suturing</td></tr><tr><td>Propofol</td><td>FRESENIUS KABI</td><td></td><td>for anaesthesia</td></tr><tr><td>Screen</td><td>SONY</td><td></td><td>for showing images&amp;nbsp;</td></tr><tr><td>Sevoflurane</td><td>Jiangsu Hengrui</td><td></td><td>for anaesthesia</td></tr><tr><td>SPSS ver22.0 (Statistical Package for the Social Sciences)</td><td>IBM</td><td></td><td>for data management, statistical analysis, graphical presentation, and predictive analytics</td></tr><tr><td>Sufentanil</td><td>Eurocept BV</td><td></td><td>for anaesthesia</td></tr><tr><td>Trocar (10 mm x 100 mm and 5 mm x 100 mm)</td><td>Unimicro</td><td></td><td>for puncturing the abdominal wall</td></tr><tr><td>Vecuronium</td><td>Zhejiang Xianju</td><td></td><td>for anaesthesia</td></tr></tbody></table>

laparoscopic common bile duct exploration followed by primary suture using a modified bile duct incision

Laparoscopic Common Bile Duct Exploration Followed by Primary Suture Using a Modified Bile Duct Incision

Cholecystolithiasis is a common clinical disease, and 10-15% of patients with cholecystolithiasis have common bile duct (CBD) stones. Laparoscopic CBD exploration (LCBDE) followed by primary closure has proven to be safe and cost-effective for treating CBD stones and is typically performed via transcystic and transductal approaches. However, traditional LCBDE with choledochotomy may lead to biliary stricture and leakage, and performing choledochoscopy in transcystic LCBDE may be challenging because of the narrow cystic duct. To reduce the incidence rate of biliary stricture and leakage and increase the success rate of choledochoscopy, we propose a modified technique for bile duct incision. We performed LCBDE via a micro longitudinal incision extended along the cystobiliary junction toward the CBD instead of the traditional anterior wall of the CBD or purely transverse transcystic incision. Our micro incision size on CBD only ranged from 5 to 10 mm according to the size of the CBD stones. Using this micro incision technique, which is less invasive, resulted in easier exploration of the CBD and preservation of the ductal wall integrity. This approach encourages surgeons to use primary closure and may be considered a viable alternative choice for patients with ductal stones in the future.

Between March 2022 and July 2024, LC + LCBDE was performed on 216 patients in our department. Transcystic LCBDE with micro incision followed by primary suture was performed on 42 patients (19.4%); traditional LCBDE + LC followed by primary suture was performed on 90 patients (41.6%); and 86 patients underwent LCBED + LC followed by T-tube drainage (40%).
We compared the modified transcystic micro incision group (42 patients) and traditional LCBDE + LC with primary suture group (90 patients). A...

Cholecystolithiasis with common bile duct stones is a common disease; however, traditional common bile duct exploration has its own limitations. We propose a modified micro incision for laparoscopic common bile duct exploration aimed at reducing complication rates.

Cholecystolithiasis is a common clinical disease, and 10-15% of patients with cholecystolithiasis have common bile duct (CBD) stones. Laparoscopic CBD ...

laparoscopic-common-bile-duct-exploration-followed-primary-suture

Research

JoVE Journal

Medicine

Programmed surgery based on surgical methods and anatomical markers helps shorten the operation time, reduce complications, and improve the safety of the surgery. This study investigated and summarized the surgical methods and anatomic markers of laparoscopic common bile duct exploration in patients with a history of biliary tract surgery.

Laparoscopic Common Bile Duct Exploration in Patients with a Previous History of Biliary Tract Surgery

Laparoscopic left lateral sectionectomy guided by the ligamentum teres hepatis and umbilical fissure vein effectively controls intraoperative bleeding even without controlled low central venous pressure and prevents loss of direction during parenchymal dissection.

Laparoscopic Left Lateral Sectionectomy: Guided by the Ligamentum Teres Hepatis and the Umbilical Fissure Vein

Here, we develop and present a T-tube and intrabiliary stent-free technique utilizing dual-lens visualization (via laparoscope and choledochoscope) combined with laparoscopic ultrasonography (LUS) to perform primary choledochal suture.

Application of Laparoscopic Ultrasonography in Primary Choledochal Suture during Combined Two-lens Surgery

Choledochal cysts in adults are relatively rare, and few reports have detailed treatment options. Here, we present a case demonstrating laparoscopic resection of choledochal cysts and posterior colonic Roux-en-Y choledochojejunostomy in adults, offering an alternative for clinical management.

Laparoscopic Choledochal Cyst Excision and Roux-en-Y Choledochojejunostomy in Adults

Intraoperative video consultation expedites and improves surgical care. Here, we present a case where intraoperative video consultation between a rural hospital and an academic hepatobiliary surgeon facilitated immediate diagnosis of bile duct transection during laparoscopic cholecystectomy, direct to operating room transfer between centers, and injury repair with robotic-assisted Roux-en-Y hepaticojejunostomy.

Intraoperative Video Consultation Following Bile Duct Transection Facilitates Direct OR Transfer for Robotic Hepaticojejunostomy at Tertiary Center

The integrated technique described in this protocol achieves real-time biliary mapping via indocyanine green (ICG) fluorescence, minimally invasive stone clearance under direct visualization, and secure primary duct repair (6-0 PDS), eliminating T-tube drainage.

Laparoscopic Cholecystectomy with Indocyanine Green Fluorescence: Choledochoscopic Stone Extraction and Primary Duct Suture

A method of visualizing and quantifying the 3-dimensional structure of mouse hepatic portal vein or intrahepatic bile duct is described. This resin cast technique can also be applied to other ductal or vascular systems and allows for in situ visualization or quantification of a system's intact communicating architecture.

3-Dimensional Resin Casting and Imaging of Mouse Portal Vein or Intrahepatic Bile Duct System

Disruption of bile flow results in severe inflammatory cholestatic liver injury with a characteristic time-dependent sequence of morphological alterations. Here we present a protocol for the surgical ligation of the common bile duct in mice that allows to induce a strong fibrotic response after 21 to 28 days.

Bile Duct Ligation in Mice: Induction of Inflammatory Liver Injury and Fibrosis by Obstructive Cholestasis

Bile fluid is a valuable source of extracellular vesicles/exosomes that contain potentially important biomarkers. This protocol represents a robust method to isolate exosomes from human bile for further analyses including miRNA profiling.

Isolation and Profiling of MicroRNA-containing Exosomes from Human Bile

Tools to diagnose bile acid malabsorption and measure bile acid transport in vivo are limited. An innovative approach in live animals is described that utilizes combined proton (1H) plus fluorine (19F) magnetic resonance imaging; this novel methodology has translational potential to screen for bile acid malabsorption in clinical practice.

Using Multi-fluorinated Bile Acids and In Vivo Magnetic Resonance Imaging to Measure Bile Acid Transport

Learn a modified laparoscopic common bile duct exploration technique using a 5-10 mm incision from the cystobiliary junction. This method reduces biliary leakage and stenosis while improving safety for patients with non-dilated cystic ducts.

Laparoscopic Common Bile Duct Exploration Followed by Primary Suture Using a Modified Bile Duct Incision

Explore More Videos