Removal of mechanical lithotripsy device with laparoscopic bile duct exploration

0:00 presenting a case of a removal of a
0:02 mechanical little tripy device via
0:04 laparoscopic common balog exploration
0:07 our patient is an 82y old female with a
0:10 previous history of acute cystis in
0:12 which she declined surgery she presented
0:14 with a two-day history of right
0:16 hypochondrial pain with bloating and
0:17 vomiting and was noted to have hyper
0:20 bmia with rais inflammatory markers and
0:23 MRCP showed distal common bow D dilation
0:26 and M Upstream intrahepatic ductal
0:29 dilation
0:30 decision was made for an
0:32 ercp during the ercp the common bow DK
0:35 was canulated with a sphincterotome and
0:37 pass was noted the cogram showed a 5mm
0:41 feeling defect in the mid common bow du
0:43 as shown by the arrow a wire trapezoid
0:46 basket was used to capture the stone I
0:48 was unable to crush the stone as the
0:50 stone was too hard attempts were made to
0:53 disengage the Stone from the basket were
0:55 unsuccessful the external sheath of the
0:57 basket was cut and the scope was
0:59 withdrawn
1:00 a SRA little trior was used to attempt
1:02 to crush the stone but the basket
1:04 handles were snapped within the little
1:06 trior handle the basket device was left
1:09 inside to as seen by the arrow the
1:11 surgeons were consulted and a decision
1:13 was made for P1 laparoscopic common B
1:16 exploration in the Emergency Operating
1:18 theater patient is positioned as shown
1:21 and the ports are placed in the position
1:22 of the Diamonds the camera is inserted
1:24 via the umbilical pod the distended
1:27 galbladder is decompressed with a needle
1:29 to reduce exposure
1:31 difficulties the ket’s triangle is
1:34 dissected and
1:48 exposed the cystic duct is traced and
1:50 dissected down to the common bow
1:58 duct
2:12 the common bow duct is aspirated with a
2:14 needle to confirm the presence of bow a
2:17 Ki was
2:28 performed
2:33 direct exploration of the common bow
2:35 duct is carried out with a flexible qual
2:37 scope by an added epigastric Port the
2:40 basket device was caught using a doia
2:43 basket and was retrieved this image
2:45 shows the basket device within the
2:48 common bow duct during the
2:51 coloscopy the basket device was with
2:53 drawn out of the common bow
2:57 duct the stone is removed from the
3:00 basket and place aside and the basket
3:02 device is returned back into the common
3:04 bow duct the basket device was then
3:06 removed
3:10 transorally the common bow duct is
3:12 repaired with polyone 4 o
3:28 sutes
3:47 further soft tissue dissection was done
3:49 around the cystic duct for subsequent
3:56 clipping the cystic duct is clipped with
3:59 two 10 mm
4:05 hols the cystic D was then
4:12 transacted the G stone is removed via
4:16 the epigastric
4:17 Port the gallbladder was taken off the
4:20 galbladder
4:28 forer
4:32 hemostasis of the gallbladder fora was
4:34 done with a diatom hook the gallbladder
4:37 was placed into a specimen B and was
4:40 subsequently removed a 19 French Blake
4:43 drain was placed into the subhepatic