The standard of laparoscopic intraoperative cholangiography: a quality control study.
OBJECTIVE
One reason why many surgeons do not attempt laparoscopic cholangiography is that it is considered to be technically difficult and to produce poor-quality images.


METHODS
A retrospective comparison was made of twenty randomly selected intraoperative cholangiograms taken during laparoscopic cholecystectomy for each year from 1991 to 1994 (n = 80) by assigning a score (0-4) on the basis of anatomical parameters and radiographic quality. Twenty randomly selected intraoperative cholangiograms taken during open cholecystectomy (OC) were used as controls.


RESULTS
The average score for the laparoscopic cholangiograms (LCs) was significantly lower than the average for OC cholangiograms (2.3 vs. 3.4, P< 0.001). In addition, a learning curve was demonstrated, which showed significant improvement in the quality of LCs over the years. Analysis showed that in LCs, only 34 % succeeded in demonstrating the entire biliary tree and only 49% managed to show the extrahepatic duct system. Choledocholithiasis could only be ruled out in 53 % of LC films, compared with 80 % of controls.


CONCLUSIONS
Despite an improvement in the quality of laparoscopic cholangiography, it remains inferior to cholangiography during open cholecystectomy. Recommendations are made regarding ways in which improvements could be achieved.
Arul
G S
GS
Dept. of Paediatric Surgery, Bristol Royal Hospital for Sick Children, United Kingdom.
Rooney
P S
PS
Gregson
R
R
Steele
R J
RJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002758:Cholangiography / Q000592:standards*; D002763:Cholecystectomy; D017081:Cholecystectomy, Laparoscopic; D042882:Gallstones / Q000000981:diagnostic imaging*; D006801:Humans; D007432:Intraoperative Period; D008875:Middle Aged; D011786:Quality Control; D011897:Random Allocation; D012189:Retrospective Studies