title: The Role of Choledochoscopy: The Eternal Problem of How to Remove a CBD Stone.
abstract: BACKGROUND
  Identifying and surgically removing bile duct calculi is challenging and critical in order to provide good patient outcomes. The history of this surgical pursuit since the introduction of anesthesia is both enlightening and fascinating.
  
  
  METHODS
  A systematic review of the literature was conducted to identify the techniques and technology used to remove bile duct calculi.
  
  
  RESULTS
  All bile duct surgical exploration advances have involved creation of tools to look within the bile duct and extract stones. The Hopkin's rod lens system was a major breakthrough in light and image transmission. However, flexible endoscope technology added the ability to maneuver better within the bile duct as well as apply the technology via laparoscopy enabling laparoscopic bile duct exploration.
  
  
  CONCLUSIONS
  Digital, image enhanced, distal tipped chip flexible endoscopes have significantly improved the surgeons' ability to see within the bile duct, improving the efficiency and ease of stone visualization and removal from both the most proximal and distal ends of the bile duct.
authors.affiliation: Cedars Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: E
authors.initials: E
authors.lastname: Phillips
authors.affiliation: Cedars Sinai Medical Center, Los Angeles, CA, USA bercig@csmc.edu.
authors.forename: G
authors.initials: G
authors.lastname: Berci
authors.affiliation: Cedars Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: K
authors.initials: K
authors.lastname: Barber
authors.affiliation: Cedars Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Williams
mesh_terms: D001662:Biliary Tract Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D003135:Common Bile Duct / Q000601:surgery*; D004867:Equipment Design; D042882:Gallstones / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation* / Q000379:methods*
keywords: choledochoscopy; laparoscopic bile duct stone removal (LCBDE)