title: Basket-in-catheter access for transcystic laparoscopic bile duct exploration: technique and results.
abstract: BACKGROUND
  When common bile duct (CBD) stones are detected during laparoscopic cholecystectomy, the insertion of baskets via the cystic duct (CD) can be difficult and may occasionally cause complications. We introduced a new technique 'basket in catheter' (BIC) for transcystic CBD exploration.
  
  
  METHODS
  Although cannulating the CD using a cholangiography catheter is successful in most cases, it may occasionally be difficult. Cystic duct anatomy may prevent the usually stiffer sharper tip of the basket, from entering the CBD, resulting in failure, perforation or a false passage. In the majority of our cases, the cholangiography catheter (CC) is not withdrawn from the duct should the intraoperative cholangiography show CBD stones. The tip of a basket is inserted into the CC and advanced to a predetermined distance, allowing the tip of the basket to exit the end of the CC into the CBD. The basket is then opened, advanced to feel the lower end and manipulated to trap the stone. The common hepatic duct is compressed gently to prevent stones from slipping upwards. The catheter and basket are pulled back together to extract the stone.
  
  
  RESULTS
  We have used this technique in 274 cases since 2010. The rate of transcystic versus choledochotomy stone extraction has increased, saving unnecessary choledochotomies. The percentage of transcystic exploration increased from 55 % for the period 2005-2009 to 70 % for the period 2010-2014. There were no conversions to open surgery and no retained stones. The morbidity rate was 4.0 % with no mortality.
  
  
  CONCLUSIONS
  We demonstrate a technique to facilitate the insertion of extraction baskets into the common bile duct using the cholangiography catheter as a guide. The 'basket-in-catheter' (BIC) technique for transcystic CBD exploration is easier and safer than inserting the basket alone.
authors.affiliation: Monklands Hospital, NHS Lanarkshire, Airdrie, ML6 0JS, Scotland, UK.
authors.forename: Haitham
authors.initials: H
authors.lastname: Qandeel
authors.affiliation: Monklands Hospital, NHS Lanarkshire, Airdrie, ML6 0JS, Scotland, UK.
authors.forename: Samer
authors.initials: S
authors.lastname: Zino
authors.affiliation: Monklands Hospital, NHS Lanarkshire, Airdrie, ML6 0JS, Scotland, UK.
authors.forename: Zulfiqar
authors.initials: Z
authors.lastname: Hanif
authors.affiliation: Monklands Hospital, NHS Lanarkshire, Airdrie, ML6 0JS, Scotland, UK.
authors.forename: M Kazem
authors.initials: MK
authors.lastname: Nassar
authors.affiliation: Monklands Hospital, NHS Lanarkshire, Airdrie, ML6 0JS, Scotland, UK. Ahmad.Nassar@glasgow.ac.uk.
authors.forename: Ahmad H M
authors.initials: AH
authors.lastname: Nassar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization; D002758:Cholangiography / Q000379:methods; D017081:Cholecystectomy, Laparoscopic / Q000295:instrumentation / Q000379:methods*; D042883:Choledocholithiasis / Q000601:surgery*; D003135:Common Bile Duct / Q000601:surgery*; D061887:Conversion to Open Surgery; D003549:Cystic Duct / Q000601:surgery*; D016208:Databases, Factual; D005260:Female; D042882:Gallstones / Q000601:surgery*; D006500:Hepatic Duct, Common; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods; D008297:Male; D008875:Middle Aged; D055815:Young Adult
keywords: Basket in catheter; Bile duct stones; Choledochoscopy; Intraoperative cholangiography; Laparoscopic cholecystectomy; Transcystic bile duct exploration