title: Laparoscopic Transcystic Common Bile Duct Exploration: T-Shaped Incision of Cystic Duct with FREDDY Laser Lithotripsy.
abstract: OBJECTIVE
  Optimal laparoscopic techniques for management of gallstones concomitant with common bile duct (CBD) stones remain under debate. The aim of this study was to evaluate a novel approach to managing gallstones concomitant with large or impacted CBD stones through a modified laparoscopic transcystic CBD exploration (LTCBDE) with frequency-doubled double-pulse neodymium:YAG (FREDDY) laser lithotripsy.
  
  
  METHODS
  This retrospective review includes 32 consecutive patients with gallstones concomitant with large or impacted CBD stones who were offered LTCBDE with FREDDY laser lithotripsy between June 2012 and December 2014. Demographic, perioperative, and follow-up data were collected and analyzed retrospectively.
  
  
  RESULTS
  CBD stone clearance was achieved for all patients. There were 13 males and 19 females, among whom there were three patients with a history of abdominal surgery. The diameter of the CBD ranged from 10 to 20 (mean 15.1) mm, and the number of CBD stones ranged from 1 to 5. CBD stones ranged in diameter from 9 to 18 (mean 11.7) mm and 9 patients had stones that were impacted in the CBD. The mean operative time was 123 ± 18 minutes with a range of 72 to 155 minutes. The mean length of postoperative hospital stay was 5.3 (range 4-7) days. All patients recovered normally without morbidity or mortality.
  
  
  CONCLUSIONS
  The modified LTCBDE with a T-shaped incision of the cystic duct and FREDDY laser lithotripsy is a safe and effective means of managing gallstones concomitant with large or impacted CBD stones.
authors.affiliation: Department of Hepatobiliary Surgery, Second Affiliated Hospital of Nanchang University , Nanchang, China .
authors.forename: Jun
authors.initials: J
authors.lastname: Lei
authors.affiliation: Department of Hepatobiliary Surgery, Second Affiliated Hospital of Nanchang University , Nanchang, China .
authors.forename: Jun
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Hepatobiliary Surgery, Second Affiliated Hospital of Nanchang University , Nanchang, China .
authors.forename: Qiang
authors.initials: Q
authors.lastname: Li
authors.affiliation: Department of Hepatobiliary Surgery, Second Affiliated Hospital of Nanchang University , Nanchang, China .
authors.forename: Peng
authors.initials: P
authors.lastname: Wu
authors.affiliation: Department of Hepatobiliary Surgery, Second Affiliated Hospital of Nanchang University , Nanchang, China .
authors.forename: Rongfa
authors.initials: R
authors.lastname: Yuan
authors.affiliation: Department of Hepatobiliary Surgery, Second Affiliated Hospital of Nanchang University , Nanchang, China .
authors.forename: Hengqing
authors.initials: H
authors.lastname: Zhu
authors.affiliation: Department of Hepatobiliary Surgery, Second Affiliated Hospital of Nanchang University , Nanchang, China .
authors.forename: Shubing
authors.initials: S
authors.lastname: Zou
authors.affiliation: Department of Hepatobiliary Surgery, Second Affiliated Hospital of Nanchang University , Nanchang, China .
authors.forename: Jianghua
authors.initials: J
authors.lastname: Shao
authors.affiliation: Department of Hepatobiliary Surgery, Second Affiliated Hospital of Nanchang University , Nanchang, China .
authors.forename: Lu
authors.initials: L
authors.lastname: Fang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D042883:Choledocholithiasis / Q000150:complications / Q000601:surgery*; D003135:Common Bile Duct / Q000601:surgery*; D003549:Cystic Duct / Q000601:surgery*; D005260:Female; D042882:Gallstones / Q000150:complications / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D053844:Lasers, Solid-State / Q000627:therapeutic use; D007902:Length of Stay; D017602:Lithotripsy, Laser / Q000379:methods*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012189:Retrospective Studies