title: LABEL procedure: Laser-Assisted Bile duct Exploration by Laparoendoscopy for choledocholithiasis: improving surgical outcomes and reducing technical failure.
abstract: Laparoscopic bile duct exploration (LBDE) is recommended in current treatment guidelines for the management of choledocholithiasis with gallbladder in situ. Failure of this technique is common as a consequence of large or impacted common bile duct (CBD) stones. In this series, we present our experience in using holmium laser lithotripsy as an adjunct to LBDE for the treatment of choledocholithiasis.
  
  
  
  Between 2014 and 2016, eighteen laparoscopic bile duct explorations utilising holmium laser lithotripsy were performed after failure of standard retrieval techniques.
  
  
  
  Choledocholithiasis was successfully treated in 18 patients using laparoscopic holmium laser lithotripsy (transcystically in 14 patients). There was one failure where a CBD stricture prevented the scope reaching the stone. Two medical complications were recorded (Clavien-Dindo I and II). There were no mortalities or re-interventions.
  
  
  
  LABEL technique is a successful and safe method to enhance LBDE in cases of impacted or large stones. In our experience, this approach increases the feasibility of the transcystic stone retrieval and may reduce overall operative time.
authors: Department of Upper GI Surgery, Northwick Park and St Mark's Hospital, North West London Hospitals NHS Trust, Watford Road, Harrow, Middlesex, London, HA1 3UJ, UK.|Hospital Universitario Insular de Gran Canaria, Avenida Marítima del Sur s/n, Las Palmas de Gran Canaria, 35016, Las Palmas, Spain.
authors: Antonio
authors: A
authors: Navarro-Sánchez
authors: Department of Upper GI Surgery, Northwick Park and St Mark's Hospital, North West London Hospitals NHS Trust, Watford Road, Harrow, Middlesex, London, HA1 3UJ, UK.|The Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Building, St Mary's Hospital, Praed Street, London, W2 1NY, UK.
authors: Hutan
authors: H
authors: Ashrafian
authors: Hospital Universitario Son Espases, Ctra. Valldemosa 79, 07120, Palma de Mallorca, Spain.
authors: Juan José
authors: JJ
authors: Segura-Sampedro
authors: Department of Upper GI Surgery, Northwick Park and St Mark's Hospital, North West London Hospitals NHS Trust, Watford Road, Harrow, Middlesex, London, HA1 3UJ, UK. a.isla@imperial.ac.uk.
authors: Alberto
authors: A
authors: Martrinez-Isla
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D042883:Choledocholithiasis / Q000628:therapy*; D003135:Common Bile Duct / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D053844:Lasers, Solid-State; D017602:Lithotripsy, Laser; D008297:Male; D008875:Middle Aged; D055815:Young Adult
keywords: Choledocholithiasis; Common bile duct; Holmium; Laparoscopy; Laser; Lithotripsy