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Minimally Invasive Surgery

Laparoscopic Common Bile Duct Exploration

To identify the key insights or developments described in this article

1 Credit CME

JAMA Surgery

Published Online: April 26, 2023

Surgical Innovation

Article Information and Disclosures

Victoria R. Rendell, MD¹;

Eric M. Pauli, MD¹

Author Affiliations

¹Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania

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As laparoscopic cholecystectomy was introduced and widely adopted in the late 1980s and 1990s, the accompanying management of choledocholithiasis changed. While endoscopic retrograde cholangiopancreatography (ERCP) was increasingly used, the cumbersome and challenging nature of laparoscopic common bile duct exploration (LCBDE) could not compete. Many surgeons deemed LCBDE too challenging, the skill set and time required were not available, and the endoscopic visualization and equipment were not satisfactory.

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Article Information

Corresponding Author: Eric M. Pauli, MD, Penn State Hershey Medical Center, 500 University Dr, MC H149, Hershey, PA 17033 (epauli@pennstatehealth.psu.edu).

Published Online: April 26, 2023. doi:10.1001/jamasurg.2022.8141

Conflict of Interest Disclosures: Dr Pauli reported consulting and/or speaking fees from Boston Scientific, Becton Dickinson, Medtronic, Ovesco, Actuated Medical, Cook Biotech, Neptune Medical, Surgimatix, Allergan, Intuitive Surgical, ERBE, Integra, Steris, and Noah Medical; royalties from UpToDate and Springer; and financial interests in IHC Inc, Contamination Source Identification, Cranial Devices Inc, and Actuated Medical outside the submitted work. No other disclosures were reported.

References

Wandling MW , Hungness ES , Pavey ES , et al. Nationwide assessment of trends in choledocholithiasis management in the United States from 1998 to 2013. JAMA Surg. 2016;151(12):1125-1130. doi:10.1001/jamasurg.2016.2059 PubMed Google Scholar Crossref

St John A , Caturegli I , Kubicki NS , Kavic SM . The rise of minimally invasive surgery: 16 year analysis of the progressive replacement of open surgery with laparoscopy. JSLS. 2020;24(4):1-5. doi:10.4293/JSLS.2020.00076 PubMed Google Scholar Crossref

Schwab B , Teitelbaum EN , Barsuk JH , Soper NJ , Hungness ES . Single-stage laparoscopic management of choledocholithiasis: an analysis after implementation of a mastery learning resident curriculum. Surgery. 2018;163(3):503-508. doi:10.1016/j.surg.2017.10.006 PubMed Google Scholar Crossref

Chen YK , Parsi MA , Binmoeller KF , et al. Single-operator cholangioscopy in patients requiring evaluation of bile duct disease or therapy of biliary stones (with videos). Gastrointest Endosc. 2011;74(4):805-814. doi:10.1016/j.gie.2011.04.016 PubMed Google Scholar Crossref

Ricci C , Pagano N , Taffurelli G , et al. Comparison of efficacy and safety of 4 combinations of laparoscopic and intraoperative techniques for management of gallstone disease with biliary duct calculi: a systematic review and network meta-analysis. JAMA Surg. 2018;153(7):e181167. doi:10.1001/jamasurg.2018.1167 PubMed Google Scholar Crossref

Dasari BVM , Tan CJ , Gurusamy KS , et al. Surgical versus endoscopic treatment of bile duct stones. Cochrane Database Syst Rev. 2013;2013(12):CD003327. doi:10.1002/14651858.CD003327.pub3 PubMed Google Scholar Crossref

Lei C , Lu T , Yang W , et al. Comparison of intraoperative endoscopic retrograde cholangiopancreatography and laparoscopic common bile duct exploration combined with laparoscopic cholecystectomy for treating gallstones and common bile duct stones: a systematic review and meta-analysis. Surg Endosc. 2021;35(11):5918-5935. doi:10.1007/s00464-021-08648-y PubMed Google Scholar Crossref

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.