Intraoperative and postoperative biliary endoscopy (choledochoscopy).

Surgical exploration of the common bile duct is performed blindly, and perhaps this is one of the reasons the incidence of retained stones is higher than it should be. The introduction of the choledochoscope was promising, but a recent survey found that although a majority of hospitals where biliary surgery is performed have the instrument in the operating room, only a small percentage of surgeons use it routinely. This means that the general surgeon is not an endoscopist and choledocholithotomy cases are only 10 to 20 per cent of the existing biliary material. The introduction of the video choledochoscope shortened the learning curve for the surgeon significantly. The enlarged image can be seen conveniently from a distance with both eyes. Intraoperative stone retrieval requires four hands, and with video endoscopy, movements are coordinated, as the entire operating team can see the process. Therefore, the procedure is more precise and faster. The few missed stones can be removed with ease in the postoperative period through the T-tube tract. The procedure is safe and accurate and can be performed on an outpatient basis.