A new T-tube applier in laparoscopic surgery

In the majority of patients undergoing laparoscopic choledochotomy, it is advisable to insert a T-tube into the duct after ductal exploration, as bile sludge or fibrin deposits may obstruct the papilla and cause postoperative cholangitis. Based on our experience in open surgery, a limited transverse choledochotomy is preferred, which reduces the possibility of damaging the common bile duct blood supply. Such a technique can complicate laparoscopic T-tube positioning, however. After experimenting with the method described by Kitano et al. [Surg Endosc 7:104-105 (1993)], which was abandoned because it was difficult to carry out with the type of soft silicone rubber tubes that we normally use, two subsequent techniques were developed and are described. They were employed in 3 and 10 patients, respectively, out of 21 who underwent laparoscopic transverse choledochotomy. The most satisfying results were obtained using a system employing two sets of telescopic cannulae of different diameters. Laparoscopic T-tube introduction through a transverse choledochotomy using two telescopic cannulae was rapid and safe and allowed to precisely guide T-tube positioning inside the common duct.