Laparoscopic Transcystic SpyGlass Discover-Assisted Common Bile Duct Exploration and Clearance: An Efficient and Cost-Effective Alternative for Common Bile Duct Stone Management

Abstract

Aim This study aimed to assess the safety and efficacy of laparoscopic transcystic SpyGlass Discover (Boston Scientific Corporation, Marlborough, MA, USA) common bile duct (CBD) exploration combined with laparoscopic cholecystectomy (LC) as a single-stage procedure for patients requiring cholecystectomy and confirmed, suspected, or complex CBD stones. The study also evaluated the cost-effectiveness of this single-stage procedure compared to the two-stage endoscopic retrograde cholangiopancreatography (ERCP) followed by LC. The study adhered to the local clinical governance unit protocol and the Strengthening the Reporting of Cohort Studies in Surgery (STROCSS) guidelines. Materials and methods This is a retrospective cohort study conducted from January 2023 to July 2024. The safety, efficacy, and cost-effectiveness of SpyGlass Discover CBD exploration performed by a single consultant were evaluated. Of the sample population, 38 patients who underwent CBD stone management were included. Twenty-one patients (Group 1) had SpyGlass Discover CBD exploration planned, while 17 patients (Group 2) underwent the conventional preoperative ERCP followed by LC. All adult patients undergoing planned management were included. Data for comparison included age, gender, length of hospital stay, operative time, and success rates. Results Twenty-one patients underwent a single-stage operation using SpyGlass Discover. In nine cases, CBD exploration was performed, but no intervention was needed. In five cases, intervention was required, consisting of two laser lithotripsies and two mechanical lithotripsies with a basket. Seven cases had OTC, which showed a clear duct. The total operative time for Group 1 was 146 minutes on average. For those who did not require intervention, the mean operative time was 117 minutes, while the mean operative time for cases requiring intervention was 175 minutes. In Group 2, the mean operative time for ERCP + LC was 131 minutes. The length of hospital stay for Group 1 averaged 1.25 days, while Group 2 had an average of 1.52 days. Conclusions It was concluded that one-stage LC combined with SpyGlass Discover-assisted transcystic CBD clearance is an effective, safe, and cost-effective procedure when performed by skilled hands.