SP 7.01 Setting up a Single-Stage Laparoscopic Bile Duct Exploration Service at a Central London Trust
Omar Haidar, Armin Fardanesh, Saneth Sellahewa, Daniel Huddart, Sanjay Purkayastha, Lalin NavaratneAbstract
Introduction
Patients with choledocholithiasis have traditionally been served in our trust with ERCP followed by interval cholecystectomy. This approach is associated with significant delays due to limited ERCP availability and prolonged surgical waiting lists. To address this, a single-stage pathway combining laparoscopic cholecystectomy with laparoscopic CBD exploration (LC+LCBDE) was developed and implemented across a three-hospital Central London Trust, delivered by a single surgeon to improve patient flow and reduce treatment delays.
Methods
Between February 2024 and December 2025, patients with CBD stones across three sites were referred for consideration of LC+LCBDE. Procedures were performed either in emergency theatre or via an expedited elective pathway. Key enablers of pathway development included:Consistent consultant-led team briefingsReproducible set up: patient positioning using the French(split-leg) positionStandardisation of equipment via a dedicated LCBDE trolley.Standardised operative technique following Leveraging Access to Technology and Enhanced Surgical Technique (LATEST) principles: including ultra-thin choledochoscopes, use of lithotripsy when required, and complete cystic duct dissection with optimal retraction.
Results
63 patients underwent LC+LCBDE. Median postoperative length of stay was 1 day with 48% managed as day cases; 14 procedures occurred in emergency theatres. A proximal view of intra-hepatic bile ducts was achieved in 65% of cases. Stone clearance was achieved laparoscopically in 62/63 patients (98%) with 40% of cases utilising lithotripsy.
Conclusion
A single-surgeon, pan-trust LC+LCBDE service is safe, feasible, and effective, offering definitive single-stage management with reduced waiting times, shorter hospital stay, and avoidance of ERCP-related risks.