Instrument improves bile duct explorations

Curved sheath protects scopes and patients

(Editor’s note: Donald E. Wenner is a founder of Lapsurgical Systems and co-inventor of the Multiple Instrument Guide and does have a fiduciary interest in the product.)

While laparoscopic cholecystectomies have become common at many same-day surgery programs, laparoscopic exploration of the common bile duct may be less common due to available equipment and potential damage of flexible scopes.

"I’ve been doing laparoscopic cholecystectomies since 1990, and I do explore the common bile duct when indicated," says Donald E. Wenner, MD, FACS, a general surgeon specializing in laparoscopic and vascular surgical procedures in Roswell, NM. "Exploration of the common bile duct requires a 90 degree turn that can damage flexible scopes and does add time to the procedure," he explains.

To address these problems, Wenner designed the Multiple Instrument Guide (MIG) that is used with flexible scopes. The curved plastic tube fits through the sheath and points baskets, balloons, lasers, and other instruments right at the stone, says Wenner. Because the MIG enables the surgeon to work through one port rather than two, procedure time also is reduced, he adds.

"I can remove an impacted stone in two hours and 10 minutes with the MIG as compared to three or four hours without it," Wenner points out. The reduced time in the operating room under anesthesia also is better for the patient, and you don’t risk injuring the patient as you try to force the scope into a 90 degree turn, he adds.

"It is very easy for the surgeons to use; and because surgeons can use multiple instruments through the guide, it is less cumbersome," says Rita Jensen, RN, operating room charge nurse at Eastern New Mexico Medical Center in Roswell.

The center began using the MIG about three years ago as a test facility. An in-house study that examined the incidence of scope damage showed a drop from 50% to 5% following regular use of the MIG for common bile duct exploration, she says.

"Scopes can be very expensive to repair, sometimes between $3,000 and $5,000," Jensen notes. "Since we began using the MIG, we rarely have to repair any."

No special training is required to use the MIG for the surgeon or any member of the operating team, Wenner explains.

The MIG is disposable and costs an average of $100. "There are some simple bile duct procedures that don’t require the use of the MIG, but this equipment enables a surgeon to perform the harder procedures in an ambulatory setting," he says.

In addition to improving efficiency and reducing equipment repair costs, Wenner says that use of the MIG is a benefit to patients as well.

"My partners and I opened our surgery center five years ago, and we are able to provide the same level of safety and service that patients receive in the hospital outpatient surgery department," he adds. "Small innovations like the MIG enable patients to choose where they want to go and get high-quality care."


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