A Novel Surgical Technique for Complex Common Bile Duct Stone Extraction: Finger Assisted Laparoscopic Surgery (FALS)

Objectives : To describe a new surgical technique for the management of complex common bile duct stone and its feasibility along with reproducibility. Methods : We developed a new surgical technique to remove the impacted stone in common bile duct which was previously attempted but failed by one or more ERCP. We did this technique by inserting one finger through the laparoscopic port to negotiate the impacted stone in CBD after failed LCBDE with presently available stone extraction methods and ultimately extracted the large stone from CBD. Results : We did this new technique on three patients who had impacted stone with one or more failed attempts by ERCP and failed by even LCBDE. We succeeded in extracting the stone with this method in all cases without any complication. The time duration to extract the stone by this method are about 5 to 7 minutes only. By adopting this method to extract the impacted large stone in CBD after failed LCBDE, we avoided conversion to open and evaded using sophisticated laser lithotripsy which might cost more with morbidity. Conclusion : The result of the study indicates that all the cases with complex CBD stone where clearance is not possible by ERCP/ LCDBE can be removed very easily by this technique without opting for electrohydraulic or laser lithotripsy which consumes more time and cost.