Chapter 742: [742] Problem identified Chapter 742: [742] Problem identified The cholangioscope was ready and entered the abdominal cavity through a special sheath, then into the Common Bile Duct through an incision. The cholangioscope’s light source was turned on, and the condition of the patient’s Common Bile Duct appeared on the connected electronic display.
The various ducts of the human body are displayed as cavities under an optical lens, and when magnified, they look like the landscape of a cave.
Similar to colonoscopy, the doctor mainly used the cholangioscope to observe the bile duct’s inner wall and the various contents within the duct lumen. Inside, there were not only possible gallstones but also the bile normally secreted by the human liver, as well as various proliferations, including tumors, that could not be ruled out.
The surgeon adjusted the focus and the direction of the cholangioscope’s light source to perform the examination, which was very similar to the operation of a Laparoscopic exam.
The difference lay in that the Laparoscopic required several people to operate together, whereas the cholangioscope was operated by a single person through one tube.
Once the cholangioscopy detected an abnormality and further operations were needed, unlike Laparoscopic surgery where an assistant could help, the doctor had to continue alone.
From this, it can be seen that the number of skills a doctor must learn to achieve proficiency far exceeds the imagination of ordinary people. The development of medical technology has increased the amount of high-tech equipment that traditional surgeons must master, and the demands on their abilities have also increased.
Without other ducts, if the doctor needed to use other instruments, they had to continue through the same cholangioscope tube. For example, a lithotrite could be inserted through another hole at the head of the cholangioscope, extended from the end where the light was cast to ensnare the stone before dragging it out of the bile duct. If stones needed to be crushed, ultrasound could be used. Saline could be connected to the rinsing tube to flush out the remaining small stones inside the duct.
These operations were admittedly more difficult than colonoscopies and gastroscopies because the bile duct lumen was small. If they reached the end of the bile duct where the cholangioscope was ineffective, they had no choice but to surgically cut.
The focus of all eyes had already shifted from the monitor of the Laparoscopic to the electronic display of the cholangioscope as soon as the examination began.
With the light source shining inside the patient’s cholangioscope, people could see the relatively smooth inner walls of the bile duct as well as the sudden appearance of a yellowish-white flocculent substance. What was this? Was it some strange growth inside the patient?
“This should be the ‘comet sign.'”
A group of doctors discussed: The band-like floating object seemed to grow from the duct wall, small in the head and larger in the tail, resembling a comet, hence the name ‘comet sign.’
“The presence of a comet sign indicates that the stone is at the back in a narrow passage,” the doctors deduced.
The comet sign was first discovered by national doctors; its significance was that it allowed the cholangioscope to continue from the “comet’s” base to find a narrow biliary opening, generally leading to the discovery of gallstones or obstructions such as ascaris. The “comet” actually results from bile ejected from a narrow place in the presence of an obstruction and spreading into a wider area. The bile ducts are small in the liver and large in the gallbladder; obstructions often occur in the liver ducts.
Discovering a comet sign was tantamount to locating the stones. Next, the stones were to be removed with the cholangioscope to clear the biliary obstruction, potentially curing the patient’s jaundice. However, for a complete cure, it was imperative to understand why the patient developed stones.
Was it merely a problem with diet? Or was there a metabolic issue with the liver cells themselves? Or was it due to some other cause?
At this crucial multiple-choice question, He Guangyou and his colleagues proposed that liver cell issues were definitely not the cause of “biliary obstruction caused by gallstones.”