Is the Ambu® aScope™ equivalent for laparoscopic common bile duct exploration as a re-usable choledochoscope?

INTRODUCTION: We have previously reported our institution’s early experience on the use of the Ambu® aScope ™ in LCBDE2. We demonstrated that the disposable scope was safe to use in LCBDE along with the benefits on cost reduction compared to reusable choledocoscopes.
METHODS: A retrospective cohort study was performed where cases between groups from June 2011 to June 2015 (for a re-usable choledochoscope (Group A)) and from July 2015 to January 2018 (for the Ambu® aScope™ (Group B)) were collected and matched retrospectively. A survey was conducted among eight surgeons who had used the Ambu® aScope™ on their views regarding its use and in comparison to a re-usable choledochoscope.
RESULTS: A total of 80 patients underwent an emergency LCBDE (40 in the re-usable choledochoscope group and 40 patients in the Ambu® aScope™ Group). The patients presented with acute cholecystitis, cholangitis, biliary colic, and pancreatitis, and there was no significant difference between the two groups. One of the 40 cases in the Ambu® aScope™ group and three of the 40 cases in the reusable scope group was converted to an open procedure. The success of CBD clearance, rate of post-operative bile leak, and conversion to an open procedure was equivalent in both groups. The majority of respondents (7/8) felt that the dexterity of the Ambu® aScope™ was inferior to the re-usable choledochoscope, and the same number (7/8) thought that the irrigation system using Ambu® aScope™ was inferior to the re-usable choledochoscope. Six of the eight surgeons reported more difficulties in using instrumentation with the Ambu® aScope™ in comparison to the re-usable choledochoscope.
DISCUSSION AND CONCLUSION: We have shown that a disposable scope may be used safely in LCBDE. However, we feel that the Ambu® aScope™ is not ideal for this task. We would open the call to the industry to support the development of a disposable choledocoscope specific for this purpose.