2. Stone extraction via the T-tube 89 3. Endoscopic method 89 4. Preparation for stone extraction 90 5. Technique 90 6. Results 91 7. Complications 91 8. Discussion 91 Index of Subjects 99 CHAPTER 1 INTRODUCTION This book was conceived as a descriptive atlas of most reliable indication for common bile duct ex routine biliary surgery i. e., cholecystectomy and ploration. The cholangioscope allows a visual ex exploration of the common bile duct. For the pro ploration of the biliary tree and permits the re ject the two authors worked together for one week moval of common bile duct calculi and other as biopsy under direct visual con at Ninewells Hospital and Medical School, Dundee procedures such on a series of patients with biliary tract disease trol. Both procedures have been described in detail especially selected for the exercise. With the con with emphasis on the practical aspects of their use. sent of the Tayside Health Board and the patients The era of blind bilary surgery is over and the concerned, all the operations and peri-operative sooner this message is received by all concerned, procedures were filmed by the photographic mem the better the outcome of biliary surgical practice bers of the team, Mr. and Mrs. Paz-Partlow. Ad overall. ditional case material has been obtained from It has not been our intention to produce a com Cedars Sinai Medical Center, Los Angeles."

This book is a tribute to early pioneers and later innovators in applications of surgical principles for biliary stone disease. It is written as a challenge to all surgeons applying these principles to approach the biliary system with the safest and most appropriate technical support. This book is also written as a challenge to all those involved in the training of future generations of surgeons in the hope that critical standards in biliary surgical management will be promulgated and highlighted. The text contains knowledge from surgical leaders who played a vital part in the modern management of biliary stone disease. These contributions include their perceptions, wisdom and recommendations for the future. In doing so, the authors aim to discover ways to make the surgical management of biliary stone disease even better. This volume, thoughtfully curated by two eminent surgical scholars, provides perhaps the most complete history of the field. Dr. Berci and Dr. Greene enlisted a remarkable panel of distinguished colleagues from around the world to discuss every important element of surgical practice. These elements include: The resourcefulness of developing novel optics and instruments on "the fly", the integration of new imaging capabilities into pre-operative assessments and intraoperative management, the challenge of educating prideful senior surgeons who were ill at ease with the distance imposed by a laparoscope, and the introduction of progressively more elegant ex vivo modules to train inexperienced juniors with limited open operative experience. Finally, it also discusses the never-ending task of ensuring the safety of one of the most common operations performed in the world, yet one with a persistent, if small, risk of life altering injury to the biliary ducts. No Stones Left Unturned aims to build on a classic surgical text and then discusses the issues faced by surgeons performing biliary surgery in the modern era. It serves as a valuable resource for surgeons, practicing clinicians, surgical residents, and fellows that wish to apply this knowledge and improve upon the current standards of biliary surgical management.