**4. Conclusion**

*Digestive System - Recent Advances*

*3.2.2 Rendezvous technique*

sphincterotomy (**Figure 1**).

sphincterotomy.

continued [37, 40]. This technique has two main shortcomings; firstly, cannulation of the bile duct in the supine position is definitely more difficult than the standard prone/left lateral position and secondly, the resultant bowel distension from endo-

A variation of this technique is postponing ERCP till after completion of LC and closure of the ports. This is to avoid the two mentioned problems of supine position and bowel distension making LC more demanding [41]. However, the obvious

This technique was first described by Cavina et al. [35]. At laparoscopy the surgeon passes a basket through the opened cystic duct and threaded down to the duodenum. At endoscopy a sphincterotome is passed through the scope biopsy channel. The basket caught the sphincterotome and guides it inside the CBD for

A simpler modification of the RV technique was proposed by others and now is considered the gold standard technique of intraoperative ERCP [12, 33, 34]. At laparoscopy a standard ERCP guidewire is passed through the opened cystic duct and threaded into the CBD under fluoroscopic guidance till protruding into the duodenum out of the papilla. At endoscopy a snare or basket is passed and catches the protruding guidewire, which is withdrawn into the biopsy channel of the scope and then a standard sphincterotome is threaded over this guidewire for subsequent

scopic manipulation may render subsequent LC more challenging.

disadvantage of this approach is the problem of failure.

**116**

**Figure 1.**

*Rendezvous technique of intraoperative ERCP. (A) Laparoscopic view showing standard ERCP guidewire passing through the cystic duct into CBD; (B) fluoroscopic view showing passage of the guidewire into the duodenum; (C) endoscopic view showing snare catching the protruding guidewire; (D) endoscopic view showing* 

*standard sphincterotome threaded over the guidewire for sphincterotomy.*

Intraoperative ERCP for managing patients with concomitant gallbladder stones and CBD stones is a promising technique that is efficient, cost-effective and safe. The only limitation for its widespread use is lack of immediate availability of endoscopists and endoscopic equipment necessary for the procedure. When local resources and expertise are available it should be offered to fit patients. Surgeons are encouraged to learn ERCP and to use it as an important tool in their hands when dealing with such patients.

### **Conflict of interest**

I have no conflict of interest.

#### **Author details**

Ahmed Abdelraouf Elgeidie Gastrointestinal Surgery Center, Mansoura University, Mansoura, Egypt

\*Address all correspondence to: ahmedraoaf8@gmail.com

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
