# Cholelithiasis — GCMD Library living collection

Everything in the library about cholelithiasis — built automatically from dossiers that name it.

Updated: n/a · 4 episodes · 72 cited statements

## Episodes
### Diagnosis & Workup
- [Choledocholithiasis with Drs. David Vitale & Lucas Neff](https://library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884) — podcast · 15:27 · [machine version](https://library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884.md)

### Surgical Management
- [Update Course 2021: THORACOTOMY VS VATS FOR OSTEO METS](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417) — video · [machine version](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417.md)
- [Update Course Rewind: Pediatric Biliary Stones - Surgery First Mindset 2024](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706) — video · 7:31 · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706.md)

### Case-Based Learning
- [Case-Based Journal Review: Cholelithiasis 2024](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797) — podcast · 18:12 · [machine version](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=0) Introduction and ICG for Cholecystectomy (Ep 1)
- [3:34](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=214) ICG Cholecystectomy Technique and Timing (Ep 1)
- [9:34](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=574) ICG for Partial Nephrectomy and Varicocele Repair (Ep 1)
- [21:24](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=1284) Pulmonary Metastasectomy Case Discussion (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=0) Introduction and Case Presentation: Timing of Cholecystectomy (Ep 2)
- [4:50](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=290) Predicting Choledocholithiasis: Machine Learning Algorithm (Ep 2)
- [7:50](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=470) Management of Choledocholithiasis: ERCP vs. Laparoscopic Exploration (Ep 2)
- [13:00](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=780) Role of ICG Fluorescent Cholangiography and Summary (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=0) Introduction and Risk Stratification (Ep 3)
- [2:38](https://library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=158) Pediatric Predictors and Treatment Approaches (Ep 3)
- [5:17](https://library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=317) Surgery-First Paradigm (Ep 3)
- [9:37](https://library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=577) Technical Details of Laparoscopic CBD Exploration (Ep 3)
- [13:47](https://library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=827) Learning Curve and Summary (Ep 3)
- [0:01](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=1) Introduction and Course Context (Ep 4)
- [1:06](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=66) Case 1: Surgery-First vs ERCP-First Approach (Ep 4)
- [2:59](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=179) ERCP Complications and Stone Clearance Rates (Ep 4)
- [5:00](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=300) Technical Considerations and Equipment (Ep 4)
- [5:43](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=343) Case 2: Sickle Cell Patient and Flushing Risks (Ep 4)
- [6:45](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=405) Summary and Conclusions (Ep 4)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "Choledocholithiasis is more common in older children, children with higher BMI, and patients of Hispanic ethnicity" — David Vitale (epidemiological) [Ep 3 · 1:03](https://library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=63)
- "Risk factors for choledocholithiasis include metabolic diseases, hemolysis such as sickle cell, and congenital biliary anomalies like choledochal cysts" — David Vitale (clinical) [Ep 3 · 0:55](https://library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=55)
- "According to ASGE guidelines, patients with high probability of common bile duct stones (common bile duct stones seen on ultrasound, ascending cholangitis, or quite high bilirubin) should go straight to ERCP" — David Vitale (guideline) [Ep 3 · 1:52](https://library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=112)
- "Patients with intermediate risk (abnormal liver biochemical tests or dilated common bile ducts) can undergo endoscopic ultrasound, MRCP, laparoscopic cholangiogram, or intraoperative ultrasound" — Cecilia Gigena (guideline) [Ep 3 · 2:11](https://library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=131)
- "In pediatric patients, direct bilirubin or conjugated bilirubin more than 2 was the most predictive factor for common bile duct stones" — David Vitale (clinical) [Ep 3 · 2:40](https://library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=160)
- "Common bile duct diameter greater than 6 millimeters was most sensitive for predicting common bile duct stones in children, although without statistical significance" — Cecilia Gigena (clinical) [Ep 3 · 2:50](https://library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=170)
- "The pediatric duct score (published in Journal of American College of Surgeons with 10 centers) found that ducts greater than 6 millimeters, common bile duct stones on ultrasound, or total bilirubin greater than 1.8 were the most predictive risk factors" — David Vitale (clinical) [Ep 3 · 3:03](https://library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=183)
- "Pediatric literature with small sample size shows that doing same anesthesia laparoscopic cholecystectomy with ERCP in stone disease led to less anesthesia time and lower length of stay" — David Vitale (clinical) [Ep 3 · 3:41](https://library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=221)
- "Retrospective data comparing ERCP versus laparoscopic common bile duct exploration is conflicted and the choice is probably institution and provider dependent based on expertise" — David Vitale (opinion) [Ep 3 · 4:03](https://library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=243)
- "Randomized trials from 2013 show no significant difference in morbidity, mortality, retained stones, or failure rates between ERCP and laparoscopic common bile duct exploration" — Cecilia Gigena (clinical) [Ep 3 · 4:18](https://library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=258)
- "Stones above the cystic duct pose a problem because they can float up during attempted laparoscopic removal, making the procedure more difficult" — David Vitale (clinical) [Ep 3 · 4:39](https://library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=279)
- "Local expertise and availability is probably the most important factor in deciding between ERCP and laparoscopic common bile duct exploration" — David Vitale (opinion) [Ep 3 · 5:00](https://library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=300)
- "Most free-standing children's hospitals do not have ERCP capabilities" — Cecilia Gigena (epidemiological) [Ep 3 · 9:12](https://library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=552)
- "The mantra for laparoscopic common bile duct exploration is all stones go forward, using balloons to dilate the sphincter and flush stones antegrade into the duodenum" — Luke Neff (clinical) [Ep 3 · 6:42](https://library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=402)
- "If you're having to open up the common bile duct to extract the stone and you had ERCP capability, that's probably not the right thing to do in most cases" — Luke Neff (opinion) [Ep 3 · 7:30](https://library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=450)
- "A 12 gauge angiocath is used for laparoscopic common bile duct exploration, with a new incision made to achieve a flat angle of entry into the cystic ductotomy" — Luke Neff (clinical) [Ep 3 · 9:37](https://library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=577)
- "A 6 French ureteral stent cut down shorter for better flow is used with a glide wire, employing a cylinder technique to navigate the valves" — Luke Neff (clinical) [Ep 3 · 9:57](https://library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=597)
- "An angioplasty balloon of 6 or 8 millimeters (but definitely not more than that) is used to dilate the sphincter" — Luke Neff (clinical) [Ep 3 · 10:37](https://library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=637)
- "The balloon is inflated in the duct and pulled back to provide tactile feedback to locate the sphincter, then partially deflated to straddle the ampulla, then inflated to full profile under fluoroscopy and held for about 5 minutes" — Luke Neff (clinical) [Ep 3 · 11:02](https://library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=662)
- "Never use a balloon larger than the dilated common bile duct because literature shows a higher rate of pancreatitis with ampullary dilation without sphincterotomy" — David Vitale (clinical) [Ep 3 · 11:23](https://library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=683)
- "If the pancreatic duct is seen on fluoroscopy during the procedure, stop because that has a higher risk for pancreatitis" — Cecilia Gigena (clinical) [Ep 3 · 12:24](https://library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=744)
- "The prevalence of stone disease is increasing" — Luke Neff (epidemiological) [Ep 3 · 12:34](https://library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=754)
- "The learning curve for laparoscopic common bile duct exploration is around 5 to 10 cases, though this is person-specific" — Luke Neff (clinical) [Ep 3 · 13:40](https://library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=820)
- "The position of the 12-gauge angiocath is really important, and the ability to manipulate the catheter and wire in the duct depends on the initial setup and how flat the angle of entry is into the cystic duct" — Luke Neff (clinical) [Ep 3 · 13:24](https://library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=804)
- "Chile has the highest rate of cholelithiasis globally" — Jose Campos (epidemiological) [Ep 2 · 1:07](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=67)
- "Historical threshold for 'cool-off period' before cholecystectomy was 7-10 days in general surgery, later reduced to 2-3 days in pediatric surgery" — Jose Campos (clinical) [Ep 2 · 1:53](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=113)
- "In multi-center study of 246 patients (167 early, 79 delayed cholecystectomy), early cholecystectomy during index admission had 2% pancreatitis recurrence vs. 22% in delayed approach" — Cecilia Gigena (clinical) [Ep 2 · 3:11](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=191)
- "When cholecystectomy was delayed more than 6 weeks, pancreatitis recurrence rate increased to 60%" — Cecilia Gigena (clinical) [Ep 2 · 3:36](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=216)
- "Even with no stones remaining, 2% baseline recurrence rate of pancreatitis exists from initial insult" — Todd Ponsky (clinical) [Ep 2 · 3:44](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=224)
- "Early cholecystectomy did not result in increased biliary complications compared to delayed approach" — Cecilia Gigena (clinical) [Ep 2 · 4:27](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=267)
- "In gallstone pancreatitis, pain and elevated enzymes typically occur as the stone is passing, often resolving overnight" — Todd Ponsky (clinical) [Ep 2 · 5:01](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=301)
- "If laboratory values normalize after gallstone pancreatitis, ERCP is not indicated; intraoperative cholangiogram is sufficient to check for retained stones" — Todd Ponsky (clinical) [Ep 2 · 5:36](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=336)
- "Western Pediatric Surgery Research Consortium machine learning algorithm for predicting CBD stones was developed from 1600 patients across 10 centers (2016-2019), with 20% having CBD stones" (clinical) [Ep 2 · 6:26](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=386)
- "The predictive algorithm has a 98% negative predictive value for common bile duct stones" — Jose Campos (clinical) [Ep 2 · 7:11](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=431)
- "Using the algorithm, risk of encountering unexpected CBD stone intraoperatively is only 2%" — Jose Campos (clinical) [Ep 2 · 7:22](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=442)
- "For patients with impacted CBD stone, worsening lipase, and increasing jaundice, ERCP is preferred because surgeon skill at retrieving impacted stones may be limited" — Todd Ponsky (opinion) [Ep 2 · 8:58](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=538)
- "Stones identified on ultrasound (non-impacted) are more amenable to intraoperative laparoscopic removal" — Todd Ponsky (clinical) [Ep 2 · 9:17](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=557)
- "In multi-center study of 252 patients (156 OR-first, 96 ERCP-first), OR-first approach with intraoperative cholangiogram had fewer complications and shorter length of stay" — Cecilia Gigena (clinical) [Ep 2 · 11:27](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=687)
- "86% of patients in OR-first group required only the initial surgery without subsequent ERCP" — Cecilia Gigena (clinical) [Ep 2 · 11:41](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=701)
- "The multi-center laparoscopic CBD exploration study included 4 centers with a broad range of surgeon expertise, demonstrating feasibility beyond single expert centers" — Jose Campos (clinical) [Ep 2 · 11:56](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=716)
- "14% of patients who underwent laparoscopic CBD exploration required subsequent ERCP without increased complications such as bile duct leak" — Jose Campos (clinical) [Ep 2 · 12:15](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=735)
- "In stepwise laparoscopic CBD exploration approach, 84% of CBD stones cleared with simple saline flush through ureteral catheter" — Jose Campos (clinical) [Ep 2 · 12:30](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=750)
- "ICG cholangiography study (2013-2023, 173 patients: 83 standard, 90 ICG) showed perioperative complication rate of 12% in standard technique vs. 0% with ICG" (clinical) [Ep 2 · 13:34](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=814)
- "ICG technique showed significantly shorter operative time, cystic duct isolation time, clipping time, and gallbladder removal time compared to standard technique" (clinical) [Ep 2 · 14:03](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=843)
- "Complete biliary tree visualization rate was significantly higher with ICG compared to standard technique" (clinical) [Ep 2 · 14:03](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=843)
- "ICG study compared different time periods (2013-2023) rather than concurrent randomized groups, introducing confounding from improved surgical technique and instrumentation over time" — Jose Campos (opinion) [Ep 2 · 14:25](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=865)
- "ICG study grouped all complications together without separately reporting common bile duct injuries, and bleeding complications are unlikely attributable to presence/absence of ICG" — Jose Campos (opinion) [Ep 2 · 14:43](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=883)
- "Zero complications in ICG group raises methodological concerns about reporting accuracy" — Jose Campos (opinion) [Ep 2 · 14:57](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=897)
- "ICG study compared ICG to simple visualization without intraoperative cholangiogram, not ICG vs. intraoperative cholangiogram" — Jose Campos (opinion) [Ep 2 · 15:38](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=938)
- "Intravenous ICG administration eliminates need for instrumentation of the biliary tree, which is a significant advantage" — Todd Ponsky (clinical) [Ep 2 · 15:26](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=926)
- "Stone disease is increasing along with obesity in pediatric patients around the world, not just in the United States" — Em Gootee (host_summary) [Ep 4 · 0:52](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=52)
- "There are two main approaches for CBD stones requiring cholecystectomy: ERCP first followed by laparoscopic cholecystectomy, or surgery-first with IOC to identify and potentially remove stones during the same surgery" — Em Gootee (host_summary) [Ep 4 · 1:25](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=85)
- "The choice between surgery-first and ERCP-first depends on the setting and the surgeon's technical capabilities" (opinion) [Ep 4 · 1:50](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=110)
- "A surgery-first pathway reduces resource utilization, including MRCP" — Em Gootee (host_summary) [Ep 4 · 2:11](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=131)
- "ERCP adds potential morbidity, with a pancreatitis rate of 10% even when performed well" — Em Gootee (host_summary) [Ep 4 · 3:02](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=182)
- "If a surgeon cannot perform a cholangiogram, then ERCP is necessary if available" — Em Gootee (host_summary) [Ep 4 · 3:16](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=196)
- "Many pediatric surgeons lack confidence in intraoperative stone removal because they have been spoiled by ERCP availability and have done very few cases" (opinion) [Ep 4 · 3:23](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=203)
- "Pediatric surgeons need courses to learn the tricks of intraoperative stone removal" (opinion) [Ep 4 · 3:37](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=217)
- "If you know how to put in a central line and understand Seldinger technique, you can perform intraoperative stone removal" — Em Gootee (host_summary) [Ep 4 · 3:44](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=224)
- "With a surgery-first mindset, stone clearance rate reflected by negative IOC was 86%" — Em Gootee (host_summary) [Ep 4 · 3:50](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=230)
- "With simple adjuncts like advancing the catheter into the CBD or reaming the sphincter, success rate rises to the 90s" — Em Gootee (host_summary) [Ep 4 · 4:01](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=241)
- "For the 15% of unsuccessful cases, the plan is to clip the cystic duct, close, and have ERCP performed within the next day or two, or same-day in the OR if an endoscopist is available" — Em Gootee (host_summary) [Ep 4 · 4:17](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=257)
- "An endo-loop may be used instead of a clip when ERCP is planned, to facilitate subsequent endoscopic access" — Em Gootee (host_summary) [Ep 4 · 4:56](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=296)
- "The learning curve for intraoperative stone removal is manageable: the first few times are difficult, but after a few cases it becomes easier and even enjoyable" — Em Gootee (host_summary) [Ep 4 · 5:06](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=306)
- "The biggest key to success is having all necessary equipment in one place, because OR staff will not know what to get on the fly" — Em Gootee (host_summary) [Ep 4 · 5:15](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=315)
- "Success depends on IOC findings: a CBD chock full of 3-4 impacted stones is typically not amenable to surgery-first approach" — Em Gootee (host_summary) [Ep 4 · 5:26](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=326)
- "When flushing an impacted stone, there is a risk of inadvertently injecting contrast into the pancreatic duct, which can increase the risk of pancreatitis" — Em Gootee (host_summary) [Ep 4 · 6:03](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=363)
- "If the pancreatic duct lights up during flushing, that is a signal to slow down and be careful to avoid causing pancreatitis" — Em Gootee (host_summary) [Ep 4 · 6:15](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=375)
- "A study demonstrated 86% success rate for surgery-first, while the ERCP group had a 10% complication rate including cholangitis, bleeding, pancreatitis, and hemophilia" — Em Gootee (host_summary) [Ep 4 · 6:33](https://library.globalcastmd.com/watch/update-course-rewind-pediatric-biliary-stones-surgery-first-mindset-2024-10706?t=393)
- "In adult centers, surgeons perform 100 to 300 cholecystectomies per year compared to 10 to 30 per year in pediatric centers" — Chiro Esposito (epidemiological) [Ep 1 · 3:34](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=214)
- "ICG is a soluble molecule that rapidly binds to albumin and is removed from circulation by the liver into bile juice" — Chiro Esposito (clinical) [Ep 1 · 0:23](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=23)
- "For cholecystectomy, ICG must be injected 12 to 15 hours preoperatively to allow secretion into bile juice for selective biliary tree visualization" — Chiro Esposito (clinical) [Ep 1 · 7:15](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=435)
- "If ICG is injected intraoperatively for cholecystectomy, the liver takes up the dye and appears green, making gallbladder identification difficult" — Chiro Esposito (clinical) [Ep 1 · 7:51](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=471)
- "For all ICG indications except cholecystectomy (kidney, varicocele, lymphoma, tumors), the injection is given intraoperatively" — Chiro Esposito (clinical) [Ep 1 · 7:51](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=471)
- "ICG vial contains 25 mg in 4 ml, diluted with 10 ml sterile water, with 6 ml injected intravenously for cholecystectomy" — Chiro Esposito (clinical) [Ep 1 · 4:40](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=280)
- "For partial nephrectomy in duplex kidney, ICG is injected three times: via ureteral catheter to identify normal ureter, intravenously to visualize kidney vasculature, and intravenously again after vessel clipping to show devascularization line" — Chiro Esposito (clinical) [Ep 1 · 9:34](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=574)
- "In duplex kidney with reflux, the two ureters are attached to each other, making identification of the normal ureter difficult without ICG" — Chiro Esposito (clinical) [Ep 1 · 9:34](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=574)
- "For varicocele repair, intratesticular injection of 2 ml ICG solution allows intraoperative fluorescence lymphography to identify and spare lymphatic vessels" — Chiro Esposito (clinical) [Ep 1 · 17:30](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=1050)
- "Palomo varicocele repair has success rate of more than 97-98% but ligating lymphatics in the spermatic bundle causes postoperative hydrocele in about 20% of cases" — Chiro Esposito (clinical) [Ep 1 · 17:30](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=1050)
- "In a series of more than 150 varicocele patients using ICG lymphatic sparing technique, there were zero postoperative hydroceles" — Chiro Esposito (clinical) [Ep 1 · 19:10](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=1150)
- "The spermatic bundle contains three to four lymphatic vessels" — Chiro Esposito (clinical) [Ep 1 · 17:30](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=1050)
- "There is no maximum dose limit for ICG based on adult surgery studies" — Chiro Esposito (clinical) [Ep 1 · 21:53](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=1313)
- "ICG vial remains usable for six hours after preparation" — Chiro Esposito (clinical) [Ep 1 · 21:24](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=1284)
- "No adverse effects of ICG were observed in the presenter's experience" — Chiro Esposito (clinical) [Ep 1 · 21:24](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=1284)
- "ICG technology can be used in both laparoscopy (requiring special camera and optic) and robotic surgery with Da Vinci XI Firefly system" — Chiro Esposito (clinical) [Ep 1 · 1:20](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=80)
- "The newer Rubin ICG system allows visualization in color with biliary tree appearing green, compared to older systems showing black and white images" — Chiro Esposito (clinical) [Ep 1 · 5:40](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=340)
- "For elective cholecystectomy cases, patients are hospitalized the day before surgery for ICG injection in the late afternoon if surgery is scheduled early morning" — Chiro Esposito (clinical) [Ep 1 · 8:42](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=522)
- "ICG technology helps reduce complications in laparoscopic cholecystectomy, particularly beneficial for trainees and in centers with longer learning curves due to lower case volumes" — Chiro Esposito (opinion) [Ep 1 · 3:34](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=214)

## Changelog
- Sep 7: 4 items added automatically

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