Re-use of Ambu aScope during exploration of the common bile duct for stones in low-resource settings- a retrospective study

Various methods confirm stone clearance during surgical exploration of bile duct, but choledochoscopy is considered the most effective. However, choledochoscopes are expensive in context of low-resource settings. The Ambu aScope, a disposable flexible video-bronchoscope used in anesthesia, has been successfully tried as a cheaper alternative for CBD (Common Bile Duct) exploration in few limited studies but in those studies the aScope had not been re-used. In Nepal, where affordability is a concern, even the reuse of properly disinfected Ambu aScopes may be justifiable if proven safe. This study is probably the first of its kind to evaluate the reuse of the Ambu aScope for choledochoscopy. This study includes all patients with CBD stones who underwent CBD exploration for stone using Ambu aScope in Department of Surgery of BPKIHS, Dharan between January 2022 and December 2024. Over the study period, a total of 75 cases of CBD exploration had been performed at our institute using Ambu aScope. These patients had a mean age of 55.21 ± 13.73 years (26–84 years) with female: male ration of 2.5:1. Choledocholithiasis was secondary to Gallbladder stone in majority (82.7% of cases) and was multiple with average size of the largest stone being 18.47 ± 3.26 mm. The approaches used for exploration of CBD were laparoscopic (in 21.3% cases) and open (in 78.7% cases). Using Ambu aScope, acceptable view of extrahepatic biliary tree with complete stone retrieval was achieved in 97.3% cases. No intraoperative complications related to the use of the Ambu aScope were encountered. Moreover, none of the patients developed cholangitis, an infectious complication that may be related to the reuse of the aScope. Based on our experience, the Ambu aScope may serve as a practical and economical alternative to the conventional choledochoscope for CBD exploration, offering acceptable visualization of the extrahepatic biliary tree without evident reuse-related infectious complications. Further studies with larger cohorts are warranted to confirm these findings. The study has been registered in ClinicalTrials.gov (ClinicalTrials.gov Identifier: NCT07285447). After the ethical clearance from Institutional Review Committee (CODE- IRC/2994/025) and Research committee of BPKIHS, this study has been conducted.