INTRAOPERATIVE LAPAROSCOPIC CHOLANGIOGRAPHY Dr. Mark Pleatman demonstrates his technique for performing operative cholangiography. The cystic duct has been dissected out and skeletonized. A clip has been placed at the junction of the infundibulum of the gallbladder with the cystic duct. A Veress needle taken apart and the outer sheath is inserted directly through the abdominal wall in such a direction that the catheter will naturally point towards the operative site. A Taut catheter attached to a syringe of saline is flushed to remove bubbles, and inserted through the needle. With an instrument behind the cystic duct to stabilize it, a microscissors is used to incise the cystic duct. Care is taken not to transect it completely. The catheter is then carefully inserted into the duct. The catheter has a steel component near the tip which allows one to secure it in place with a clip, without having to worry about crushing the catheter and occluding it. Under direct fluoroscopic guidance, Conray 30 is injected through the catheter and the cholangiogram obtained. The fluoroscopic approach allows one to monitor the procedure and watch for small stones or air bubbles. If there are any questions, the duct can be flushed clear with saline and the study can be repeated. This study demonstrates the catheter in the cystic duct, with free flow of contrast through a normal common bile duct into the duodenum.