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September 4, 1972

Operative Cystic Duct Cholangiography

JAMA. 1972;221(10):1163. doi:10.1001/jama.1972.03200230049017

To the Editor.—  Operative cystic duct cholangiography, introduced by Mirizzi in 1937, continues to be a valuable tool and has its advocates in many quarters. Its use remains as a vexing technical pathway unless one maintains facility in performing the maneuver. Consistent good quality records are difficult to obtain and each operator has his own peculiar method of accomplishing this intraoperative roentgenogram.The intracystic duct cannula, a metal tube as originally described by Mirizzi,1 has numerous modifications. The latest, an 18-gauge plastic catheter tipped with an expanded head, still requires that a ligature be placed about the cystic duct with just the proper tension to prevent leakage of contrast material but not occlude the tube. The Orr cystic duct clamp concept has eliminated many of our technical problems (Dittmar and Penn Corp, Philadelphia).We have modified a right angle clamp as seen in the Figure. A 2-mm groove is