(EN) Obesity and type 2 diabetes mellitus (T2DM) are among metabolic disease with increasing incidence and prevalence. Last decade has been devoted to intensive research focused on pathophysiological mechanisms underlying development of these diseases. Besides environmental factors, lifestyle and amount and composition of food, adipose tissue is a key player in the pathogenesis of obesity and its metabolic complications including insulin resistance (IR) and T2DM. Primary aim of our work was to evaluate the role of recently discovered adipokine omentin and the role of mitochondrial dysfunction in subcutaneous adipose tissue (SCAT) and in peripheral monocytes (PM) in patients with obesity and T2DM with respect to the development of insulin resistance and diabetes. A total number of 118 subjects enrolled in the study were divided into three groups: patients with obesity and T2DM (T2DM group), obese non-diabetics (OB) and healthy lean subjects as a control group (KO). Study subjects underwent several types of interventions - 2 to 3 weeks of very-low calorie diet (VLCD, energy intake 600 kcal per day), regular physical activity program or bariatric surgery (laparoscopic sleeve gastrectomy, LSG). Results indicate that low serum omentin concentrations may contribute to development of obesity-associated...

The purpose of this study was to compare two transvaginal NOTES ovariectomy (OVE) techniques in bitches regarding technical issues, surgical time, complications, as well as plasma cortisol concentration and postoperative pain scores. A sample of 16 dogs was divided into two groups: GNH patients (n=8) underwent transvaginal hybrid-NOTES OVE; and GNT dogs (n=8) were submitted to transvaginal total-NOTES OVE. The surgical time was not different between groups. None of the dogs required rescue analgesic during or after surgery at any time point. Groups did not differ significantly from each other regarding pain scores, except for 72 hours after extubation on visual analogue scale (EVA) assessment. GNH group presented higher pain score than GNT at 72 hours. Plasma cortisol did not differ between groups in most time points. However, GNT group presented higher plasma cortisol at the baseline. Cortisol peaked at the immediate postoperative period in both groups, but was significantly raised only in the GNH group. Both NOTES OVE techniques were feasible and safe in dogs. However, proper patient selection is advised. Techniques showed similar results for all assessment. Both techniques presented low complications rates and reduced pain during and after surgery. / O presente estudo busca comparar duas novas técnicas de ovariectomia (OVE) por NOTES transvaginal em cadelas quanto a viabilidade técnica, tempo cirúrgico e incidência de complicações trans e pós-operatórias, bem como quanto à concentração de cortisol plasmático e escores de dor no período pós-operatório. Para tanto, uma amostra de 16 cadelas foi separada em dois grupos, sendo os pacientes do GNH (n=8) submetidos à OVE por NOTES transvaginal híbrida e os do grupo GNT (n=8) submetidas à OVE por NOTES transvaginal total. Os tempos cirúrgicos não diferiram entre os grupos experimentais. Nenhum dos cães requereu resgate analgésico nos períodos trans ou pós-operatório. Quanto ao escore de dor, os grupos não diferiram significativamente entre si na maioria dos tempos estudados, com exceção da avaliação nas 72 horas após extubação, na escala visual analógica (EVA), onde o GNH demonstrou índices mais elevados de dor que o grupo GNT. Os valores do cortisol plasmático não diferiram entre os grupos na maioria dos tempos, exceto no basal, onde os do grupo GNT foram superiores. Os valores mais elevados de cortisol para ambos os grupos experimentais foram encontrados no pós-operatório imediato, porém considerados significativos apenas para o grupo GNH. Ambas as técnicas de NOTES propostas se mostraram viáveis e seguras na realização de OV em cadelas, desde que executadas em pacientes selecionados quanto às condições anatômicas. As duas técnicas apresentaram resultados semelhantes para os parâmetros avaliados, com baixas taxas de complicações e reduzido estímulo álgico nos períodos trans e pós-operatório.

La réalité augmentée permet d'aider les chirurgiens à localiser pendant l'opération la position des structures d'intérêt, comme les vaisseaux sanguins. Dans le cadre de la chirurgie laparoscopique, les modèles 3D affichés durant l'intervention ne correspondent pas à la réalité à cause des déformations dues au pneumopéritoine. Cette thèse a pour objectif de corriger ces déformations afin de fournir un modèle du foie réaliste. Nous proposons de déformer le modèle préopératoire du foie à partir d'une acquisition intraopératoire de la surface antérieure du foie. Un champ de déformations entre les modèles préopératoire et intraopératoire est calculé à partir de la distance géodésique à des repères anatomiques. De plus, une simulation biomécanique du pneumopéritoine est réalisée pour prédire la position de la cavité abdomino-thoracique qui est utilisée comme condition limite. L'évaluation de cette méthode montre que l'erreur de position du foie et de ses structures internes est réduite à 1cm. / Augmented reality can provide to surgeons during intervention the positions of critical structures like vessels. The 3D models displayed during a laparoscopic surgery intervention do not fit to reality due to pneumperitoneum deformations. This thesis aim is to correct these deformations to provide a realistic liver model during intervention. We propose to deform the preoperative liver model according to an intraoperative acquisition of the liver anterior surface. A deformation field between the preoperative and intraoperative models is computed according to the geodesic distance to anatomical landmarks. Moreover, a biomechanical simulation is realised to predict the position of the abdomino-thoracic cavity which is used as boundary conditions. This method evaluation shows that the position error of the liver and its vessels is reduced to 1cm.

Introduction: Transabdominal laparoscopic (TAPP) approach in the therapy of inguinal hernia is a suitable alternative to classical open inguinal hernia repair mainly in the hands of an experienced surgeon. TAPP repair offers the possibility of gentle dissection with implantation of the mesh from posterior approach. Hypothesis and objectives of the work: The fixation of mesh through penetrating techniques using staples, clips or screws is associated with a significantly increased risk of developing a post-herniotomy inguinal pain syndrome (CPIP). The aim of the thesis is to review options of self-fixating meshes in laparoscopic TAPP procedure without additional fixation. Furthermore to evaluate effect of this technique on development of the chronic postoperative groin pain and also on frequency of hernia recurrence and mesh migration. Patients and methods: Data analysis included all patients, who underwent inguinal hernia surgery at our Surgical Department within the period from 1.10.12 to 31.12.14 and fulfilled the inclusion criteria. Standard surgical technique was used. Data were entered and subsequently analyzed on Herniamed platform. Results: There were 241 patients enrolled to the group of which 396 inguinal hernias were repaired. The minimal follow up was at 12 months. At the assessment in one...

Background: Due to the deficit of knowledge on fine motor skill far transfer from one domain of expertise to another, piano performance and surgical training serve as a relevant, interdisciplinary context in which to study the transfer of motor skills given both have relatively well-established levels of performance and require complex fine motor skills. Musicians tend to demonstrate greater ease in all aspects of procedural knowledge which are known to contribute to the early stages of motor learning. Previous research in the Piano Pedagogy Research Laboratory (PPRL) found that extensive piano training was correlated with faster learning of surgical knot-tying skills. However, the short-term two-day timeline was a limitation of the study. Objective: Our project has built on previous work in the PPRL to address the short-term nature of previous studies by measuring a long-term performance curve as well as retention of surgical training and also expanded on the previous project by focussing this time on laparoscopic tasks. This study compared performance curves of two participant groups (pianists and controls) over five consecutive days and retention one week later, as measured by speed and accuracy of task completion. Laparoscopic training consisted of six tasks repeated at every session. Since laparoscopy involves a variety of abilities concurrently, we also administered a battery of ten psychometric tests to isolate and measure specific aspects of non-motor and fine motor skills. Results: There was no statistical difference between participant groups on the majority of laparoscopic training and psychomotor assessments based on two-way mixed ANOVA and Mann-Whitney U test analysis, respectively. There were also little to no significant correlations between abilities and laparoscopic performance. The only significant confounding variable was that the control group was significantly more interested in surgery than the musician group (p = .037). Conclusion: Overall, these results demonstrate that piano performance training did not far transfer to laparoscopic surgery. This is relevant to the debate on far transfer of motor skills given this study’s robust design which addressed previous shortcomings by including a longer timeline and more specifications of musicians’ characteristics. Our findings indicate that fine motor skills are domain specific to music and surgery, respectively.

Background: To explore cross‐sectional and longitudinal differences in general health‐related and prostate cancer‐specific quality of life (QoL) after robotic‐assisted (RARP) and laparoscopic (LRP) radical prostatectomy and to analyze predictive variables for QoL outcomes. Methods: In this multicenter, randomized controlled trial, prostate cancer patients were randomly assigned 3:1 to undergo either RARP or LRP. Patient‐reported outcomes were prospectively collected before and 1, 3, 6, 12 months after radical prostatectomy and included QoL as a secondary outcome. Validated questionnaires were used to assess general health‐related (EORTC QLQ‐C30) and prostate cancerspecific (QLQ‐PR25) QoL. Cross‐sectional and longitudinal contrasts were analyzed through linear mixed models. Predictive variables for QoL outcomes were identified by general linear modeling. Results: Of 782 randomized patients, QoL was evaluable in 681 patients. In terms of general QoL, the cross‐sectional analysis showed only small differences between study arms, whereas longitudinal comparison indicated an advantage of RARP on recovery: RARP patients reported an earlier return to baseline in global health status (3 vs. 6 months) and social functioning (6 vs. 12 months). In role functioning, only the RARP arm regained baseline scores. Regarding prostate‐specific QoL, LRP patients experienced more urinary symptoms and reported 3.2 points (95% confidence interval 0.4–6, p = 0.024) higher mean scores at 1‐month follow‐up and in mean 2.9 points (0.1–5, p = 0.042) higher urinary symptoms scores at 3‐month follow‐up than RARP patients. There were no other significant differences between treatment groups. Urinary symptoms, sexual activity, and sexual function remained significantly worse compared with baseline at all time points in both arms. Conclusions: Compared with LRP, the robotic approach led to an earlier return to baseline in several domains of general health‐related QoL and better short‐term recovery of urinary symptoms. Predictive variables such as the scale‐specific baseline status and bilateral nerve‐sparing were confirmed.:1 Abkürzungsverzeichnis 3 2 Einführung 4 2.1 Das Prostatakarzinom 4 2.1.1 Vorsorge und Diagnostik 4 2.1.2 Grundsätze der Therapie 5 2.1.3 Die radikale Prostatektomie 6 2.2 Lebensqualität 8 2.2.1 Gesundheitsbezogene Lebensqualität 8 2.2.2 Lebensqualität von Prostatakarzinompatienten 9 2.2.3 Prädiktoren der Lebensqualität nach radikaler Prostatektomie 12 2.3 Die LAP-01 Studie 13 2.3.1 Studiendesign 13 2.3.2 Lebensqualität im Rahmen der LAP-01 Studie 15 2.4 Zielsetzung und Fragestellung 16 3 Publikationsmanuskript 17 4 Zusammenfassung der Arbeit 28 5 Literaturverzeichnis 33 6 Anlagen 39 6.1 EORTC QLQ-C30 39 6.2 EORTC QLQ-PR25 42 7 Darstellung des eigenen Beitrags 44 8 Selbstständigkeitserklärung 45 9 Lebenslauf 46 10 Danksagung 48

In recent years laparoscopic liver surgery established itself into today’s standard of care regarding surgical liver treatment. It was a long way for minimally invasive liver resection to develop and popularize as it was accompanied by initial reservations and concerns. Some of these already had been clarified while other questions still remain and require further investigation in the complex field of laparoscopic liver surgery. Initial concerns with respect to oncological inferiority and technical inapplicability in contrast to open surgery treatment could have been disproved within the framework of retrospective studies. In contribution to that, the aim of the study was to compare the surgical results and postoperative outcomes of consecutive laparoscopic liver resections (LLR) and open liver resections (OLR) at the high-volume liver tumor center of Leipzig university hospital. Since common classification systems for open liver surgery cannot be applied for LLR, the introduction of specific difficulty scoring systems for LLR helps to assess and classify the complexity of minimal invasive liver resection. With an increase in experience, modification of hybrid surgery and the application of novel visualization techniques such as indocyanine green (ICG) staining or hyperspectral imaging (HSI), more challenging procedures were accomplished, that initially would have been contraindicated for the laparoscopic approach (e.g. perihilar cholangiocarcinoma (pCCA) requiring biliary reconstruction). During the years 2018 and 2019 42% of all liver resections were approached laparoscopically at the Leipzig University hospital. A retrospective data analysis of n=231 patients undergoing LLR or OLR for the years 2018 and 2019 was performed and previously determined variables were collected. As a primary outcome measure, the short-term surgical and postoperative outcome of patients receiving LLR (=LLR group) compared to the patient cohort being treated by open resection (=OLR group) was evaluated. All liver resections were executed or assisted by the same two surgeons. Prior to surgery, every case was reviewed in a multidisciplinary tumor-board meeting and primarily assessed for possible minimal invasive approach. Analysis for patient demographics, pathologic diagnosis, radiologic findings and peri- and intraoperative surgical data was carried out. For LLRs intraoperatively, ICG counter perfusion staining was used in anatomic liver resection and direct ICG tumor staining was employed for tumor demarcation. With respect to classification, the extent of OLR was graded according to the Brisbane 2000 terminology in minor and major resections, whereas LLRs were categorized by means of difficulty (in accordance with Ban et al. and Di Fabio et al.). For measurement of surgical complication and assessment of morbidity, the Clavien-Dindo classification was applied. OLR was performed in n=124 (57%) and LLR in n=93 (43%). From all minimally invasive treated patients, 79% were operated totally laparoscopic and 16% were laparoscopic-hand-assisted due to infeasible lesions in the posterosuperior segments 7, 8 and 4a. In 5 cases a conversion to open surgery was necessary because of inaccessibility, tumor infiltration or morbid obesity. 28% of patients had previous upper abdominal surgery, whereof 36% in the OLR group and 19% in the LLR group. Regarding patient demographics, the mean age was significantly higher in OLR and the sex ratio was in favor of men for both groups. Malignant tumor lesions comprised 77%, while 24% were benign lesions. In both groups this larger number of malignant oncologic operation remained valid. The most common benign indications comprised focal nodular hyperplasia (FNH) and liver adenomas. It was shown that patients with CCA and Colorectal liver metastases (CRLM) were predominantly treated by open surgery, while patients with HCC diagnosis received LLR to a greater extent. Concerning the type of liver resection, non-anatomical resections were the most frequent in the cohort with 47%, thereof 55% LLR and 40% OLR. Followed second most by anatomic right and left hemihepatectomies and third most by left lateral resections, which were predominantly performed in laparoscopic technique. On the other hand, extended resections and trisectionectomies were predominantly operated by OLR. Radical lymphadenectomy was performed to a greater extent during OLR. Results showed that the mean operative time was longer for OLR (341 minutes in median) compared to LLR (273 minutes in median). Also the mean length of hospital stay was shorter for LLR patients, as well as abdominal drains were placed to lesser extent in LLR compared to OLR. In regard to R0-resection, R0-rates were higher in LLR with 98% vs. 86% in OLR. Thereby being highest for CRLM resections, followed by HCC and CCA. Putting all liver resections into classification systems, it was found that of all open procedures, 52% had major and 48% underwent minor resection according to Brisbane 2000. From the LLR group, in accordance with Di Fabio et al. 39% were classified as laparoscopic major hepatectomies, comprising 44% laparoscopic traditional major hepatectomies (LTMH) and 56% laparoscopic posterosuperior major hepatectomies (LPMH), which were technically challenging. The difficulty index stated by Ban et al. was classified as low for 8% of all performed LLRs, intermediate for 45% and of high difficulty in even 47%. Relating to morbidity (=Clavien-Dindo 3b or greater), patients with LLR had significantly lower morbidity compared to OLR. The same applies for in-hospital mortality. Our data show that despite the high number of complex and high-difficulty-classified liver resections that were performed, morbidity and mortality rates were low. As mentioned before, R0 resection rate in the LLR group was better than in the OLR group, however, this was not a case matched study, so a direct comparison is not valid. But still the study could demonstrate that the high number of LLRs being performed at the Leipzig University hospital, did not impair R0-resection rates. With an overall hospital mortality rate of 5.9% in the cohort, good results were achieved. Particularly the low rate of 1% in the LLR group speaks for itself and confirms that the development of a minimal invasive liver resection program should be on the right track. The majority of patients in the LLR and OLR group received an oncologic resection, what also resembles the global attitude that minimally invasive techniques are not reserved for selected tumor entities. Still it should be emphasized, the indication for a liver resection should not be loosened just due to minimal invasive accessibility, especially in benign liver lesions. Nevertheless, in the study the majority of benign lesions was operated by LLR. A few patients diagnosed with CCA received LLR. Thereof predominantly iCCA cases were indicated for a minimal invasive approach without biliary duct reconstruction and satisfying short-term outcomes over OLR could be obtained. However, only one case of pCCA which required Roux-Y bile duct reconstruction was treated with LLR in the study group, so if laparoscopic surgery is capable to replace the open approach in terms of treatment strategies for pCCA remains questionable. Patients with CRLM represent the centerpiece of our study population, still only 13% received LLR. The main reason of applying OLR was the high tumor load requiring future liver remnant augmentation strategies. As liver resection is confirmed to be the approach of choice for patients with HCC in cirrhosis, it is not surprising that HCC diagnosis accounted for the major part of LLRS in our collective.:Vorbemerkung und Bibliographie, 3 Abkürzungsverzeichnis, 4 Einführung, 5 - 1. Development of minimal invasive liver surgery, 5 - 2. Prior concerns of LLR, 6 - 3. Benefits of laparoscopic surgery, 6 3.1 General advantages of minimal invasive surgery, 6 3.2 Specific benefits of applying LLR, 7 - 4. Indications for LLR, 7 4.1 Benign liver lesions, 8 4.2 Malignant liver lesions, 8 4.3 Liver transplantation, 9 - 5. Technical supplement, 9 5.1 Hybrid and hand-assisted techniques, 10 - 6. Classification systems, 11 6.1 Difficulty scoring, 11 6.2 Clavien-Dindo Classification ,12 - 7. Limitations of LLR, 12 - 8. Aim of the study, 13 Publikation, 14 Zusammenfassung, 26 Literaturverzeichnis, 30 Darstellung des eignen Beitrags, 34 Selbstständigkeitserklärung, 35

Patienter som genomgår laparoskopiska ingrepp sövs med anestesiläkemedel och behöver administration av intravenösa vätskor och inblåsning av koldioxidgas i bukhålan under operationen. Ju längre anestesitid och ju längre tid det laparoskopiska ingreppet tar desto större är risken att patienter drabbas av perioperativ hypotermi. Icke-invasiva och invasiva uppvärmningsmetoder visar kunna förebygga perioperativ hypotermin och de postoperativa komplikationer som associeras med hypotermiuppkomst vid laparoskopiska ingrepp.Syfte: Syftet är att beskriva omvårdnadsåtgärder som kan förebygga uppkomsten av perioperativ hypotermi och dess postoperativa komplikationer hos patienter som genomgår laparoskopisk kirurgi. Metod: En integrativ litteraturöversikt. Resultat: Studien visar att icke-invasiva och invasiva uppvärmningsåtgärder kan förebygga perioperativ hypotermi och minska de postoperativa komplikationerna associerade med hypotermi vid laparoskopisk kirurgi. Forcerad varmluftsbehandling visar sig vara den mest effektiva metoden för att förebygga perioperativ hypotermi. Andra icke-invasiva och invasiva värmebehandlingar är effektiva när de kombineras med varandra men inte när de administreras enskilt.Uppvärmningsmetoder visar sig förebygga uppkomst av hypotermi, bibehålla intraoperativ normotermi, öka komfort, minska postoperativa komplikationer vilket även leder till bättre återhämtning hos patienter som genomgår laparoskopisk kirurgi. Slutsats: Denna studie belyser att uppvärmnings åtgärder med invasiva och icke-invasiva uppvärmningsmetoder kan behandla och förebygga hypotermiuppkomst under den perioperativa perioden hos patienter som genomgår laparoskopisk kirurgi. Studien även visar att dessa uppvärmningsmetoder förebygger även de postoperativa komplikationer som associeras med perioperativ hypotermin vid laparoskopisk kirurgiuppkomst. / Patients undergoing laparoscopic procedures need anesthetics, intravenous fluids and insufflation of carbon dioxide gas during laparoscopic surgery. The larger the time of the anesthesia and the laparoscopic procedure is, the greater is the risk of the patients being affected by perioperative hypothermia. Non-invasive and invasive warming methods can prevent the onset of perioperative hypothermia during laparoscopic surgery. Purpose: The aim of the study is to describe the nursing interventions that can prevent the onset of perioperative hypothermia and its postoperative complications during laparoscopic surgery. Method: An integrative review. Result: The study indicates that non-invasive and invasive warming methods can prevent the onset of perioperative hypothermia and complications during laparoscopic surgery. Forced air warming turns out to be the most effective treatment to prevent perioperative hypothermia. Invasive and non-invasive warming treatments seem to be more effective in combination with each other to prevent perioperative hypothermia than when administered alone. These treatments prevent intraoperative hypothermia, maintain intraoperative normothermia, increase comfort, decrease postoperative complications and improve patient recovery after laparoscopic surgery. Conclusions: This study illustrates that non-invasive and invasive warming methods can treat and prevent the onset of perioperative hypothermia during laparoscopic surgery. The study even illustrates that these warming methods prevent the postoperative complications associated with perioperative hypothermia during laparoscopic surgery.

<p>Training and ergonomics evaluation for laparoscopic surgery is an important tool for the assessment of trainees. Timely and objective assessment helps surgeons improve hand dexterity and movement precision, and perform surgery in an ergonomic manner. Traditionally, skill is evaluated by expert surgeons observing trainees, but this approach is both expensive and subjective. The approach proposed by this research employs an Ascension 3DGuidance trakSTAR system that captures the positions and orientations of hand and laparoscopic tool trajectories. Recorded trajectories are automatically analysed to extract meaningful feedback for training evaluation using statistical and machine learning methods.</p> <p>The data are acquired while a subject performs a standardized task such as peg transfer or suturing. The system records laproscopic instrument positions, hand, forearms, elbows trajectories, as well as wrist angles. We propose several metrics that attempt to objectively quantify the skill level or ergonomics of the procedure. The metrics for surgical skills are based on surgical instrument tip trajectories, whereas the ergonomics metric uses wrist angles. These metrics have been developed using statistical and machine learning methods.</p> <p>The metrics have been experimentally evaluated by using a population of seven first year postgraduate urology residents, one general surgery resident, and eight fourth year postgraduate urology residents and fellows. The machine learning approach discriminated correctly in 73% of cases between experts and novices. The machine learning approach applied to ergonomics data correctly discriminates between experts and novices in 88% of the cases for the peg transfer task and 75% for the suturing task. We also propose a method to derive a competency-based score using either statistical or machine learning derived metrics.</p> <p>Initial experimental data show that the proposed methods discriminate between the skills and ergonomics of expert and novice surgeons. The proposed system can be a valuable tool for research and training evaluation in laparoscopic surgery.</p> / Master of Applied Science (MASc)

A cirurgia geral tem experimentado após a década de noventa, com o desenvolvimento da laparoscopia, espetacular melhoria em todos os resultados. Uma menor morbimortalidade se deve ao menor trauma cirúrgico causado pelas cirurgias feitas por pequenos orifícios. O desenvolvimento tecnológico de endoscópios rígidos e flexíveis, propiciou aos médicos um acesso direto às patologias abdominais sem a necessidade de grandes aberturas da cavidade celômica. Assim, houve grande melhoria não somente dos resultados estéticos, mas principalmente na redução de morbidade. Nas cirurgias das vias biliares isso não foi diferente. Com o aprimoramento da técnica cirúrgica laparoscópica, a via de acesso cirúrgico endoscópica passou a ser preferida. Entretanto, a realidade da laparoscopia em muitos locais não se faz presente no tratamento da coledocolitíase, principalmente quando tal patologia é tratada em centros com menor aporte de recursos financeiros. A retirada de cálculos da via biliar principal exige o uso de fibroscópios de alto custo, bem como dispositivos descartáveis de alto valor, forçando o cirurgião desprovido de tais recursos muitas vezes a realizar a cirurgia de maneira convencional ou, no mínimo, aumentado a dificuldade do procedimento por via laparoscópica. Com o intuito de equacionar tal dificuldade, propõe-se com este dispositivo, mais um conceito de abordagem para este problema, inédito, testado em macroambiente, com utilização de cateter contendo balão com polímero autoexpansivo capaz de apreender os cálculos da via biliar principal por meio de inclusão. Utilizando os preceitos da colangiografia per operatória, o novo método propõe a retirada dos cálculos da via biliar principal de maneira indireta com auxílio de métodos de imagem comuns à maioria dos hospitais de média complexidade. / General surgery has experienced after the nineties, with the development of laparoscopy, spectacular improvement in outcomes. Lower morbidity and mortality is due to less surgical trauma caused by surgeries performed by small orifices. The technological development of rigid and flexible endoscopes gave doctors direct access to abdominal pathologies without the need for large openings in the coelomic cavity. Thus, there was a great improvement not only in the aesthetic results, but mainly in the reduction of morbidity. In biliary surgeries this was not different. With the improvement of the laparoscopic surgical technique, the endoscopic cirurgical approach was favored. However, the reality of laparoscopy in many places is not present in the treatment of choledocholithiasis, especially when such pathology is treated in centers with lower financial resources. Removal of stones from the main biliary tract requires the use of high-cost fibroscopes as well as high-value disposable devices, forcing the surgeon devoid of such resources, many times undergoing conventional surgery or at a minimum, increasing the difficulty of the procedure by laparoscopic approach. With the purpose of equating this difficulty, it is proposed with this device, another concept of approach to this problem, novel, tested in macro environment, with the use of balloon catheter containing self expanding polymer capable of grasping the calculi of the common bile duct by inclusion. Using the trans-operative cholangiography precepts, the new method proposes to extract the principal biliary tract calculi indirectly with the help of imaging methods common to the most hospitals.