SpyGlass

Posting:

Post as LC, psb IOC, psb LCBDE, psb endoscopic biliary exploration. Adding LCBDE alone will not pull spyglass.

Must add 47550 to cases that will require SpyGlass. 

Use this PL, which ONLY includes SpyGlass equipment and materials.

MUST be added in addition to lap chole or lap chole with IOC.

For billing, use CPT 47564 and also the 47550 code. 

The tower will live in Madison’s office for now. 

There is a set up QR code on the cart. Also attached is a set up and procedure guide

OR Nursing Instructions and Supplies:

FOR COMMON BILE DUCT EXPLORATION (SPYGLASS):

• Do NOT open any SpyGlass supplies until asked by surgeon

• SpyGlass cart located in general surgery coordinator office (A.02.603), key at desk

• Must use IV saline for lithotripsy, get IV tubing and pressure bag from anesthesia

SpyGlass Supply SAP #s

1. SpyGlass Scope 404083
2. IOC Catheter 404085
3. Guidewire 404085
4. Sheath 404087
5. 6 x 40mm Balloon Catheter 404089
6. 7 x 40mm Balloon Catheter 404090
7. 8 x 40mm Balloon Catheter 404091
8. Inflation Device 404092
9. Retrieval Basket 404084
10. Lithotripsy Probe 404088

Also Need: Spyglass Discover Tower

SpyGlass Discover Set Up Instructions

1.                  Equipment Needed

a.       SpyGlass CBDE cart with monitor attached

b.       SpyGlass Discover Digital Catheter

c.       SpyGlass Discover Retrieval Basket

d.       SuperSheath CBDE (12F)

e.       SpyGlass Discover Jagwire (0.035”)

f.        SpyGlass Discover Dilation Balloon (6, 7, or 8mm diameter)

g.       Encore 26 inflation device

h.       Autolith EHL Probe

i.         Image II IOC Catheter + 3 way stopcock + 2 50cc Luer Syringes

j.         1L Saline bag

k.       IV Tubing (10, 15 or 20 drops/mL faster flowrate)

l.         IV Pressure bag

m.     18G Angiocath or larger

2.                  Cart and Monitor Set Up

a.      Plug the gray power cord on the back of the SpyGlass Cart into power source. Power SpyGlass Discover controller (white box) on. SpyGlass Discover logo will appear on the monitor screen.

b.      Surgeon scoping will be standing on patient’s right side, best to place cart + monitor on patient’s left side

3.                  Irrigation Set-Up Options

a.      Spike pressure bag with IV tubing.  Irrigation channel (blue water droplets) will be passed off the sterile field and connected to IV tubing (luer connector)

4.                  During the Procedure: Cholecystectomy

a.      Separate stab incision site will be determined for Cholangiogram, direct access into cystic duct

                                                              i.      18G or larger angio catheter

                                                             ii.      Pass 0.035 spyglass discover jagwire through 18G just through the abdominal wall

                                                           iii.      Remove angiocatheter, leave wire in place

                                                           iv.      Load 12F super sheath CBDE over the guidewire, remove blue dilator

                                                             v.      Pass Imager II IOC Catheter through sheath and into ductotomy, secure IOC catheter onto cystic duct

                                                           vi.      Connect 3-way stopcock to IOC Catheter, one syringe 100% saline, one syringe 50/50 saline and contrast

                                                         vii.      If IOC is positive, pass spyglass Discover jagwire through IOC Catheter and into cystic and CBD, confirm wire placement into duodenum with fluoroscopy

b.      Remove IOC catheter while leaving wire in place

c.       Surgeon may choose to dilate the cystic duct. Dilation balloon goes over the 0.035 guidewire.

                                                              i.      Use Encore inflation device and SpyGlass Discover Dilation Balloon (6, 7 or 8 MM)

d.      Remove dilation balloon and leave wire in place

e.      Surgeon may then load SpyGlass Discover scope over the wire and into cystic duct

f.        Wire will be removed to pass the retrieval basket down working channel to capture stone.