LAUSR

Common bile duct (CBD) stones are present in approximately 3% to 16% patients with symptomatic gallstones [1– 3]. Laparoscopic common bile duct exploration (LCBDE) and laparoscopic cholecystectomy (LC) could treat cholecysto-choledocholithiasis in one session. However, some drawbacks including the unsatisfactory controllability of the surgical choledochoscope, postoperative bile leak, and the use of the T-tube have hindered the further development of LCBDE+ LC. To solve these problems, we introduced LCBDE through the cystic duct using a more flexible cholangioscope combined with cholecystectomy for cholecysto-choledocholithiasis. A 59-year-old man with abdominal pain underwent computed tomography (CT) examination and the result showed cholecysto-choledocholithiasis. He chose LCBDE+ LC to treat the gallstones and CBD stones in one session. During this procedure, we used a novel cholangioscope with flexible controllability, which was initially designed as a single-operator peroral cholangioscopy system [4]. First the gallbladder, cystic duct, and cystic artery were dissociated under laparoscopy, and the cystic artery was cut off using the electrocoagulation function. Then a 5-mm incision was created on the cystic duct (▶Fig. 1 a). The cholangioscope was inserted into the cystic duct through the trocar with the help of the laparoscope (▶Fig. 1 b). Multiple CBD stones were found and extracted using a basket under cholangioscopy in multiple sessions (▶Fig. 2, ▶Fig. 3). No residual stones were found under cholangioscopy and cholangiography (▶Fig. 4). Finally, the cystic duct was clamped, and the gallbladder was removed (▶Fig. 5, ▶Video 1). The patient’s recovery was smooth without any adverse events. Of note, this is the first experience of this technique in our team, and we hope that patients with cholecysto-choledochoE-Videos