Single-Incision Plus One-Port Laparoscopic Choledocholithotomy with Primary Suture for Choledocholithiasis

Summary

This study demonstrates that single-incision plus one-port laparoscopic common bile duct exploration with primary suture is a safe, effective, and minimally invasive alternative for choledocholithiasis, offering faster recovery and comparable safety to traditional approaches.

Abstract

The purpose of this study protocol is to describe and verify the safety, feasibility, and efficacy of single-incision plus one-port (S+1) laparoscopic choledocholithotomy with primary suture for the treatment of choledocholithiasis, aiming to balance minimal invasiveness, operative precision, and enhanced patient recovery S+1 group. This study enrolled patients with choledocholithiasis who underwent the target surgical procedure and selected concurrent patients who received traditional multi-port laparoscopic choledocholithotomy with T-tube drainage as the control group. The specific surgical protocol includes placing a transumbilical multi-channel trocar and a 5 or 10 mm subxiphoid auxiliary port to optimize instrument distribution; making a longitudinal incision on the common bile duct (CBD) using an electrified small needle for stone extraction; and suturing the CBD with 5-0 absorbable sutures. Intraoperative choledochoscopy was used to confirm the clearance of stones, and perioperative indicators, including operative time, intraoperative blood loss, postoperative hospital stay, and complication rate, were compared between the two groups. Results showed no statistically significant differences in intraoperative blood loss or total complication rate between the two groups; however, the S+1 group had significantly shorter operative time, postoperative flatus time, and hospital stay. Complications (such as biliary leakage and residual stones) in both groups were resolved by minimally invasive interventions without the need for reoperation. This surgical procedure provides a safe and effective minimally invasive option for the treatment of choledocholithiasis. While avoiding T-tube-related complications, it also has the advantages of cosmetic effect and accelerated recovery, providing a basis for its clinical application in appropriately selected patients.

Introduction

Choledocholithiasis is a prevalent disease in hepatobiliary surgery. Without timely intervention, it may lead to severe complications such as acute cholangitis, obstructive jaundice, and biliary pancreatitis, which can even be life-threatening¹. Currently, surgical treatment remains the mainstay for choledocholithiasis. The traditional surgical approach is laparoscopic common bile duct exploration (LCBDE) combined with T-tube drainage, which can effectively remove stones. However, during the indwelling period of the T-tube, complications such as drainage tube blockage, infection, and electrolyte imbalance are prone to occur. Moreover, long-term....

Protocol

This study was approved by the Ethics Committee of Dongguan Tungwah Hospital, which waived the requirement for informed consent due to the anonymous retrospective design of this study.

1. Patient selection criteria

1. Inclusion criteria: Include participants diagnosed with choledocholithiasis confirmed by preoperative imaging (ultrasound, CT, or magnetic resonance cholangiopancreatography [MRCP]); age 18–80 years; American Society of Anesthesiologists (ASA) classification I–III; common bile duct (CBD) diameter ≥8 mm on preoperative imaging; and provision of written informed consent.
2. Excl....

Results

Between January 2022 and January 2025, our department performed S+1 laparoscopic common bile duct exploration (LCBDE) with primary suture on 56 patients. During the same period, 55 patients who underwent traditional LCBDE with T-tube drainage were selected as the control group for comparative analysis. All data were expressed as mean ± standard deviation (SD). Inter-group comparisons of significance were analyzed using the chi-square test (χ² test) for categorical data, and continuous data were analyzed using .......

Discussion

The core philosophy of minimally invasive surgery is to continuously pursue reduced trauma and faster recovery while ensuring surgical safety and therapeutic efficacy^8,9. This study integrates the laparoscopic technique with primary suture following common bile duct exploration, as none of the 56 patients in this group developed biliary stricture. Our findings indicate that this combined procedure significantly shortens operative time and accelerates postoperativ.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Google Forms	Google LLC	N/A	Used to distribute and collect responses for the online survey
Microsoft Excel	Microsoft Corporation	N/A	Used for data organization and export prior to analysis
PubMed Database	U.S. National Library of Medicine	N/A	Used for literature review and retrieval of references
Questionnaire	Liu D, Sawyer J, Luna A, Aoun J, Wang J, Boachie L, Halabi S, Joe B Perceptions of US Medical Students on Artificial Intelligence in Medicine: Mixed Methods Survey Study JMIR Med Educ 2022;8(4):e38325 URL: https://mededu.jmir.org/2022/4/e38325 DOI: 10.2196/38325	N/A	Validated questionnaire assessing perceptions of AI in medicine, adapted from a previously published study in JMIR Medical Education (2022)
R (Statistical Software)	R Foundation for Statistical Computing	N/A	Used for statistical analysis and data visualization