Three-dimensional visualization technology for guiding one-step percutaneous transhepatic cholangioscopic lithotripsy
Yong-Qing Ye1, Ya-Wen Cao2, Rong-Qi Li3
1Department of Hepatobiliary Surgery, The Second People's Hospital of Foshan, Foshan 528000, Guangdong Province, China.
Insights
Three-dimensional visualization significantly improves one-step percutaneous transhepatic cholangioscopic lithotripsy (PTCSL) for hepatolithiasis. This technique offers higher stone clearance and stricture resolution, with fewer complications and lower recurrence rates.
Area of Science:
- Hepatobiliary surgery
- Minimally invasive procedures
- Gastroenterology
Background:
- Biliary stone disease, including hepatolithiasis with strictures, is common and challenging.
- Traditional PTCSL often results in high residual and recurrent stone rates.
Purpose of the Study:
- To evaluate the efficacy of one-step PTCSL using percutaneous transhepatic one-step biliary fistulation (PTOBF) guided by 3D visualization.
- To compare outcomes between 3D-PTOBF and standard PTOBF techniques.
Main Methods:
- Retrospective analysis of 140 patients undergoing one-step PTCSL for hepatolithiasis (Oct 2016 - Oct 2023).
- Patients divided into 3D-PTOBF and PTOBF groups.
- Assessment of stone clearance, complications, and long-term outcomes.
Main Results:
- The 3D-PTOBF group showed significantly higher immediate stone clearance (88.6% vs 27.1%) and stricture resolution (97.1% vs 78.6%).
- Postoperative complications (8.6% vs 41.4%) and stone recurrence rates (7.1% vs 38.6%) were significantly lower in the 3D-PTOBF group.
- Biliary strictures were more common in the 3D-PTOBF group initially (P=0.001), but resolution was superior.
Conclusions:
- Three-dimensional visualization enhances one-step PTCSL, making it a safe and effective treatment for complicated hepatolithiasis.
- This minimally invasive approach yields satisfactory perioperative and long-term outcomes.
- 3D-guided PTCSL shows potential as an alternative to traditional hepatobiliary surgery.
Background:
Biliary stone disease is a highly prevalent condition and a leading cause of hospitalization worldwide. Hepatolithiasis with associated strictures has high residual and recurrence rates after traditional multisession percutaneous transhepatic cholangioscopic lithotripsy (PTCSL).
Aim:
To study one-step PTCSL using the percutaneous transhepatic one-step biliary fistulation (PTOBF) technique guided by three-dimensional (3D) visualization.
Methods:
This was a retrospective, single-center study analyzing, 140 patients who, between October 2016 and October 2023, underwent one-step PTCSL for hepatolithiasis. The patients were divided into two groups: The 3D-PTOBF group and the PTOBF group. Stone clearance on choledochoscopy, complications, and long-term clearance and recurrence rates were assessed.
Results:
Age, total bilirubin, direct bilirubin, Child-Pugh class, and stone location were similar between the 2 groups, but there was a significant difference in bile duct strictures, with biliary strictures more common in the 3D-PTOBF group (P = 0.001). The median follow-up time was 55.0 (55.0, 512.0) days. The immediate stone clearance ratio (88.6% vs 27.1%, P = 0.000) and stricture resolution ratio (97.1% vs 78.6%, P = 0.001) in the 3D-PTOBF group were significantly greater than those in the PTOBF group. Postoperative complication (8.6% vs 41.4%, P = 0.000) and stone recurrence rates (7.1% vs 38.6%, P = 0.000) were significantly lower in the 3D-PTOBF group.
Conclusion:
Three-dimensional visualization helps make one-step PTCSL a safe, effective, and promising treatment for patients with complicated primary hepatolithiasis. The perioperative and long-term outcomes are satisfactory for patients with complicated primary hepatolithiasis. This minimally invasive method has the potential to be used as a substitute for hepatobiliary surgery.
