Introduction: Choledocholithiasis remains a common complication of gallstone disease, with endoscopic
retrograde cholangiopancreatography (ERCP) being the current gold standard for management. However, ERCP
has limitations, particularly in cases involving large or impacted stones. Laparoscopic common bile duct exploration
(LCBDE) using flexible choledochoscopes offers an alternative but is underutilized due to high costs. This study
evaluates the feasibility, safety, and short-term outcomes of LCBDE using flexible ureteroscopes as a cost-effective
alternative.
Patients and methods: This prospective observational study included 15 patients with choledocholithiasis who
had previously failed ERCP and underwent LCBDE assisted by a flexible ureteroscope at Ain Shams University
Hospital between October 2023 and September 2024. Procedures were performed using standardized laparoscopic
techniques, with stone retrieval achieved by using flexible ureteroscope. Technical success was defined as complete
stone clearance with primary closure of the CBD.
Results: The mean age of the cohort was 52.1±9.7 years, with males representing 60% of the patients. The
mean operative time was 163.3±29.2 minutes, and the mean hospital stay was 5.1±1.0 days. Blood loss averaged
168.7±85.4 mL. Technical success was achieved in 14 out of 15 patients (93.3%), with one case requiring
conversion to open surgery due to stone impaction. Complications occurred in 13.3% of patients, including one
instance of biliary leakage managed conservatively and one missed stone detected during follow-up, which was
resolved via ERCP.
Conclusion: Flexible ureteroscopy-assisted LCBDE is a feasible, safe, and effective option for managing
choledocholithiasis, particularly in resource-constrained settings. While further studies with larger cohorts and
longer follow-up periods are needed to evaluate long-term outcomes, this technique holds promise for addressing
gaps in hepatobiliary care access.