Textbook outcome and associated risk factors in laparoscopic transcystic common bile duct exploration

Figure 1 Trocar position. A 1.5-2 cm infraumbilical incision was created to establish pneumoperitoneum at an intra-abdominal pressure of approximately 12 mmHg. A trocar, cannula, and laparoscope were inserted in sequence. Additional ports were introduced via puncture sites at the xiphoid process, 2 cm inferior to the right midclavicular line at the costal margin, and 2 cm below the right anterior axillary line at the costal margin.

Figure 2 Surgical procedure. A: Clip the cystic artery and the gallbladder-side of the cystic duct, make a transverse incision on the cystic duct 1-2 cm from the common bile duct, and extend a longitudinal incision from the transverse incision along the cystic duct to its junction with the common bile duct; B: Sequentially insert 6F, 8F, 10F, 12F, 14F, and 16F dilators through the incision to dilate the bile duct; C: Insert a choledochoscope through the cystic duct to explore the common bile duct and remove stones; D: Perform interrupted suture at the junction of the cystic duct and common bile duct with absorbable sutures; E: Clip the cystic duct with absorbable clips; F: Complete cholecystectomy.

Figure 3 Nomogram for predicting the probability of achieving textbook outcome after laparoscopic transcystic common bile duct exploration. ALP: Alkaline phosphatase; ERCP: Endoscopic retrograde cholangiopancreatography.

Figure 4 Receiver operating characteristic curve for risk factors associated with textbook outcome failure after laparoscopic transcystic common bile duct exploration. ROC: Receiver operating characteristic; ALP: Alkaline phosphatase; ERCP: Endoscopic retrograde cholangiopancreatography.