Patients aged 18 years or older with gallbladder and bile duct stones who are suitable for surgery under general anesthesia.

Using a single 2 cm umbilical incision, a one-stage procedure addresses both bile duct and gallbladder stones, preventing future gallbladder stone migration into the bile duct and subsequent obstruction. This approach avoids complications associated with two-stage treatments like endoscopic retrograde cholangiopancreatography (ERCP), such as pancreatitis, duodenal bleeding or perforation, chronic cholangitis, and bile duct stone recurrence.

Compared to traditional laparoscopic surgery, single-incision laparoscopic surgery eliminates the need for T-tube bile drainage, resulting in less pain, faster recovery, and a scar concealed within the navel, achieving excellent cosmetic outcomes. For rare and complex cases of Mirizzi Syndrome McSherry type II, we developed the groundbreaking technique, single-incision laparoscopic transfistulous bile duct exploration. This approach has a 100% bile duct stone clearance rate, an average postoperative hospital stay of just four days, and zero rates of stone recurrence or delayed bile duct stricture, making it a global pioneer.

This surgery is also safely applicable to elderly patients, and the results have been published in the prestigious international journal Surgical Endoscopy.

Single-incision laparoscopic choledocholithotripsy with choledochoscopy, single-incision laparoscopic choledocholithotripsy via longitudinal cystic ductotomies, and single-incision laparoscopic bile duct suturing.

Since August 2020, the Kaohsiung Medical University Hospital (KMUH) surgical team has completed over 100 cases of Single-Incision Laparoscopic Common Bile Duct Stone Extraction (SIL-CBDE) combined with Cholecystectomy within approximately four years. Including previous cases performed at other hospitals, the team leader, Dr. Shu-Hung Chuang, has completed more than 300 of these procedures.

• Clinical Outcomes

• Based on retrospective study data from KMU between August 2020 and January 2024:

• The average patient age was 62 years, with half being elderly patients aged 65 and above.

• The average surgical duration was 3.5 hours.

• The mean operative blood loss was 34 mL.

• The average postoperative hospital stay was 4.4 days.

• The stone clearance rate was 98.8%. One case (1.3%) of residual stones was successfully cleared by a gastroenterologist using endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (EST).

• The success rate of single-incision laparoscopic surgery was 93.8%, with a conversion rate of 6.2% (five cases required conversion to two-port laparoscopic surgery).

• There were 12 cases (15%) of complications, of which ten (83.3%) were mild, classified as Clavien-Dindo grade I or II. The remaining twoi cases were classified as grade IIIA.

• To date, there are three cases of bile duct stone recurrence without mortality.

• Compared with recent large-scale studies on multi-incision laparoscopic bile duct exploration, our outcomes are superior in terms of stone clearance rate, postoperative hospital stay, and conversion to open surgery rate. The rate of Clavien-Dindo grade II or higher complications is well within international benchmarks.

• Key Quality and Safety Mechanisms

• All instruments and equipment (3D/2D laparoscopic imaging systems, extended length laparoscopic instruments, choledochoscopy sets) and disposable products (self-paid single-incision laparoscopic devices) are certified by Taiwan FDA.

• Choledochoscopic bile duct exploration and intraoperative cholangiography to double-check bile duct stone clearance.

• Morning surgical case reviews and complication discussion meetings.

• Establishment of a prospective database to regularly review treatment outcomes.

• Collection of postoperative quality of life questionnaires and patient satisfaction surveys.

• Engaging in various clinical research studies: randomized controlled trials, case-control studies, cohort studies, retrospective studies, etc.

Many patients have reported a postoperative pain score of only 1 (on a 10-point Verbal Rating Scale, where 10 represents the most severe pain imaginable).

• Eight papers on Single-Incision Laparoscopic Common Bile Duct Stone Extraction (SIL-CBDE) have been published in international medical journals, half of which were contributed by our team.

• Our approach—integrating single-incision minimally invasive surgery, one-stage common bile duct stone extraction and cholecystectomy, a transcystic approach for bile duct exploration, and the avoidance of T-tube drainage—either meets or exceeds international trends and standards. Compared to international single-incision and multi-port techniques, our performance consistently ranks above the global standard.

Analysis at Kaohsiung Medical University Hospital (KMUH) from 2017 to 2023 indicates that SIL-CBDE offers distinct advantages over multi-port or endoscopic surgeries, including shorter hospital stays and fewer required treatment sessions.