Comprehensive and innovative techniques for laparoscopic choledocholithotomy: A surgical guide to successfully accomplish this advanced manipulation

Figure 6 Laparoscopic choledocholithotomy. A: Generally, both the transductal incision and subsequent primary closure are made in the same direction along the long axis; B: In ducts with diameter smaller than 7-8 mm, primary closure is performed in the direction of the short axis to avoid postoperative stenosis; C and D: Though severe adhesions and dense tissue are often intractable during reoperative surgery, a laparoscopic approach is safe and feasible for choledocholithotomy; E and F: A transductal incision (blue arrow) is made along the long axis, and full-layer interrupted sutures are placed at the upper and lower edges of the transductal incision to avoid severe laceration of the extrahepatic bile duct during cholangioscope maneuvers. CHD: Common hepatic duct; CBD: Common bile duct.