To evaluate clinical efficacy of a novel type of laparoscopic pneumoperitoneum-free rigid endoscopic holmium laser lithotripsy in the treatment of hepatolithiasis.

Clinical data of 6 patients with hepatolithiasis who underwent laparoscopic pneumoperitoneum-free rigid endoscopic holmium laser lithotripsy in People's Hospital of Hunan Province from March 2023 to May 2023 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 1 patient was male and 5 female, aged 46-68 years, with a median age of 62 years. A new type of laparoscopic rigid endoscopic holmium laser lithotripsy was self-designed, and pneumoperitoneum was not required intraoperatively. Perioperative conditions and complications were observed.

All patients successfully completed the surgery, and no conversion to open surgery occurred. The average operation time was (145±22) min, and intraoperative blood loss was 5-50 ml, witha median blood loss of 10 ml. The length of postoperative hospital stay was (5.0±0.6) d. No death occurred during perioperative period. No complications, such as hypercapnia, air embolism, subcutaneous emphysema, abdominal infection and biliary bleeding, occurred during and after surgery. All patients were recovered and discharged. CT scan at postoperative 3 d showed no residual hepatolithiasis.

The self-designed novel type of laparoscopic pneumoperitoneum-free rigid endoscopic holmium laser lithotripsy is a safe and efficacious treatment for hepatolithiasis, which can effectively reduce the incidence of intraoperative pneumoperitoneum-related complications, improve surgical efficiency and shorten operation time.