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  Executive Summary Hepatolithiasis (HL), characterized by calculi in the proximal hepatic ducts, is a complex condition that often leads to biliary obstruction, infection, and irreversible liver parenchymal damage . Traditional classifications are frequently too complex for practical clinical application. This document outlines a study of a new, simplified classification system based on the pathological evolution of the disease , categorizing HL into four distinct types: Primary, Inflammatory, Mass-forming, and Terminal . Analysis of 68 patients treated under this framework demonstrates that tailored surgical strategies —incorporating precise liver resection and choledochoscopy—yield high therapeutic efficacy. Key findings include an immediate stone clearance rate of 73.5%, a final stone clearance rate of 89.7%, and a 96.6% satisfactory postoperative quality of life among followed-up patients. This classification provides a scientific and reasonable guide for optimizing treatment ...

  Executive Summary Laparoscopic liver resection (LLR) has become a primary treatment for intrahepatic duct (IHD) stones due to its safety and benefits in recovery. However, existing Difficulty Scoring Systems (DSS) are predominantly designed for hepatocellular carcinoma (HCC), failing to account for the unique pathological challenges of IHD stones , such as biliary strictures, hepatic atrophy, and history of multiple surgeries. A recent retrospective cohort study published in the World Journal of Gastrointestinal Surgery (October 2024) successfully developed and validated a novel DSS specifically for IHD stone patients . By analyzing clinical data from 80 patients across two medical centers, the study identified five independent predictors of surgical difficulty : stone location, stone count, bile duct grade, frequency of previous biliary surgery, and distal bile duct atrophy. The resulting DSS categorizes surgical difficulty into three tiers ( Low, Medium, and High ). Externa...

  Executive Summary In laparoscopic surgery, the requirement to perform sutures traditionally necessitates the use of 10-mm or 12-mm trocars to accommodate the passage of surgical needles. This technical note describes a specialized " trick " developed by Nohuz et al. (2017) that allows surgeons to perform one or more stitches while utilizing only 5-mm trocars throughout the procedure. By avoiding the transition to larger diameter devices, surgical teams can minimize postoperative complications —specifically trocar-site hernias—and improve patient recovery through reduced incision sizes and decreased scar-related pain . The technique is applicable across various disciplines, including gynecological, digestive, and urological surgeries. Rationale and Clinical Indications The primary motivation for this technique is the optimization of outpatient surgery and the reduction of morbidity associated with larger laparoscopic ports. Limitations of Standard Practice Standard laparo...