To explore the feasibility and clinical efficacy of tubeless percutaneous transhepatic cholangioscopic lithotomy.

Two patients with hepatolithiasis admitted to The First Affiliated Hospital of Guangzhou Medical University on Apr. 2026 and Jun. 2026 were enrolled in this study. Two patients underwent tubeless percutaneous transhepatic cholangioscopic lithotomy. Clinical baseline data, operative time, surgical procedures, intraoperative blood loss, postoperative hospital stay, postoperative complications of the two patients were analyzed.

Ultrasound-guided one-step percutaneous transhepatic biliary puncture and sinus tract dilation for lithotomy were performed in both patients. Complete stone clearance was achieved in one case, an 8.5 Fr biliary internal stent was placed, then the percutaneous transhepatic sheath was removed without percutaneous transhepatic biliary external drainage. In the other case, after complete stone removal, the hepatic sinus tract was sealed with absorbable human fibrin glue, with neither biliary internal stent nor external biliary drainage placed. Tubeless percutaneous transhepatic cholangioscopic lithotomy was successfully accomplished in both patients. The operative time was 90 min and 70 min, respectively. Intraoperative blood loss was less than 10 ml in both cases. No intraoperative or postoperative complications such as biliary hemorrhage, peritoneal effusion or bile leakage occurred. Postoperative abdominal CT showed no residual stones in both patients.

Tubeless percutaneous transhepatic cholangioscopic lithotomy can achieve onestage complete stone clearance without placement of percutaneous transhepatic biliary external drainage tube. It provides a novel surgical strategy for percutaneous transhepatic cholangioscopic management of hepatolithiasis.