Background: Hepatic resection requires precise knowledge of vascular anatomy and remnant liver volume to guarantee both safety and efficacy. Three-dimensional (3D) models, either virtual or printed, have been proposed as tools to optimize surgical planning, education, and intraoperative navigation. Material and Methods: This retrospective observational study evaluated the impact of 3D model utilization (virtual and printed), in 89 patients who underwent elective hepatectomy at Infanta Elena University Hospital (Valdemoro, Madrid, Spain) between May 2018 and May 2023. The implementation of 3D modeling began to be routinely implemented as of November 2020. Patients were divided into two groups: those without 3D modeling (n = 40) and those with 3D modeling (n = 49). Results: Baseline characteristics were comparable between groups. Intraoperative blood loss was significantly lower in the 3D model group (median 175 mL vs. 262.5 mL; p < 0.001), with no statistically significant differences in operative time, complication rate (Clavien–Dindo classification), length of hospital stay, or in-hospital mortality. Multivariable analysis identified dyslipidemia, postoperative sodium delta, and postoperative increase in direct bilirubin as independent risk factors for complications, whereas albumin demonstrated a protective effect. Conclusions: Three-dimensional modeling improves anatomic orientation and reduces intraoperative blood loss, although it does not significantly modify classic perioperative outcomes. Its principal value appears to reside in preoperative planning and technical safety rather than direct clinical impact.

Background: Laparoscopic transcystic bile duct exploration has progressively evolved as an effective single-stage approach for the management of choledocholithiasis in patients with gallbladder in situ. Although endoscopic retrograde cholangiopancreatography followed by cholecystectomy remains widely practiced, growing evidence supports the transcystic approach as a safe, minimally invasive, and cost-effective alternative. Methods: We present a standardized, step-by-step description of the laparoscopic transcystic technique developed through our experience in over 100 consecutive patients. The procedure is detailed, including the management of specific intraoperative scenarios. Technical tips and tricks are provided to optimize performance in cases of narrow cystic ducts, impacted or large stones, prior biliary prostheses and complex inflammatory conditions. In addition, we developed a learning-curve modeling framework to quantify how surgical experience influences key outcomes and to estimate the procedural volume required to achieve reproducible and acceptable results in other centers adopting this technique. Results: The standardized technique proved feasible and reproducible across a broad range of clinical presentations. The transcystic approach allowed successful clearance of the bile duct in the vast majority of patients. Our cumulative experience demonstrates that the technique can be safely adopted regardless of cystic duct diameter, number or size of stones, or patient characteristics. Conclusion: The transcystic approach represents a valid, safe, and reproducible first-line technique for choledocholithiasis in patients with gallbladder in situ. Its standardization facilitates consistent outcomes and significantly shortens the learning curve, enabling its adoption as a routine practice in centers experienced in advanced laparoscopic biliary surgery.

Víctor Nieto Barros, Laura Alonso Murillo, Raúl Castañeda Vozmediano, Carlos García Vásquez, Santos Jiménez-Galanes Marchán. Ann Hepatobiliary Pancreat Surg -0001;0:. https://doi.org/10.14701/ahbps.25-145

María Victoria Vieiro Medina, Laura Alonso Murillo, Carlos Ernesto García Vasquez, Victor Nieto Barros, Marta de la Fuente Bartolomé, Fernando Neria, Santos Francisco Jiménez de los Galanes Marchán. Ann Hepatobiliary Pancreat Surg -0001;0:. https://doi.org/10.14701/ahbps.25-250