**6. Application of intraoperative techniques for LCBDE**

The laparoscopic CBD exploration should be performed by an experienced surgeon. After exposure to the inferior surface of the liver, we start the dissection in the Calot's triangle with the identification of cystic duct and cystic artery. After the division of the cystic artery between two 5 mm titanium clips, we assess the diameter of the cystic duct. If it is dilated and thickened, we perform a transverse or T-type microincision at the level of confluence with scissors and the duct is cannulated with a 4- or 5-Fr cholangiogram catheter. By intraoperative C-arm fluorocholangiography, we can visualize the bile duct anatomy and the presence of CBD stones.

The gallbladder is usually left in place, held by the second assistant during laparoscopic exploration of CBD.

From a technical point of view, it is possible to perform the LCBD exploration by a transcystic route or after choledochotomy. Generally, an indication for choledochotomy is a diameter of CBD ≥ 10 mm and a cystic duct ≥5 mm for insertion of 5 mm choledochoscope (**Figure 1**). Even though the two trials [60, 61] defined minimum required
