Three-dimensional visualisation combined with intraoperative ultrasound in laparoscopic hepatectomy for complex hepatolithiasis: a propensity score-matched retrospective cohort study

Abstract Objective Complex hepatolithiasis remains challenging for laparoscopic hepatectomy. Three-dimensional visualisation technology (3DVT) alone is limited by its static, preoperative nature, whereas intraoperative ultrasound (IOUS) lacks a global anatomical overview, and quantitative evidence for their synergistic benefit remains insufficient. This propensity score-matched (PSM) retrospective cohort study evaluated whether combined 3DVT and IOUS navigation improves perioperative safety and long-term outcomes compared with conventional two-dimensional imaging in patients with complex hepatolithiasis. Results Among 180 patients who underwent laparoscopic hepatectomy between January 2020 and December 2025, 66 matched pairs were analysed. The combined-navigation group had significantly shorter operative time, less intraoperative blood loss and lower conversion and transfusion rates than the control group (all P < 0.05). The one-stage stone clearance rate was 100.0% versus 90.9% (P = 0.028), and the overall postoperative complication rate was 3.0% versus 18.2% (P = 0.009). Over a mean follow-up of approximately 37 months, the stone recurrence rate was 1.5% versus 10.6% (P = 0.039), with significantly better recurrence-free survival (log-rank P = 0.039). Combined navigation was an independent protective factor for postoperative complications (OR = 0.313, 95% CI 0.107–0.915; P = 0.034).