Fig. 1

PTOBF surgical procedure. A Puncture plan based on preoperative imaging findings. B Intraoperative US exploration to determine the puncture point. C After US-guided puncture, bile was seen on retraction to represent successful puncture. D US-assisted judgment of guidewire placement position. E US-guided dilator gradually dilates the sinus. F Placement of 14Fr protective sheath. G US-assisted choledochoscopic stone extraction. H Placement of a “J” shaped drain