Background: Endoscopic retrograde cholangiopancreatography (ERCP) may be inappropriate for most patients with choledocholithiasis. This study aimed to evaluate one-step percutaneous transhepatic cholangioscopic lithotripsy (PTCSL) in the treatment of patients with choledocholithiasis who could not undergo ERCP (e.g., failed ERCP, altered anatomy, and/or contra-indications). Method: This was a retrospective single-centre series of 67 patients who underwent choledocholithiasis between November 2015 and March 2018: 35 with one-step PTCSL (Group A) and 32 with laparoscopic common bile duct (CBD) exploration (Group B). Results: Compared with Group B, Group A showed shorter duration of operation, length of stay in the hospital, postoperative hospital stay, postoperative drainage time, and time to oral intake (all P < 0.05). Intraoperative blood loss, costs, conversion to open surgery (one in group A vs. seven in group B; P = 0.023), and bile leakage (none in group A vs. four in group B; P = 0.047) were lower in Group A than in Group B. There were no significant differences between the two groups regarding the intraoperative clearance rate, ultimate clearance rate, and several postoperative complications. Conclusion: One-step PTCSL could be an alternative for patients with choledocholithiasis, especially when ERCP is not feasible. (c) 2020 Elsevier Masson SAS. All rights reserved.