Objective:To systematically evaluate the efficacy and safety of laparoscopic transcystic approach with micro-incision of the cystic duct confluence in common bile duct exploration (LTM-CBDE) versus laparoscopic common bile duct exploration (LCBDE) for the treatment of choledocholithiasis.Methods:PubMed, Library, Embase, Cochrane, CNKI, VIP, CBMdisc, Wanfang and other databases were searched to collect relevant literature about LTM-CBDE treatment of choledocholithiasis from December 2013 to December 2023. The main observational indexes were operation time, intraoperative bleeding, drainage tube banding time, postoperative gastrointestinal function recovery time, hospitalization time and postoperative complication rate. Meta-analysis was performed using Review Manager 5.4 software.Results:A total of 15 studies were collected, including one in English and 14 in Chinese. Five were randomized controlled clinical trials and 10 were case-control studies. A total of 1 493 patients, including 690 males and 803 females, aged (53.7±9.2) years old. Among them, 732 patients underwent LTM-CBDE as the microdissection group and 761 patients underwent LCBDE as the control group. Compared with the control group, the meta-analysis showed that patients in the microdissection group had a shorter drain banding time ( MD=-3.34, 95% CI: -4.69--1.99, P<0.001), a faster recovery time of postoperative gastrointestinal function ( MD=-0.63, 95% CI: -1.00--0.25, P=0.001), a shorter hospital stay ( MD=-2.18, and 95% CI: -2.79--1.57, P<0.001), and a lower incidence of bile leak ( OR=0.36, 95% CI: 0.22-0.59, P<0.001) and overall complications ( OR=0.28, 95% CI: 0.18-0.42, P<0.001). Conclusion:LTM-CBDE is safer and more effective than LCBDE in the treatment of choledocholithiasis and deserves clinical promotion.