Surgical Techniques Development
The Biliary Endovascular Toolkit: Transcystic Laparoscopic Common Bile Duct Exploration with Balloon Sphincteroplasty for Single-Stage Choledocholithiasis Management
By Mason H Remondelli, Kyle Patterson, Kennedy Nye and 7 others.
Abstract
Background
Choledocholithiasis complicates 10–15% of patients undergoing cholecystectomy. While endoscopic retrograde cholangiopancreatography (ERCP) followed by cholecystectomy is common, access to ERCP is inconsistent in rural and military hospitals, highlighting the role for single-stage laparoscopic common bile duct exploration (LCBDE).
Methods
We describe a technical approach for fluoroscopy-guided, wire-based transcystic LCBDE using standardized endovascular tools, the “Biliary Endovascular Toolkit”. We performed a retrospective review of five patients undergoing cholecystectomy and transcystic LCBDE at our military hospital between May 2024 and October 2025. The operative technique employed percutaneous micropuncture sheath access, fluoroscopy-guided transcystic wire cannulation of the ampulla, and balloon dilation with sphincteroplasty for stone clearance.