Overview
One operation, not two.
When stones move out of the gallbladder and lodge in the common bile duct, they cause pain, jaundice, and sometimes life-threatening cholangitis. The classic management is two separate procedures: ERCP first to clear the bile duct, then a separate laparoscopic cholecystectomy to remove the gallbladder. Single-stage laparoscopic common bile duct exploration with SpyGlass cholangioscopy combines both into one operation — the gallbladder is removed and the bile duct is cleared in the same trip to the operating room.
SpyGlass is a thin, disposable cholangioscope that gives the surgeon a direct video view inside the bile duct. We pass it through the cystic duct (the small duct that originally drained the gallbladder) or, when needed, through a small opening in the bile duct itself. Stones are captured with baskets, larger stones are fragmented with electrohydraulic or laser lithotripsy, and the duct is verified clean before closing. The patient avoids a second procedure, the risk of post-ERCP pancreatitis, and an extra hospital stay.
Who is a candidate?
Anyone undergoing planned gallbladder removal where stones are known or suspected to be in the common bile duct. We screen with pre-op MRCP or with an intraoperative cholangiogram. Patients with prior gastric bypass are a particularly good fit because ERCP is hard to do after bypass — the SpyGlass approach goes around that problem entirely. Patients with failed prior ERCP are also good candidates. Patients with severe cholangitis usually need urgent drainage first (ERCP or PTC) and then come to surgery later.
How we perform it
At the start of the operation, we perform an intraoperative cholangiogram through the cystic duct to map the biliary tree and confirm stones. We then pass the SpyGlass cholangioscope through the cystic duct (or through a small choledochotomy when the cystic duct is too narrow or the stones too large) into the common bile duct. Under direct vision we extract stones with baskets, fragment them with lithotripsy if needed, and verify clearance. The duct is closed primarily, over a T-tube, or with a transcystic drain depending on what was done.
Recovery
Most patients stay 1–2 days in the hospital. Pain is mild — typical of a laparoscopic procedure. You can eat the day of or after surgery and most return to office work in a week. Patients who had a choledochotomy or a T-tube placed have a slightly longer recovery and follow-up imaging before drain removal. Long-term, the stones are gone and the operation is durable.
Why Florida Surgical
Single-stage laparoscopic bile-duct exploration is a foregut and HPB skill — it is not universally offered. Dr. Shaw is fellowship-trained in HPB surgery and routinely performs SpyGlass-assisted cholecystectomy and bile-duct exploration. The approach is particularly valuable for our many post-bypass patients in whom ERCP is not easily available, and it gives every patient an option for one-trip, one-operation stone clearance when it is the right fit.
Frequently asked questions
What is SpyGlass cholangioscopy?
SpyGlass is a thin, single-use cholangioscope that gives a direct video view inside the bile ducts. Through it we can see stones, take biopsies, treat strictures, and use targeted lithotripsy. We use SpyGlass during the same operation as the gallbladder removal to find and clear stones from the common bile duct.
How is this better than ERCP first, then cholecystectomy later?
Single-stage management — gallbladder removal plus bile-duct clearance in one operation — avoids a second procedure (ERCP), reduces total hospital time, and avoids the small but real risks of pancreatitis from ERCP. For many patients, especially those who are otherwise healthy, it is the more efficient option. We coordinate with GI when ERCP is the right path.
What kind of stones can be treated this way?
Most common-duct stones can be cleared. Small to medium-sized stones are captured with baskets through the cystic duct or through a small opening in the duct. Larger stones are broken up with electrohydraulic or laser lithotripsy under direct vision through SpyGlass.
Does the bile duct have to be opened?
Not always. The cystic-duct approach goes through the existing duct that connected the gallbladder, leaving the common bile duct itself untouched. For larger stones or when the cystic duct is too small, we make a small opening in the bile duct (choledochotomy) and close it over a T-tube or with primary closure. We always choose the least invasive route that works.
Who is a candidate?
Patients with bile duct stones found on MRCP or intraoperative cholangiogram during planned cholecystectomy. We confirm at the start of the operation with a cholangiogram and then proceed to SpyGlass exploration when stones are present. Patients with severe biliary anatomy abnormalities, severe inflammation, or specific contraindications may be better served by post-op ERCP.