Transcystic biliary tract exploration during single-stage treatment for cholecystitis/symptomatic cholelithiasis plus choledocholithiasis using the SpyGlass system: a favorable therapeutic proposal

Choledocholithiasis is traditionally managed via a two-stage approach involving endoscopic retrograde cholangiopancreatography followed by laparoscopic cholecystectomy. However, this method carries significant morbidity and logistical challenges. We report a case of a 70-year-old woman with symptomatic choledocholithiasis and mild pancreatitis successfully treated with a single-stage laparoscopic cholecystectomy and transcystic bile duct exploration using the SpyGlass DS II system. This technique enabled direct stone visualization, electrohydraulic lithotripsy, and successful ductal clearance without the need for choledochotomy or papillary trauma. The patient experienced an uneventful recovery, resuming oral intake within 6 hours and being discharged within 36 hours postoperatively. SpyGlass-assisted transcystic exploration offers important advantages over endoscopic retrograde cholangiopancreatography, including reduced complication rates, shorter hospital stays, and cost-effectiveness in experienced centers. This case supports the integration of SpyGlass technology into surgical algorithms for choledocholithiasis management, especially in high-risk or anatomically challenging patients. Further studies are warranted to confirm its role in broader clinical practice.