March 16th Morning


PG Course: Common Bile Duct Stones - Intraoperative Cholangiography (IOC) to Laparoscopic Common Bile Duct Exploration (LCBDE)

7:30 AM - 12:00 PM

Session Chair: Nathaniel Soper, MD
Session Co-chair: Fernando Santos, MD

Session Description

The management of choledocholithiasis remains a problem inherent to the modern practice of cholecystectomy. The modern surgeon must remain knowledgeable and facile in the diagnostic and therapeutic techniques required for the management of choledocholithiasis, and develop an approach that does not merely relegate the care of these patients to other consultants. This session will allow participants to evaluate the effectiveness of diagnostic and therapeutic techniques in the management of choledocholithiasis, and to develop an approach to patients with these problems that incorporates evidence-based recommendations, technical advice from experts, and resources available at the individual’s institution.

Session Objectives

At the conclusion of this session, participants will be able to:

  • Describe the benefits and effectiveness of routine imaging use (cholangiogram or ultrasound) to evaluate the biliary tree and reduce the rate of bile duct injuries and retained stones during laparoscopic cholecystectomy

  • Describe the technique of intraoperative cholangiography and ultrasonography, and identify technical pearls and pitfalls of each technique

  • Develop a management strategy for suspected or confirmed choledocholithiasis that incorporates LCBDE, taking into account skill level and local resources

  • Describe techniques of LCBDE and identify typical equipment needs for the procedures

  • Discuss the role of open bile duct exploration in the modern management of choledocholithiasis and describe the key steps of the technique

  • Discuss the role of adjuncts to bile duct exploration, such as biliary stent placement, for the management of patients with choledocholithiasis

Session Outline

Time Presentation Title Faculty Name

PG Course: Common Bile Duct Stones - Intraoperative Cholangiography (IOC) to Laparoscopic Common Bile Duct Exploration (LCBDE)


Intraoperative Evaluation of the Common Bile Duct – Ultrasound tips, tricks, results

Nathaniel Soper, MD


Intraoperative Evaluation of the Common Bile Duct – Cholangiogram tips, tricks, results

Edward Phillips, MD
8am Intraoperative cholangiography – Routine versus selective and the importance of interpretation

George Berci, MD

8:15am Q&A Panel Discussion  
8:30am Break



Common bile duct stones – Management options, selection criteria, single-stage versus two-stage, and when ERCP is preferred

Leslie Nathanson, MD
9:00am Endoscopic Management of Choledocholithiasis (role of EUS, appropriate indications for ERCP, techniques, and implications of ERCP-related infections)

Melissa Phillips LaPinska, MD

9:20am Laparoscopic trans-cystic exploration – Tips, tricks, results Joseph Petelin, MD

Laparoscopic trans-choledochal exploration – Tips, tricks, results

Morris Franklin Jr, MD

Q&A Panel Discussion





Open common bile duct exploration – Tips, tricks, results

David Rattner, MD


Adjuncts to common bile duct exploration - Biliary stents or ampullary dilation

Benjamin Poulose, MD, MPH


Routine single-stage management of choledocholithiasis - from idea to institutional reality Ahmad Mirza, MD


Reclaiming our surgical heritage: Teaching the next generation of surgeons the art of bile duct exploration Eric Hungness, MD


Questions for the panel All Speakers

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