LAUSR

P rior to the advent of laparoscopic surgery, patients who presented with symptomatic cholelithiasis and concurrent choledocholithiasis underwent open cholecystectomy with simultaneous common bile duct exploration. The routine management of these patients within the operating room is a much less familiar concept, however, for surgeons entering practice in the past two to three decades. As laparoscopic cholecystectomy became the standard of care for symptomatic cholelithiasis, patients often required separate endoscopic interventions to address choledocholithiasis because most surgeons did not possess enough experience to perform laparoscopic common bile duct exploration (LCBDE) effectively and safely. In fact, a US nationwide inpatient sample review found that 93% of patients with concurrent choledocholithiasis underwent endoscopic retrograde cholangiopancreatography (ERCP) before or after laparoscopic cholecystectomy instead of one-stage LCBDEwith cholecystectomy. While ERCP is highly effective in clearing common bile duct stones, patients are subjected to additional anesthetic exposure, a procedure with its own complication risks, and potentially longer length of hospitalization. Today, general surgeons are becomingmore skilled in performing complex laparoscopic procedures, such as LCBDE. Competency in advanced laparoscopic tasks, such as suturing, is now a core component of residency training, and practicing surgeons can gain proficiency in these skillsets through hands-on courses offered by surgical societies. Along with advanced skill acquisition, improved technology and devices have simultaneously been developed over time to improve ease of use, enhance endoscopic visualization of bile duct lumen, and assist in the safe retrieval of stones. In this perspective, we explore how general surgeons can “reclaim” their role in managing patients with symptomatic cholelithiasis and concurrent choledocholithiasis through a one-stage laparoscopic treatment.