Although often asymptomatic, common bile duct (CBD) stones – choledocholithiasis – can result in life-threatening complications such as biliary pancreatitis, acute cholangitis, or obstructive jaundice if not promptly managed [1–3]. Interestingly, despite the minimal symptoms in many cases, their detection and removal remain a high priority in clinical practice. These stones are present in roughly 10–20% of patients undergoing cholecystectomy for gallstones, with or without clinical manifestations.

Cholangioscopy-guided lithotripsy, particularly with laser or electrohydraulic energy, offers a more direct and targeted alternative, especially in complex situations where standard methods fall short [3–6]. As endorsed by European Society for Gynaecological Endoscopy (ESGE) and other international bodies, early intervention is strongly advised to prevent complications, regardless of symptom presence. In some instances, particularly when the anatomy is unfavourable or stones are difficult in size or number, conventional endoscopic retrograde cholangiopancreatography (ERCP) becomes ineffective, failing in about 10% to 15% of attempts [1, 2].

Remarkably, a flexible ureteroscope – more common in urological procedures – was used successfully in the current case to manage an impacted CBD stone. The innovative use of laparoscopic cholangioscopy with laser lithotripsy is the focus of this report. It demonstrates how tools from one specialty can be repurposed effectively in another, especially in advanced centres dealing with difficult biliary cases.

Typically, ERCP – considered the standard of care – relies on endoscopic sphincterotomy followed by extraction using a balloon or basket catheter. When this method fails, clinicians must rely on alternative strategies to relieve the biliary obstruction and avoid emergency scenarios. This case illustrates the feasibility of such an approach when ERCP is either not feasible or unsuccessful and highlights its potential as a rescue therapy.

Six weeks of gradually worsening yellowish discoloration of the skin and sclera prompted a 44-year-old male to seek evaluation in the emergency department. He had no documented medical comorbidities. Notably, the patient had previously been diagnosed with obstructive jaundice and had undergone ERCP, during which a stent was placed in the CBD. The progression of jaundice occurred despite...


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