The management of common bile duct (CBD) stones has changed dramatically in recent years, with advances in imaging, minimally invasive surgery, and multidisciplinary collaboration reshaping how surgeons approach these complex cases.
During the Panel Session, "Contemporary Management of Common Duct Stones and Cholangitis," on Sunday afternoon, September 27, experts from a range of surgical specialties will examine the latest evidence and technologies while providing guidance for managing both routine and challenging biliary disease.
According to co-moderator Chad M. Hall, MD, FACS, from the University of Colorado Health Memorial Hospital Central Trauma Center in Colorado Springs, the session reflects one of the most rapidly evolving areas in general surgery.
"The common bile duct seems to be one of the hottest topics in general surgery these days," said Dr. Hall. "Surgeons should know that a common bile duct exploration doesn't equate to an open, morbid procedure in 2026. There are new minimally invasive techniques that can be performed laparoscopically and robotically. If those options aren't available in your practice, don't worry; we'll discuss the open duct exploration as well."
The panel will review current evaluation and management strategies for CBD stones and cholangitis and discuss multidisciplinary treatment algorithms, particularly for patients with altered anatomy or other complex clinical presentations. Faculty also will discuss advances in laparoscopic and robotic exploration, as well as emerging technologies that improve stone clearance and expand minimally invasive treatment options.
Co-moderator Raul J. Rosenthal, MD, FACS, from University of California Los Angeles Health, said one of the biggest shifts in biliary surgery has been moving away from a "one-size-fits-all" treatment strategy toward individualized, evidence-based care. Improved diagnostic tools such as magnetic resonance cholangiopancreatography and endoscopic ultrasound have increased diagnostic accuracy while reducing unnecessary procedures. At the same time, surgeons are increasingly adopting single-stage management, combining cholecystectomy and CBD exploration into one operation when appropriate.
"The best outcomes occur when clinicians understand the strengths and limitations of all available options," Dr. Rosenthal said. "Successful management is not about choosing the 'best procedure' but rather selecting the best procedure for the individual patient."
That patient-centered philosophy underscores the multidisciplinary nature of the session. Modern management often requires coordination among surgeons, gastroenterologists, advanced endoscopists, radiologists, and other specialists, particularly when treating patients with acute cholangitis, altered anatomy, previous bariatric surgery, impacted stones, or significant comorbidities. Rather than viewing surgical and endoscopic approaches as competing options, panelists will demonstrate how integrating available expertise leads to better patient outcomes.
Attendees also will hear how advances in robotic surgery are expanding treatment possibilities. Improved visualization, greater dexterity, and enhanced suturing capabilities are making robotic CBD exploration more accessible without sacrificing the benefits of minimally invasive surgery.
“The robotic platform is redefining how surgeons practice. It utilizes the advantages of minimally invasive surgery while overcoming the technical limitations of standard laparoscopy," Dr. Hall said. “I believe this ‘renaissance’ is occurring because the robotic platform enables surgeons to perform common bile duct explorations with a high success rate, minimal morbidity, and fast recovery for the patient. I foresee more surgeons using the robotic platform to manage common duct stones and proceed with a surgical-first approach in patients at high risk for choledocholithiasis."
Ultimately, the moderators hope attendees will leave with practical decision-making frameworks they can immediately apply in practice.
"Our goal is to cover the clinical scenarios that you see commonly, and the ones that you may only encounter a few times in your career," Dr. Hall said. "Anyone who even occasionally treats biliary disease and is looking to adopt new techniques for managing CBD stones should attend this session."
