Robotic-Assisted Transcystic Endoscopic Common Bile Duct Exploration
Marc Mankarious, MD¹; Benjamin S. C. Fung, MD, FRCSC²; Joshua S. Winder, MD^1
1Penn State Health Milton S. Hershey Medical Center
²North York General Hospital, University of Toronto

Choledocholithiasis complicates cholecystectomy in 10–15% of patients. In individuals with prior Roux-en-Y gastric bypass (RYGB), altered foregut anatomy renders traditional endoscopic retrograde cholangiopancreatography (ERCP) technically challenging or unsuccessful. This report details the use of robotic-assisted transcystic endoscopic common bile duct exploration (TCBDE) in a patient with RYGB and choledocholithiasis. For patients with surgically altered anatomy and urgent need for stone clearance, robotic TCBDE represents a safe, cost-effective, single-stage alternative to two-stage approaches, effectively bypassing the anatomical limitations imposed by RYGB.