The patient is an 84-year-old male who was admitted to the medicine service with a diagnosis of symptomatic choledocholithiasis after presenting with 1 week of chills, poor PO intake, and intermittent right upper quadrant pain. An MRCP was obtained which demonstrated a 2.1-cm obstructing common bile duct stone causing significant ductal dilatation. He was offered a single-stage procedure for management. The gallbladder was dissected in the standard fashion to obtain the critical view of safety. A cholangiogram was performed which demonstrated a markedly dilated CBD with a filling defect in the distal CBD and minimal emptying of contrast into the duodenum. Given the size of the stone, we proceeded immediately to transcholedochal exploration. The stone was partially fragmented with wire baskets but had a dense central core which could not be extracted. We then used a holmium laser to fragment the stone into pieces which were removed with baskets. A transpapillary choledochal stent was placed, and completion cholangiogram demonstrated a patent CBD with flow of contrast into the duodenum. The CBD was closed with a running suture and the cholecystectomy was completed. The patient was discharged on post-operative day two with an uneventful recovery. The biliary stent was removed 6 weeks post-operatively via outpatient EGD.