This conversation traces Dragonfly from an idea “in the back of a cab” to a clinically focused cholangioscopy platform that rotates through the biopsy channel for predictable, millimeter-level control. We delve into the mechanics (≈1.7 mm channel supporting 1.5 mm forceps and 4.5 Fr EHL), exploring how the catheter’s suppleness and internal rigidity enhance distal duct stability and device passability, and why micro-movements and neutral ergonomics are crucial for case efficiency. We map where cholangioscopy shifts the algorithm—medium/large stones, altered anatomy, tight distal duct work, and stricture evaluation with larger bites—and talk learning curve (~3–5 cases), setup tips, and the Medtronic distribution partnership. Finally: adoption math, fair-use evaluations despite contracting realities, and a look toward accessory innovation and AI-aided visualization. Key takeaways Rotation-first control → faster targeting, less wall fighting, better stability in tight anatomy. Larger working channel enables bigger biopsies and higher-energy lithotripsy. Aim for complete fragmentation in session one; repeat procedures should be the exception. Ergonomics: neutral hand position and micro-movements reduce fatigue. Practical adoption requires training support and a fair, multi-case evaluation window. LinksDragonfly Endoscopy: https://dragonflyendoscopy.com Medtronic: https://www.medtronic.com/en-us/healthcare-professionals/products/digestive-gastrointestinal/ercp-devices/dragonfly-pancreaticobiliary-system.html