Laparoscopic Transcystic Treatment Biliary Calculi by Laser Lithotripsy

Abstract

Background and Objectives:Laparoscopic transcystic common bile duct exploration (LTCBDE) is a complex procedure requiring expertise in laparoscopic and choledochoscopic skills. The purpose of this study was to investigate the safety and feasibility of treating biliary calculi through laparoscopic transcystic exploration of the CBD via an ultrathin choledochoscope combined with dual-frequency laser lithotripsy.Methods:From August 2011 through September 2014, 89 patients at our hospital were treated for cholecystolithiasis with biliary calculi. Patients underwent laparoscopic cholecystectomy and exploration of the CBD via the cystic duct and the choledochoscope instrument channel. A dual-band, dual-pulse laser lithotripsy system was used to destroy the calculi. Two intermittent laser emissions (intensity, 0.12 J; pulse width 1.2 μs; and pulse frequency, 10 Hz) were applied during each contact with the calculi. The stones were washed out by water injection or removed by a stone-retrieval basket.Results:Biliary calculi were removed in 1 treatment in all 89 patients. No biliary tract injury or bile leakage was observed. Follow-up examination with type-B ultrasonography or magnetic resonance cholangiopancreatography 3 months after surgery revealed no instances of retained-calculi–related biliary tract stenosis.Conclusion:The combined use of laparoscopic transcystic CBD exploration by ultrathin choledochoscopy and dual-frequency laser lithotripsy offers an accurate, convenient, safe, effective method of treating biliary calculi.

Holmium laser lithotripsy improves the rate of successful transcystic laparoscopic common bile duct exploration

“…However, there are major methodological differences between these studies and the study we present here, making direct comparison difficult. One study excluded patients if the transcystic route was not possible [28], and another study excluded patients presenting acutely with cholecystitis and obstructive jaundice or having failed ERCP [16]. These factors most likely decrease the complexity of reported cases in previous cohorts compared to the present study, which included patients with acute presentations and those requiring TD LCBDE.…”

“…The use of laser lithotripsy as an adjunct to LCBDE was first described in a small five-patient case series, which demonstrated efficacy even when faced with large and/or impacted ductal calculi [13,17]. Subsequently, larger studies have reported its safety and efficacy, demonstrating no associated increase in biliary related or other complications [15,16,28,29]. Results from this study have comparable rates of duct clearance to these larger series but suggest that there is a small but significant increase in the rate of post-operative bile leak with LABEL cases.…”

“…In vitro studies have demonstrated minimal tissue damage with the FREDDY laser, even upon direct application to animal or human epithelial tissue, especially when compared to the standard holmium laser [38,39]. More recently, this system has been applied via TC LCBDE with excellent results, and it is likely that its use will become more widespread in the future [28,29]. Furthermore, the use of EHL has recently gained popularity due to the fact that it utilises high-voltage electric sparks, rather than laser radiation, and hence requires less specialised theatre equipment [8].…”

Comparison of open, laparo-endoscopic and one-stage laparoscopic approaches for treatment of gallbladder and common bile duct stones

“…[14] Despite of its several advantages, transcystic management also has some disadvantages such as cannulation difficulty, transition to choledochotomy in large stones, [8,15] and lithotripsy. [16] Some authors consider the transcystic approach as risky in stones of larger than 20 mm. [17] There is no unanimous opinion regarding the completion of choledochotomy with T-drainage, primary suture or stend, which is another issue of laparoscopic choledochotomy.…”

“…Literature recommends lithotripsy and abdominal lithotripter tools for removal of riveted stones. [16,25] Our study has a number of limitation, which include non-randomization of groups, and failure to provide dimensions of stones and choledoch.…”