title: Percutaneous obliteration of the cystic duct with a holmium:yttrium-aluminum-garnet laser: results of in vitro and animal experiments.
abstract: OBJECTIVE
  The purpose of this study was to investigate the feasibility of using a holmium:yttrium-aluminum-garnet laser to permanently occlude the cystic duct in order to isolate the gallbladder from the biliary-enteric circulation and prevent gallstone formation.
  
  
  METHODS
  To determine the optimal laser parameters (power and pulsing rate) for cystic duct thermocoagulation, 20 freshly excised porcine gallbladders with intact cystic ducts underwent low-energy (0.075-0.085 J/pulse) or high-energy (0.20-0.25 J/pulse) thermocoagulation. Histopathologic examination was done to determine the extent of cystic duct injury. After in vitro experiments, percutaneous transcholecystic laser thermocoagulation of the cystic duct was performed on 23 anesthetized domestic pigs (four controls). Cholangiograms immediately after laser thermocoagulation were obtained to assess cystic duct occlusion. Animals were sacrificed for histopathologic correlation immediately after laser thermocoagulation (n = 4), 72 hr later (n = 4), and 6 weeks later (n = 15).
  
  
  RESULTS
  In the in vitro studies, all 10 cystic ducts in the high-energy group were occluded, while only four in the low-energy group were occluded. At histology, all cases in both groups showed circumferential injury to the cystic duct wall without injury to the cystic artery or vein. In the in vitro experiments, the cystic duct was successfully cannulated in 21 (91%) of 23 animals. Cholangiography after thermocoagulation showed occlusion of the cystic duct in 16 (84%) of 19 cases. Immediately after laser thermocoagulation, the cystic duct mucosa was circumferentially destroyed, whereas after 72 hr necrosis of the cystic duct wall and periductal tissues had occurred. By 6 weeks, all pigs had complete cystic duct fibrosis without injury to the common bile duct.
  
  
  CONCLUSIONS
  Holmium:yttrium-aluminum-garnet laser thermocoagulation of the cystic duct can be performed easily, results in immediate cystic duct occlusion, and leads to permanent fibrous ductal obliteration by 6 weeks.
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Boston 02114.
authors.forename: M J
authors.initials: MJ
authors.lastname: Girard
authors.forename: S
authors.initials: S
authors.lastname: Saini
authors.forename: P R
authors.initials: PR
authors.lastname: Mueller
authors.forename: T J
authors.initials: TJ
authors.lastname: Flotte
authors.forename: M
authors.initials: M
authors.lastname: Staritz
authors.forename: Y
authors.initials: Y
authors.lastname: Domankevitz
authors.forename: J T
authors.initials: JT
authors.lastname: Ferrucci
authors.forename: N
authors.initials: N
authors.lastname: Nishioka
mesh_terms: D000818:Animals; D002758:Cholangiography; D002767:Cholecystostomy; D002769:Cholelithiasis / Q000517:prevention & control*; D003549:Cystic Duct / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D017075:Laser Coagulation; D012008:Recurrence; D013552:Swine; D013997:Time Factors