Endoscopic pulsed dye laser lithotripsy of gallbladder calculi in vivo.
We have evaluated the efficacy and safety of pulsed dye laser lithotripsy of gallbladder calculi using a percutaneous endoscopic technique in a porcine model. Fragmentation was readily achieved in vivo. Using a combination of laser lithotripsy and saline lavage, complete removal of all stone debris was feasible through a 24 F tract (N = 3). However, the degree of fragmentation required rendered removal through a smaller tract inefficient, a mean 53% of stone mass being retrievable through a 16 F tract (N = 11). Repeated laser activation at 1 mm from the gallbladder mucosa produced minimal injury, regardless of pulse energy. When the laser fiber was pressed against the mucosa, perforation of the gallbladder was possible at therapeutic pulse energy, but this did not lead to clinical sequelae. We conclude that the pulsed dye laser is a safe and effective means of fragmenting gallbladder calculi in vivo.
Department of Surgery, University Hospital, Boston, Massachusetts 02118.
D P
DP
O'Leary
D R
DR
Cave
A
A
Greenfield
E
E
Kuligowska
D H
DH
Birkett
D000818:Animals; D002769:Cholelithiasis / Q000628:therapy*; D016145:Endoscopy, Digestive System / Q000379:methods; D005069:Evaluation Studies as Topic; D053685:Laser Therapy; D008096:Lithotripsy / Q000379:methods*; D017602:Lithotripsy, Laser; D013552:Swine