Painless lithotripsy by flashlamp-excited dye laser for impacted biliary stones: an experimental and clinical study.
OBJECTIVE
To find out the appropriate dye laser output and frequency for each kind of stone experimentally, and to use flashlamp-excited dye laser for impacted biliary stones.


METHODS
Prospective study.


METHODS
University hospital, Japan.


METHODS
12 patients undergoing lithotripsy for both intrahepatic and extrahepatic impacted biliary stones.


METHODS
Appropriate dye laser output and frequency, histological changes in the bile duct wall, and outcome.


RESULTS
Stones were pulverised, and required a median 155 pulses (range 80-205) at 40 mJ for bilirubin stones and 355 pulses (range 205-405) at 50 mJ for cholesterol stones. At the standard energies used, the laser caused only superficial damage to the serosa of the common bile duct. It was successful in fragmenting 133/135 stones (99%), and in addition pulverised 125/135 stones (93%). No patients complained of pain during laser lithotripsy even under local anaesthesia. All patients were discharged from the hospital after an uneventful recovery, and no recurrent stones have been found at outpatient follow-up ranging between 2 and 85 months.


CONCLUSIONS
Flashlamp-excited dye laser with a small choledochoscope seems to be safe and painless way of treating biliary stones, even if they are impacted in the peripheral biliary tree and patients are at high risk.
Watanabe
Y
Y
Second Department of Surgery, Ehime University, Shitsukawa, Japan.
Sato
M
M
Tokui
K
K
Nezu
K
K
Shiraishi
S
S
Sato
K
K
Kawachi
K
K
D000368:Aged; D000772:Anesthesia, Local; D001663:Bilirubin / Q000032:analysis; D002118:Calcium / Q000032:analysis; D002769:Cholelithiasis / Q000737:chemistry / Q000628:therapy*; D004864:Equipment and Supplies; D005260:Female; D006801:Humans; D017602:Lithotripsy, Laser / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011446:Prospective Studies; D012307:Risk Factors
D001663:Bilirubin; D002118:Calcium