title: Holmium: YAG laser lithotripsy for gallstones. A preliminary report.
abstract: BACKGROUND
  Most retained gallstones can be extracted at the time of operative exploration or endoscopic retrograde cholangiopancreatography (ERCP). Infrequently, impaction or associated anatomic abnormalities may prevent their clearance. We assessed the efficacy of the holmium:YAG laser in managing retained biliary calculi that had proven refractory to the usual methods of extraction.
  
  
  METHODS
  Two patients with calculi impacted in the intrapancreatic common bile duct and one patient with residual stones in a nonfunctional gallbladder were treated with holmium:YAG laser lithotripsy. Two of these patients were treated under conscious sedation, and one received a general endotracheal anesthetic. Laser energy was delivered by a 272-mm optical fiber inserted through a 7-Fr fiberoptic endoscope. The ablative effects were monitored continuously via videoscopic.
  
  
  RESULTS
  All of the stones were cleared successfully in a single therapeutic setting. In one patient, fragments of the impacted intraductal stone were extracted with an endoscopic wire basket. In the other two patients, stone debris was completely cleared with saline irrigation. No complications developed, and all patients remained free of recurrence during a 6-month follow-up period.
  
  
  CONCLUSIONS
  The holmium:YAG laser is a multidisciplinary instrument that is safe and effective in the fragmentation of both urinary and biliary calculi. Because it can be delivered through a small-caliber fiberoptic endoscope, it should be particularly useful to laparoscopic surgeons who manage complicated biliary tract disease.
authors.affiliation: Department of Surgery, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78284-7845, USA. teichman@uthscsa.edu
authors.forename: J M
authors.initials: JM
authors.lastname: Teichman
authors.forename: W H
authors.initials: WH
authors.lastname: Schwesinger
authors.forename: J
authors.initials: J
authors.lastname: Lackner
authors.forename: R M
authors.initials: RM
authors.lastname: Cossman
mesh_terms: D000328:Adult; D002769:Cholelithiasis / Q000175:diagnosis / Q000628:therapy*; D016145:Endoscopy, Digestive System; D042882:Gallstones / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D017602:Lithotripsy, Laser / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome