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. 2016 Oct-Dec;20(4):e2016.00068.
doi: 10.4293/JSLS.2016.00068.

Laparoscopic Transcystic Treatment Biliary Calculi by Laser Lithotripsy

Jun Liu  1 , Lan Jin  1 , Zhongtao Zhang  1
Affiliations

Laparoscopic Transcystic Treatment Biliary Calculi by Laser Lithotripsy

Jun Liu et al. JSLS. 2016 Oct-Dec.

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.

Keywords: Biliary calculi; Dual-frequency laser; Laparoscope; Transcystic common bile duct exploration; Ultrathin choledochoscope.

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Figures

Figure 1.
Figure 1.
Incision of the cystic duct.
Figure 2.
Figure 2.
Placement of the choledochoscope in the CBD via a transcystic approach.
Figure 3.
Figure 3.
Visualization of a stone in the CBD with a choledochoscope.
Figure 4.
Figure 4.
Insertion of laser fiber into the CBD through the choledochoscope working port.
See this image and copyright information in PMC

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