| [ Summary ] |
The indications for cholangioscopic laser lithotripsy include; 1) intrahepatic duct stones with no surrounding liver atrophy, 2) unsuccesful stone extraction with ERCP or EPT, using mechanical lithotripsy, and 3) high surgical risk patients with difficult biliary stones. Laser lithotripsy is also useful for stones which cannot be extracted by use of perctaneous cholangioscopy, using the conventional basket methods, for cases such as chronic intrahepatic stones, incarcerated stones, or large CBD stones. Two types of lasers commonly usedare : 1) Nd:YAG laser and 2) flashlamp excited dye laser. Both types can easily pass through the biopsy channel of the cholangioscope. The Nd : YAG laser delivers thermal energy to the stone surface, which perforates the stone and allows it to be easily crushed with alligator forceps. The flashlamp excited dye laser produces a plasma bubble that rapidly expands and contracts, resulting in a shockwave that pulverizes the stone. Proper positioning of the laser fiber against the stone minimizes bile duct wall injury. Cholangioscopic laser lithotripsy has facilitated the treatment of difficult biliary stones. |