Intraductal Lithotripsy in Sialolithiasis Using the Calculase III™ Ho:YAG Laser: First Experiences

Abstract

Background and Objectives To report the first experiences with a newly available Ho:YAG laser system for the treatment of salivary stones. Study Design/Materials and Methods A retrospective study in a tertiary referral center was conducted. Patients diagnosed with sialolithiasis were treated in Erlangen using the Calculase III™ Ho:YAG laser (Karl Storz, Tuttlingen, Germany). Preset parameters had a frequency of 4 Hz and energy of 0.8–1.2 J, resulting in 3.2–4.8 W. Following total fragmentation, one to two serial sialendoscopies were performed to achieve complete fragment clearance. Results A total of 55 stones in 49 patients were treated; 17 stones in 15 submandibular glands and 38 in 34 parotids. In total, 61 laser lithotripsies (range 1–3 per stone) were performed using various modes (long, short, and burst) and with preset parameters of 4 Hz and energy of 0.8–1.2 J, resulting in effective power of 3.2–4.8 W. Complete fragmentation was achieved in all the accessible stones. Sialendoscopes, fibers, or the mode used had no significant influence on success rates. A multimodal therapy concept was employed to treat stones in 12.24% of the cases; 95.92% of the patients were ultimately stone‐free, and all became symptom‐free. All glands were preserved. Conclusions The new Calculase III™ Ho:YAG laser was effective in the treatment of sialolithiasis with no increased risk of complications in the patients or damage to the sialendoscopes. Clinical factors such as the type of gland involved, or the location and size of stones had a greater impact on success rates than the technical or preset parameters. Lasers Surg. Med. © 2020 Wiley Periodicals LLC

Treatment of Sialolithiasis: What Has Changed? An Update of the Treatment Algorithms and a Review of the Literature

“…Among the lasers currently available, the Ho:YAG laser has been reported to be the most suitable [ 96 ], a finding that was underlined by success rates >80% in recent publications [ 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 ].…”

“…The primary indication for ISWL is with stones in which gland-preserving treatment is not possible using the well-established techniques. All stones that are accessible with the sialendoscope but not treatable with conventional intSE in the parotid gland, and all stones that cannot be treated with conventional intSE or TDS in the submandibular gland, are recognized indications for ISWL [ 97 , 98 , 99 , 100 , 101 , 103 , 104 , 105 , 106 , 107 ].…”

Intraductal Fragmentation in Sialolithiasis Using Pneumatic Lithotripsy: Initial Experience and Results

“…The data presented here thus appear to indicate that ISWL is a more elaborate procedure in the SMG compared to the PG, as has also been reported and discussed previously. [34][35][36] The significant differences in the location of the treated stones between the glands (P = .0001) reflect the treatment indications that corresponded to wellestablished treatment algorithms. 7 With regard to the gas pressure levels needed to achieve successful fragmentation, definitive values have not yet been reported in the literature.…”

“…It is less often due to primary accompanying stenosis (less than 10% in the literature and 6.45% in the present study). [32][33][34][35][36] The duct system was stented in 55.1% of all patients-the parotid duct system in 23 cases, with no stenting in the submandibular ducts (P = .0001). Differences in the specificities of the duct anatomy, like the narrowness of the duct or duct bending in the SMG and a higher frequency of accompanying stenosis and insufficient gland function in the PG, were the main factors why stent implantation was performed only in the PG.…”

“…[34][35][36][37][38] Aftercare and follow-up examinations were performed as described in our previous publications. 7,[34][35][36] A follow-up investigation was planned 4 to 12 weeks later. It was checked if the salivary secretion after gland massage was abundant and clear or not.…”