Laser Lithotripsy of Gallstone by Means of a Pulsed Neodymium-YAG Laser - In Vitro and Animal Experiments

Ell, C.; Hochberger, J.; Müller, D; Zirngibl, H.; Giedl, J; G, Lux; Demling, L

doi:10.1055/s-2007-1018339

Cited by 45 publications

(7 citation statements)

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“…However, the meeting rate (percentage of impulses with full energy that was applied to the stone) was comparably high (74% vs 75%). ELL et al (4) even report a need for a higher meeting rate in cases of radiological steering. In that study, patients in whom fluoroscopic control was employed, received significantly more laser impulses than patients submitted to cholangioscopic control (2,�40 vs 1,611), although the meeting rate was similar in about 89%.…”

Section: Discussionmentioning

confidence: 99%

“…However this method is limited by a huge stone size and, especially, by stone impaction. For these rare cases, e�tracorporeal shoc�-wave lithotripsy (ESWL), electrohydraulic (EHL) or laser lithotripsy (LISL) could be applied (1,2,4) . EHL is performed under cholangioscopic control and LISL is usually carried out under fluoroscopic guidance only.…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic laser lithotripsy for complicated bile duct stones: is cholangioscopic guidance necessary?

Jakobs

Pereira-Lima²,

Schuch³

et al. 2007

Arq. Gastroenterol.

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-Background -Endoscopic papillotomy is successful in more than 95% of the cases of choledocholithiasis. For patients with difficult bile duct stones not responding to mechanical lithotripsy, different methods for stone fragmentation have been developed. Aims -To compare the results of laser lithotripsy with a stone-tissue recognizing system, when guided by fluoroscopy only or by cholangioscopy. Methods -Between 1992 and 2002 we have treated 89 patients with difficult bile duct stones by endoscopic retrograde cholangiopancreatography endoscopic retrograde cholangiopancreatography and laser lithotripsy. Unsuccessful e�tracorporeal shoc�-wave lithotripsy and electrohydraulic were also performed before laser in �5% e�tracorporeal shoc�-wave lithotripsy and electrohydraulic were also performed before laser in �5% and electrohydraulic were also performed before laser in �5% electrohydraulic were also performed before laser in �5% were also performed before laser in �5% and 26% of the cases, respectively. Results -Laser was effective in 79.2% of 72 patients guided by cholangioscopy and in 82.4% of 17 cases steered by fluoroscopy. The median number of impulses in the latter was 4,��5 and 1,800 with the former technique. Two parameters influenced the manner of laser guidance. In cases of stones situated above a stricture, cholangioscopic control was more effective (64.7% vs. �1.9%). When the stones were in the distal bile duct, fluoroscopic control was more successful. Conclusion -In cases of difficult stones in the distal bile duct, laser lithotripsy under fluoroscopic control is very effective and easily performed. Cholangioscopic guidance should be recommended just in cases of intrahepatic stones or in patients with stones situated pro�imal to a bile duct stenosis. In these cases, cholangioscopy should be performed either endoscopically or percutaneously.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Endoscopic laser lithotripsy for complicated bile duct stones: is cholangioscopic guidance necessary?

Jakobs

Pereira-Lima²,

Schuch³

et al. 2007

Arq. Gastroenterol.

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“…This plasma becomes highly pressurized, and generated shock waves to rupture and disintegrate the calculus. 7,9,24 With either method, bile duct injury and residual calculi cannot be completely prevented due to the possibility of crushed fragments or laser irradiation mistakes. [25][26][27] Thus, we conducted the crushing experiment described herein, aimed at crushing calculi in isolation, rather than by lithotripsy in which calculi are ruptured using conventional methods.…”

Section: Discussionmentioning

confidence: 99%

“…However, the crushing into tiny fragments of calculi is difficult because bile duct injury and residual calculi are prone to occur as a result of irradiation errors and the size and shape of biliary calculi, and because there are limits to the capacity of the laser itself to crush calculi. [6][7][8][9][10][11] Therefore, we investigated a new laser technique designed to crush bilirubin calculi, one of the most common forms of bile duct stone, with the aim of being able to crush calculi without injuring the bile duct. First, we ascertained the characteristic absorption spectrum and molecular structure of bilirubin calculi using infrared spectroscopy.…”

mentioning

confidence: 99%

Bilirubin Calculi Crushing by Laser Irradiation at a Molecular Oscillating Region Wavelength Based on Infrared Absorption Spectrum Analysis Using a Free-Electron Laser: An Experimental Study

et al. 2001

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We investigated a new laser technique of crushing bilirubin calculi, our aim being to crush calculi in isolation using a minimally invasive procedure. Infrared absorption spectrum analysis of the bilirubin calculi was conducted, revealing maximum absorption spectrum at a wavelength of the C=O stretching vibration of ester binding that exists within the molecular structure of bilirubin calcium. As an experiment to crush calculi using the free-electron laser, we set the laser at the effective irradiation wavelength of ester binding, and conducted noncontact irradiation of the bilirubin calculi. The calculi began to slowly ablate until the irradiated site had been completely obliterated after 20s of irradiation. Moreover, absorption spectrum analysis of the irradiated site, from a comparison of absorption peak ratios, revealed that absorption peak intensities decreased over time at the absorption wavelength of ester binding. These findings suggest that irradiation of molecular oscillating region wavelengths peculiar to calculi based on infrared absorption spectrum analysis results in the gradual crushing of calculi in isolation by breaking down their molecular structure.

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“…In 1986 retrograde laser‐induced lithotripsy became possible. 25,27 One great advantage of this method is the possibility of transmitting the laser energy via a high flexible glass fiber with no appreciable loss of energy ( Fig. 1).…”

Section: Intracorporeal Laser Lithotripsymentioning

confidence: 99%