Novosti
Khirurgii

 This journal is
indexed in Scopus
journal cover
android icon Android Applicaion

Year 2013 Vol. 21 No 2

GENERAL AND SPECIAL SURGERY

S.V. ALEXANDROV 1,2

POSSIBILITIES OF ENDOSCOPIC LASER LITHOTRIPSY IN PATIENTS WITH CHOLANGIOLITHIASIS

SEE “Belarusian Medical Academy of Post-Graduate Education”1,
ME “Minsk Regional Clinical Hospital”2,
The Republic of Belarus

Objectives. To determine the wave length of laser radiation with the most marked lithotripsy effect concerning the concretions of the extrahepatic bile ducts as well as to find out the optimal parameters of laser radiation to carry out lithotripsy.
Methods. Affecting the concretions of the extrahepatic bile ducts by laser radiation of 1064, 1320 and 1440 nm wavelengths in liquid medium we have ascertained the wavelength with most expressed effect of lithotripsy. Then, changing stepwise the energy of the laser radiation impulse of 1320 and 1440 nm wavelengths we have determined the optimal values of the impulse energy to carry out lithotripsy.
Results. The largest size of the concretion could be destroyed by a single impulse of 1440 nm wavelength of laser radiation at the same parameters.
The minimal lithotripsy effect is found at 1064 nm wavelength. The optimal values of the impulse energy for the performance of extrahepatic bile duct concretions lithotripsy by 1320 nm wavelength radiation are considered to be within the limits of 0.9-1,5 J and 0,5-0,8 J for 1440 nm. Higher values of the impulse energy are considered as dangerous for application in connection with impossibility to control distinctly the process of concretion destruction and damage risk of the adjacent tissues.
Conclusions. A 1440 nm wavelength radiation has the greatest effect of lithotripsy out of three wavelengths (1064, 1320 and 1440 nm) and is considered the most safe and effective for lithotripsy performance at cholangiolithiasis. 1320 nm wavelength radiation can be also applied to destroy large concretions of the extrahepatic bile ducts at laparoscopic and videoendoscopic interventions.

Keywords: cholelithiasis, cholangiolithiasis, laser lithotripsy
p. 45 – 53 of the original issue
References
  1. Tanaka M. Problems inherent to balloon dilation for the treatment of common bile duct stones in comparison with endoscopic sphincterotomy. Digestive Endoscopy. 2000 Apr;12(2):112–15.
  2. Gusev AV, Borovkov IN, Martinsh ChT, Guseva EV, Pokrovskii EZh, Evtikhova EIu. Novye tekhnologii pri mekhanicheskoi zheltukhe dobrokachestvennogo geneza [New technologies in obstructive jaundice of benign origin]. Annaly Khirurg Gepatologii. 2008;13(1):72–75.
  3. Coelho-Prabhu N, Dzeletovic I, Baron TH. Outcome of access sphincterotomy using a needle knife converted from a standard biliary sphincterotome. Endoscopy. 2012 Jul;44(7):711–14.
  4. Snigirev IuV, Troshkin VV, Modzelevskaia SM, Brizh AM, Alekseev NA, Taraskina EB. K voprosu o laparoskopicheskoi kholedokholitotomii [Some aspects of laparoscopic choledocholitotomy]. Endoskop Khirurgiia. 2005;(1):135.
  5. Binmoeller KF, Bruckner M, Thonke F, SoehendraN. Treatment of difficult bile duct stones using mechanical, electrohydraulic and extracorporeal shock wave lithotripsy. Endoscopy.1993 Mar;25(3):201–6.
  6. Karimov ShI, Kim VL, Alimukhamedova DK, Kurbanov OSh. Litolizis i udarno-volnovaia litotripsiia v lechenii zhelchnokamennoi bolezni [Litholysis and shock wave lithotripsy in the treatment of gallstone disease]. Endoskop Khirurgiia. 2003;(1):27–29.
  7. Ogawa K, Ohkubo H, Abe W, Maekawa T. Percutaneous transhepatic small-caliber choledochoscopic lithotomy: a safe and effective technique for percutaneous transhepatic common bile duct exploration in high-risk elderly patients. J Hepatobiliary Pancreat Surg. 2002;9(2):213–7.
  8. Harris VJ, Sherman S, Trerotola SO, Snidow JJ, Johnson MS, Lehman GA. Complex biliary stones: treatment with a small choledochoscope and laser lithotripsy. Radiology.1996 Apr;199(1):71–7.
  9. Nevorotin AI. Vvedenie v lazernuiu khirurgiiu: ucheb posobie [Introduction to laser surgery: a study guide]. Saint-Petersburg, RF: Spets. Lit; 2000. 175 p.
  10. Juhasz T, Kastis GA, Suarez C, Bor Z, Bron WE. Time-resolved observations of shock waves and cavitation bubbles generated by femtosecond laser pulses in corneal tissue and water. Lasers Surg Med. 1996;19(1):23–31.
  11. Rink K, Delacretaz G, Salathe RP. Fragmentation process of current laser lithotriptos. Laser Surg. Med.1995; 16(2):134–46.
  12. Khriachkov VV, Levchenko NV, Belousov VV. Pritsel'naia kontaktnaia lazernaia litotripsiia – novye vozmozhnosti v lechenii zhelchnokamennoi bolezni [Targeted contact laser lithotripsy - new possibilities in the treatment of gallstone disease]. Uspekhi Sovrem Estestvoznaniia. 2008;(5):152–54.
  13. Jacobs R, Pereira-Lima JC, Schuch AW, Pereira-Lima LF, Eickhoff A, Riemann JF. Endoscopic laser lithotripsy for complicated bile duct stones. Is cholangioscopic guidance necessary? Arq Gastoenterol. 2007 Apr-Jun;44(2):137–40
  14. Grachev SV. Gol'mievyi lazer v meditsine [Application of Holmium laser in medicine]. Moscow, RF: Triada-X; 2003. 240 p.
  15. Kim HI, Moon JH, Choi HJ, Lee JC, Ahn HS, Song AR, Lee TH, Cho YD, Park SH, Kim SJ. Holmium laser lithotripsy under direct peroral cholangioscopy by using an ultra-slim upper endoscope for patients with retained bile duct stones. Gastrointest Endosc. 2011 Nov; 74(5):1127–32
Address for correspondence:
223052, Respublika Belarus', Minskaia oblast', Minskii raion, p. Lesnoi-1; UZ «Minskaia oblastnaia klinicheskaia bol'nitsa», khirurgicheskoe otdelenie ¹2,
e-mail: dr_Alexandrov@tut.by,
Aleksandrov Sergei Vladimirovich
Information about the authors:
Alexandrov S.V. A head of the surgical department ¹2 of ME “Minsk regional clinical hospital”, lecturer of the surgery chair of SEE “Belarusian Medical Academy of Post-Graduate Education”.
Contacts | ©Vitebsk State Medical University, 2007-2023