Holmium laser for treatment of left hepatic duct stone

Abstract

Endoscopic biliary lithotripsy can generally be performed using mechanical techniques. However, this has a failure rate of 10% to 15% even if performed by experienced endoscopists.1 Failure occurs when stones cannot be captured in a basket or when sufficient mechanical pressure cannot be applied to achieve fragmentation. Nonsurgical options are available for treatment of these refractory stones including extracorporeal or intracorporeal lithotripsy. Intracorporeal lithotripsy can be performed with various modalities including electrohydraulic devices or pulse dye lasers, including alexandrite, coumarin, or rhodamine lasers.2-4 A new laser (holmium:yttrium aluminum garnet [Ho:YAG]) has been developed for lithotripsy, although it also has soft tissue applications.5,6 The mechanism of lithotripsy with the holmium laser differs from that of pulse dye lasers. We report the use of a holmium laser to successfully remove a refractory left hepatic duct stone that could not be removed by percutaneous and endoscopic basket methods.