Percutaneous transhepatic electrohydraulic lithotripsy under endoscopic control

Abstract

With endoscopic papillotomy, extraction of bile duct stones has become a routine procedure. However, removal of large common bile duct stones or intrahepatic stones remains a difficult problem. To overcome this problem, several nonsurgical methods have been developed. Techniques of dissolution! by transhepatic catheter or nasobiliary drain are useful, but these require a relatively long period of treatment and have only moderate success. Lithotripsy in a retrograde manner employing a Nd:YAG laser or an electric spark,4 have proved to be very efficient, but choledoscopic control is compulsory and despite the development of several cholangioscopes, therapeutic retrograde choledoscopy still remains very difficult to perform. Lithotripsy using ultrasound is still experimental since bile ducts cannot be approached with a straight probe. Mechanical endoscopic lithotripsy requires the stone to be captured within a basket, and then some stones are too hard to be smashed in this way.6,? The development of percutaneous access to the kidney and the availability of the electrohydraulic or ultrasonic lithotripter have been combined to permit removal of renal and ureteral stones on a routine basis.s This combination has not been widely employed for bile duct stones. Recently, the use of percutaneous transhepatic electrohydraulic lithotripsy has been reported. The main problem with this technique is holding the electrode close to the calculus. We report a technique using percutaneous access, endoscopic control of the position of the lithotripter, and electrohydraulic lithotripsy.