Retrieval Basket Research Articles

Impacted Stone Retrieval Basket and Lithotripter: An Unusual Complication of ERCP for Choledocholithiasis

Impacted Stone Retrieval Basket and Lithotripter: An Unusual Complication of ERCP for Choledocholithiasis

PTH-008 Safety And Efficacy Of Balloon Sphincteroplasty Using Controlled Radial Expansion (cre) Balloon During Endoscopic Retrograde Cholangio Pancreatography In The Management Of Large Common Bile Duct (cbd) Stones: A District General Hospital Experience

IntroductionExtraction of large (>1 cm) CBD stones at ERCP is often difficult despite adequate sphincterotomy. Failure of extraction of stones warrants repeat ERCPs and also referral to advanced techniques such...

Outcomes of Holmium Laser–Assisted Lithotripsy with Sialendoscopy in Treatment of Sialolithiasis

The purpose of the current study was to compare outcomes and complication rates of sialolithiasis treated with intracorporeal holmium laser lithotripsy in conjunction with salivary endoscopy with those treated with simple basket retrieval or a combined endoscopic/open procedure. Case-comparison study. Tertiary hospital. Review of prospectively collected data of patients who underwent treatment for sialolithiasis by the senior author during 2011 to 2013. Patient demographics, operative techniques, surgical findings, clinical outcomes, and complications were recorded. Additional information regarding symptoms and satisfaction with treatment was obtained via standardized telephone questionnaire at the time of the data analysis. Thirty-one patients were treated for sialolithiasis. Sialoliths averaged 5.9 mm in size (range, 2-20 mm) and were comparable between both groups. Sixty-eight percent were in the submandibular gland (n = 21), with the remaining 32% in the parotid gland (n = 10). Fifty-two percent of patients (n = 16) were treated endoscopically with intracorporeal holmium laser lithotripsy, while the remaining 48% (n = 15) were treated with salivary endoscopy techniques other than laser lithotripsy. Successful stone removal without additional maneuvers occurred in 81% of the laser cases and 93% of the nonlaser group. Patients in the laser group reported an average improvement of symptoms of 95% compared with 90% of the nonlaser group when adjusted for outliers. Complications in all patients included ductal stenosis (n = 2) and salivary fistula (n = 1). The results of our series show favorable results with the use of intracorporeal holmium laser lithotripsy for the endoscopic management of sialolithiasis with minimal adverse events.

A novel basket catheter to facilitate endoscopic removal of pancreatic stones (with video)

Endoscopic removal of pancreatic stones in patients with chronic pancreatitis is still challenging. With a conventional basket catheter, introduction to the target area or catching pancreatic stones is sometimes difficult. To evaluate a novel double-lumen basket catheter composed of nitinol wires with fine reticular structures in the distal end and loose mesh in the proximal part. A prospective feasibility study. Tertiary-care center. This study involved 10 patients with main pancreatic duct stones of 5 mm or less in the shorter diameter of the largest stone. In the first 5 cases, a nitinol basket catheter was used as salvage after stone extraction with a conventional basket catheter and retrieval balloon (salvage group). In the following 5 cases, stones were initially removed by using a nitinol basket catheter, and the presence of residual stones was evaluated by pancreatogram along with balloon sweep (initial group). Success rate of removal of the target stones and procedure-related adverse events. A nitinol basket catheter was easily introduced to the target stone in all patients. In the salvage group, additional stones were retrieved with a nitinol basket catheter in 3 of 5 patients. In the initial group, stone extraction by a nitinol basket catheter was successful, and no residual stones were extracted by additional balloon cleaning in any patients. Basket impaction or after-ERCP pancreatitis was not observed. A small sample size without a control group. This novel nitinol basket catheter is useful for the extraction of small pancreatic stones. A randomized, controlled trial is warranted to confirm its efficacy.

Laser‐Assisted Lithotripsy in the Minimally Invasive Treatment of Sialolithiasis

Objectives: In the minimally invasive treatment of sialolithiasis, lasers can be used to fracture stones, allowing for the endoscopic extirpation of larger lesions. The purpose of the current study was to evaluate outcomes following the use of the holmium YAG laser for intracorporeal salivary lithotripsy. Methods: Review of prospectively collected data regarding patients who underwent interventional sialoendoscopy for sialolithiasis was performed, recording patient demographics, surgical findings, and clinical outcomes. Patients who were treated with intracorporeal laser lithotripsy were compared with those who had simple basket retrieval or endoscopic assisted open removal. Patients were surveyed by phone for current symptom follow-up. Results: Thirty-one patients (average age 56, range 14-84) were treated for sialolithiasis with endoscopic techniques at our academic institution from 2011-2012. Sialoliths averaged 5.9 mm in size (range 2-20mm), arising from the submandibular ducts (n=20), parotid (n=10), or both (n=1). The holmium YAG laser was used in 16 patients. Of these cases, 6 patients required additional maneuvers to open the duct to allow for stone extraction compared to 10 cases in which the laser was not used. At last follow-up, 77% of patients who had laser assistance reported improvement of symptoms compared with 56% of the non-laser group. Complications in all patients included ductal stenosis (n=1), residual stone fragments (n=2), salivary fistula (n=1), and the need for additional procedures (n=6). Conclusions: The results of our series indicate that intracorporeal laser assisted lithotripsy is an effective addition to the armamentarium of sialoendoscopy.

Sp611 Endoscopic Resection of Hilar Papillomatosis After Whipple Procedure for Ampullary Adenoma

73-year-old female presented for definitive treatment of biliary papillomatosis. Evaluation for acute pancreatitis in 2006 noted an ampullary adenoma with intraductal extension. She underwent Whipple procedure. Histology demonstrated adenomatous tissue with acute and chronic inflammation. In 2011, she was incidentally found to have abnormal liver chemistries. CT scan revealed intrahepatic bile duct dilatation; however, ERCP was unsuccessful due to altered anatomy. Percutaneous transhepatic cholangiography (PTC) showed a possible mass at the hilum but brushings were negative. Cholangioscopic biopsies (via PTC) demonstrated pyloric gland adenoma with acute and chronic inflammation and low grade dysplasia. The patient was offered surgery but declined. She was then referred to our institution for endoscopic intervention. The PTC catheters were injected with water-soluble contrast. Injection of the left catheter revealed a large left hepatic duct with a multilobulated filling defect at the bifurcation. Intraductal ultrasound probe placed over a guidewire demonstrated an echogenic lobulated polyp within the left hepatic duct. A single-balloon enteroscope was successfully passed into the afferent limb roughly 10cm distal to the hepaticojejunal anastomosis.The left guidewire was grasped with a snare and the snare was pulled from the tip of the endoscope through the anastomosis and out the percutaneous site. It could then be grasped on both sides. The scope was advanced through the hepaticojejunostomy into the common hepatic duct. The lesion was visualized and resected using a combination of snare polypectomy, retrieval basket, needle knife, and argon plasma coagulation. All guidewires were removed and internal drainage was unnecessary. No obstruction was evident endoscopically or cholangiographically. In patients with ampullary adenomas and intraductal extension, preoperative evaluation of the proximal biliary tree may be indicated to evaluate for additional lesions. Direct endoscopic therapy to the proximal bile duct is feasible in patients with surgically-altered anatomy; however, advancement of the endoscope to the anastomosis remains challenging.

Trifurcated hepatic duct with low union complicated by choledocholithiasis

A 74-year-old man was admitted to our hospital with right upper quadrant pain. Laboratory data on admission were as follows: aspartate transaminase (AST) 26 IU/L, alanine transaminase (ALT) 70 IU/L, total bilirubin 0.9 mg/dL, alkaline phosphatase 337 U/L, and γ-glutamyl transpeptidase 552 U/L. Magnetic resonance cholangiopancreatography (MRCP) revealed a trifurcated configuration of hepatic ducts with an unusual low union, and drainage of the cystic duct into the right posterior segmental duct, accompanied by several common bile duct (CBD) stones ([Fig. 1]). Endoscopic retrograde cholangiopancreatography (ERCP) revealed similar findings to those of the MRCP. The CBD stones were removed successfully using a retrieval basket after endoscopic sphincterotomy ([Fig. 2]). After 4 days, the patient underwent cholecystectomy followed by hepaticojejunostomy.

1.2 French stone retrieval baskets further enhance irrigation flow in flexible ureterorenoscopy

Ureterorenoscopy (URS) has revolutionized upper urinary tract stone therapy. However, the size of the working channel and the stone baskets limit irrigation flow as well as vision. This study determined further improvements of irrigation flow, deflection capacities and impairments of breaking resistance in a new 1.2 French (F) ultra-miniaturized basket. Irrigation measurements were performed in semirigid URS (semiURS, working channel 5F) and in flexible URS (flexURS, 3.6F) in 0°, 90° and 270° deflection with 1.2F, 1.8F, 1.9F and 2.2F baskets and compared with empty channel. Breaking strength of 1.2F, 1.8F and 1.9F baskets were evaluated using a material testing machine. Tested baskets affected irrigation in semiURS and flexURS (p < 0.05). Mean ± SEM (standard error of the mean) for semiURS flow rates counted 197.1 ± 2.0, 140.9 ± 1.6, 111.1 ± 1.5, 98.0 ± 1.3 and 77.1 ± 0.9 ml/min for empty channel, 1.2F, 1.8F, 1.9F and 2.2F baskets (p < 0.05). Using unbent flexURS flow rates of 44.2 ± 0.4, 20.4 ± 0.2, 5.9 ± 0.1, 5.4 ± 0.1 and 1.5 ± 0.1 ml/min for empty channel, 1.2F, 1.8F, 1.9F and 2.2F baskets, were observed (p < 0.05). The 1.2F versus 2.2F basket showed a 13.6-fold increase in flexURS irrigation (p < 0.05), while only the 2.2F basket reduced deflection by 20.3 %. The breaking strength decreased with a reduced basket size (1.2F: 6.4 ± 0.46 vs. 1.8F: 16.8 ± 2.79 vs. 1.9F: 32.2 ± 2.74 N, p < 0.05). Ultra-miniaturized baskets of 1.2F ensured a sufficient irrigation flow as needed for high quality vision in URS stone management. However, miniaturization of the 1.2F basket resulted in a reduced breaking strength compared with larger sized devices which in turn may hamper stone removal by an increased vulnerability.

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Case Reports: Gastric decontamination in ingestion has been deemphasized in the recent past predicated on extensive evidence-based medicine review and guidelines. We describe a case of life-threatening ingestion complicated by a charcoal-medication gastric bezoar that was removed by EGD at 18 hours (h) post ingestion with subsequent abatement of symptoms. A 16-year-old female was found unresponsive with labored breathing and generalized seizures after an ingestion of an unknown quantity of bupropion and aripiprazole tablets. She was intubated by pre-hospital responders and at the outside hospital received 3L of crystalloid and dopamine and norepinephrine drips to maintain a MAP >60 torr. Seizures were controlled with lorazepam and phenytoin. Activated charcoal was delivered via NG tube. Benztropine was given for suspected extrapyramidal movements and dantrolene for increased temperature (T). At PICU admission, she was unresponsive with poor perfusion, BP 82/36, HR 153, T 38.1, SaO2 94% on FiO2 1.0 and PEEP 8 cm H2O. Exam was significant for 1+ pulses, 5mm minimally reactive pupils, no eye opening, weak corneal reflex, hyperreflexic lower extremity DTRs and marginal withdrawal to stimuli. ARDS and hypotension dominated the early course despite additional fluid resuscitation, dopamine, milrinone and norepinephrine. A T 41?C prompted neuromuscular blockade, midazolam and cyproheptadine for presumptive serotonin syndrome. At 18 h, EGD revealed a large intragastric mass of charcoal with intact and fragmented pills. Medication concretions were removed by endoscopy-directed high pressure lavage and additional extrication of 5 intact pills via a retrieval basket. Within 12 h the patient became euthermic with continued cardiopulmonary improvement allowing norepinephrine cessation at 40 h and extubation at 60 h. The patient recovered intact. This case illustrates the need to consider pharmacobezoars in ingestions with refractory toxicity and the potential role for delayed aggressive gut decontamination with EGD. Consideration criteria may also include delayed or recurrent toxicity, absorption characteristics, gastro-intestinal ileus, altered pharmacokinetics and radiologic findings.

Incidental renal stones in potential live kidney donors: prevalence, assessment and donation, including role of ex vivo ureteroscopy

WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Previously, donors with asymptomatic stones found incidentally on CT were not considered ideal donor candidates because of the presumed risk of morbidity to both the donor and recipient. Increasingly, studies show that these risks are low. This study aims to evaluate the long-term safety of using ex vivo ureteroscopy to remove the stones from the donor kidney on the bench before donation. Outcomes so far suggest that this technique can safely render a kidney stone-free before transplantation. This has led to 20 more transplants in our institution than would otherwise be possible. To evaluate the prevalence of asymptomatic renal stones in our potential donor population. To assess the safety and success of ex vivo ureteroscopy (ExURS) to remove stones from explanted donor kidneys before transplantation. We conducted a retrospective analysis of 377 computed tomography (CT) angiograms of potential kidney donors between October 2004 and May 2007 to assess the prevalence of asymptomatic renal stones in our donor population. Between October 2005 and October 2011, kidneys from suitable donors underwent ExURS. Stones were removed using basket extraction or were fragmented with holmium laser on bench before transplantation. Immediate and long-term complications of the transplanted recipients were recorded. Donors were followed with yearly ultrasonography of the remaining kidney in addition to standard follow-up protocol. Review of 377 CT angiograms between October 2004 to May 2007 showed a 5% prevalence of asymptomatic renal stones. Out of 55 potential donors (19 identified between October 2004 to May 2007 and a further 36 identified since May 2007), 20 donors with stones proceeded to donation, with stone size ranging from 2 to 12 mm. Of the patients, 17 proceeded to ExURS. Stones were removed in 10 patients; five with basket retrieval, four with laser fragmentation and one with both laser fragmentation and basket retrieval. There were no early or late allograft stone-related complications and no evidence of stones on follow-up imaging at a mean (range) of 10 (1-24) months. There has been no reported stone recurrence in any of the donors to date and no stone on ultrasonography of eight donors with >1-year follow-up (mean 26 months, range 12-49 months). Asymptomatic renal stones are present in 5% of our donors. ExURS can be safely used to remove stones in these kidneys before transplantation, without the risk of subjecting the donor to an additional stone-removing procedure. Continued long-term follow-up of donors and recipients is still required to ensure the safety of this approach.

Endoscopic treatment for Bouveret syndrome

Gallstone ileus is an uncommon cause for small bowel obstruction. Less than 3 % of cases are due to a gallstone impacted in the duodenum or pylorus resulting in a gastric outlet obstruction, described by Bouveret in 1896. Most of the successful therapeutic maneuvers described involve open surgical removal of the stone through either a gastrotomy or duodenotomy, and reported morbidity is not insignificant. Endoscopic techniques continue to evolve, allowing for more complex procedures and avoidance of open surgery and its accompanying high morbidity. This video displays a rarely used endoscopic method of relieving gastric outlet obstruction caused by a stone in a patient with Bouveret syndrome. Video of successful endoscopic retrieval of a gallstone lodged in the pylorus is presented. An endoscopic retrieval basket is used, and key maneuvers highlighted include passage of the closed device distal to the stone, opening of the basket, and withdrawal of the stone under direct vision. After successful retrieval, endoscopic inspection revealed a normal duodenum and relief of the obstruction. Cholecystectomy was not performed, given that most cholecystoduodenal fistulae are large and will spontaneously close, especially if a patent cystic duct is present. Liver function tests were normal postoperatively, so no further evaluation of the bile duct was necessary. With new advances in technology, the endoscopic approach should be considered as the first line of treatment for cases of Bouveret syndrome because most patients are elderly with multiple comorbidities.

Video Cholangioscopy Using Conventional Gastroscope or Enteroscope for Stone Extraction and Management of Bile Duct Strictures

Purpose: Cholangioscopy is a vital tool in therapeutic endoscopic retrograde cholangiopancreatography (ERCP). The more widely used catheter-based systems provide limited therapeutic options and sub-optimal visualization while video cholangioscopes are restricted to only certain centers. We report a case series of direct cholangioscopy using regular gastroscopes with varying diameter (5.9 mm-9 mm) for intraductal therapy of bile duct stones and strictures. Methods: We performed direct cholangioscopy for patients with presence of large bile duct stones or undiagnosed biliary strictures. Carbon dioxide (CO2) was used for insufflation during the procedures. Where applicable, a sideviewing duodenoscope was utilized to obtain a cholangiogram and to perform a sphincterotomy. The biliary orifice was then dilated to 12 mm-15 mm using dilating balloons. The duodenoscope was then removed and a forward-viewing gastroscope (adult or pediatric) or an enteroscope was advanced to the papilla. Using a stiff wire or extraction balloon, the endoscope was advanced into the bile duct for direct visualization. If stones were present, removal was attempted using Electro-hydraulic lithotripsy (EHL), an extraction balloon or retrieval net. If strictures were present, white light and narrow band imaging was used to determine mucosal abnormalities and perform directed biopsies. Balloon-assisted dilation of the strictures was also performed with direct visualization. Results: Six patients underwent eight ERCP procedures with direct cholangioscopy for a pre-operative diagnosis of bile duct stones (n=4) and biliary stricture (n=4). The average time of procedure was 80 min (38-113 min). The average size of the bile duct was 10.9 mm (10-20 mm). Sphincterotomy was performed in one patient and already present in 4 patients; one patient had a Roux-en-y bypass and this patient underwent three separate procedures. Three of the four procedures with pre-operative diagnosis of bile duct stones had confirmed stones on cholangioscopy. The stones were removed using EHL and extraction balloon or retrieval basket. All strictures appeared benign endoscopically. Two strictures were imaged with NBI and one underwent directed biopsies of an ulcer at the stricture site. There were no complications, including venous or systemic air embolus. Conclusion: Direct cholangioscopy using a regular gastroscope or enteroscope with CO2 insufflation is a safe and effective way to remove intraductal stones and to evaluate and treat biliary strictures.

Safety and efficacy of ureteroscopic lithotripsy for stone disease in obese patients: a systematic review of the literature

To look at the role and safety of ureteroscopy for stone management in obese patients. We searched MEDLINE, PubMed and the Cochrane Library from January 1990 to June 2011 for results of ureteroscopy and stone treatment in obese patients. Inclusion criteria were all English language articles reporting on ureteroscopy in patients with morbid obesity. Data on the outcomes and complications was extracted and a meta-analysis of the results conducted. Seven studies with 131 patients (136 renal units) were included. All the studies included obese patients (mean BMI 42.2) treated with flexible URS for urinary calculi. The mode of fragmentation was pulse dye laser, holmium laser, and combined modality including electrohydraulic lithotripsy and basket retrieval in others. The average stone size was (1.37). The stone free rate was 87.5% after completion of treatment with a ranged follow up between 3 months and 3.5 years. The mean operative time was 97.1 minutes (30-275). There was an overall 11.4% complication rate, however, none of the patients needed further monitoring and were treated conservatively. A sub-group analysis of the stones depending on size found the URS has a higher stone free rate in stones <2 cm in size (P = 0.0003). Furthermore, URS has a higher stone free rate when treating ureteric stones compared to renal stones (P = 0.04). Retrograde stone treatment using ureteroscopy is a safe and efficient modality for treating obese patients with urinary tract calculi with an increased efficiency with smaller stones less than 2 cm in size.

Single-operator cholangioscopy-guided laser lithotripsy in patients with difficult biliary and pancreatic ductal stones (with videos)

Scant data exist on the utility of the holmium:yttrium-aluminum-garnet laser for the treatment of biliary or pancreatic duct stones. To evaluate the efficacy and safety of fiberoptic probe and catheter system-guided holmium laser lithotripsy of difficult biliary and pancreatic duct stones. Prospective study. Tertiary-care referral center. This study involved 64 patients who underwent holmium laser stone fragmentation. A total of 64 patients (60 bile duct stones, 4 pancreatic duct stones) underwent endoscopic retrograde stone fragmentation with a holmium laser and a fiberoptic probe and catheter system. The inclusion criterion for bile duct stones was stones not amenable to retrieval by mechanical lithotripsy and/or balloon sphincteroplasty or standard techniques. Pancreatic duct stones included in this study were not amenable to removal by stone retrieval basket or balloon. Rates of ductal clearance and procedural complications. All 64 patients had successful fragmentation of biliary and pancreatic duct stones with the holmium laser. Fifty of 60 patients (83.3%) had complete biliary duct clearance after a single session; 10 patients required an additional session. All pancreatic duct stones were fragmented in a single session. Mean duration of ERCP sessions was 45.9 minutes (range 30-90 minutes). Complications were mild and were encountered in 13.5% of patients; fever (n = 3), transient abdominal pain (n = 4), and biliary stricture (n = 1). No comparative treatment group. The fiberoptic probe and catheter system facilitates transpapillary access for holmium laser fragmentation of difficult biliary and pancreatic duct stones. The technique is safe and highly effective for single-setting duct clearance. Complications are minimal and transient.

Outcome after endoscopically assisted surgical retrieval of symptomatic parotid stones

10% of symptomatic parotid stones cannot be removed by minimally invasive radiological or endoscopic techniques alone. In these cases endoscopically assisted surgical parotid sialolithectomy can be performed via an extraoral approach, reconstituting the duct and preserving functioning glandular tissue. Between 2003 and 2010, 55 consecutive patients underwent endoscopically assisted surgical removal of parotid stones from 57 glands, two having bilateral procedures. Outcome was assessed using a structured questionnaire. 39/55 patients (71%) patients were successfully contacted (40 procedures; one bilateral case). At median follow-up of 3.1 years 28 glands (70%) were symptomless, whilst 11 (28%) were much improved but causing mild or occasional residual symptoms. One patient required postoperative lithotripsy and basket retrieval of a retained stone, but was subsequently symptom free. A further patient was initially symptom free then relapsed, did not respond to lithotripsy and is awaiting further assessment. In 10% of cases a short-lived sialocoele developed postoperatively. No individual reported facial weakness and one had a scar of concern. 37/39 (95%) patients were pleased to have had the operation and would have the procedure contralaterally in similar circumstances. Endoscopically assisted surgical removal of parotid stones is a successful technique with low morbidity that is well received by patients.

In Vitro Evaluation of Nitinol Stone Retrieval Baskets for Flexible Ureteroscopy

Because of increased clinical relevance of retrograde intrarenal surgery (RIRS), a variety of stone retrieval baskets have been introduced into endourology. Differences in shape and material may have consequences in performance and efficacy of RIRS. The aim of the study was to evaluate the in vitro performance of multiple commercially available nitinol retrieval baskets. Ten manufacturers of baskets for RIRS were invited to participate in this evaluation. The evaluation included measurement of the basket's internal resistance toward deflection, the influence on the deflection angle of a flexible ureteroscope (URF-P5, Olympus), and basket function in maximum deflection of the scope. All measurements were performed five times. Nine manufacturers, providing a total of 15 baskets, decided to participate in this evaluation. Maximum deflection of the ureteroscope (275 degrees) was achieved in 12 baskets and reduced in 3. In maximum deflection, complete opening of the basket was possible in 13 samples. In one case, partial opening of the basket was possible; one basket failed. The measurement of the basket's internal resistance showed wide variations (5.97 to 38 mm deflection/g), consecutively leading to increased inner radius of the fully deflected scope in 10 of 15 tested samples. The tested baskets showed wide variations in their resistance toward bending. Influence on overall deflection capacity seems minor, however. On the other hand, higher resistance leads to increased inner radius of the fully deflected renoscope, which may alter functionality. Knowledge about the basket's key feature and differences in basket performance may be crucial to choose the best tool for the patient.

Complete endoscopic removal of colloid cyst using a nitinol basket retriever

Neuroendoscopic treatment of colloid cysts is limited by the reach and flexibility of the instruments that can be passed through the working channels of the rigid neuroendoscope. The authors describe a case of a third ventricular colloid cyst where a large solid colloid fragment was recovered using a nitinol stone retrieval basket as a flexible wall-guided atraumatic salvage instrument. A flexible nitinol stone retrieval basket was successfully used through an endoscopic working channel to retrieve a large portion of the colloid cyst from the occipital horn of the lateral ventricle in a 70-year-old man who presented with progressive memory loss, urinary incontinence, and slowness of gait. A flexible nitinol stone retrieval basket can be safely and effectively maneuvered in the ventricular system, using the ventricular wall for deflection, and can be used to retrieve colloid cyst fragments as a salvage technique. Remaining free-floating large colloid cyst fragments in the ventricular system do not necessarily require a second craniotomy or bur hole for access but may be retrieved using a nitinol stone retrieval basket.

Impact of Collateral Damage to Endourologic Tools During Laser Lithotripsy—In Vitro Comparison of Three Different Clinical Laser Systems

During laser lithotripsy, working instruments are often in close proximity to the distal fiber tip and may be damaged accidentally or even intentionally. The aim of this study was to compare the amount of damage to a standard guidewire and the nitinol wires of endourologic retrieval baskets that were affected by three different clinically available laser systems. The impact of pulsed laser irradiation on a standard hydrophilic guidewire and a retrieval basket were investigated. One infrared (IR) laser system (holmium:yttrium-aluminum-garnet [Ho:YAG]: λ = 2100 nm) and two laser systems emitting light in the visible (VIS) spectral range (frequency-doubled double-pulse neodymium:YAG [FREDDY]: λ = 532 nm/1064 nm and flashlamp pulsed dye [FLPD]: λ = 598 nm) were used. Experimental parameters were fiber core diameter, laser pulse energy, and distance between the fiber tip and the investigated tool. Damage was evaluated by microscopic investigation and by quantifying the damage size and magnitude by creating laser impact related damage factors. After application of one single laser pulse, IR-laser related maximum damage to guidewires occurred, depending on the pulse energy and the fiber core diameter, either in contact mode or in a distance of maximum 2 mm. Maximum VIS-laser related damage occurred in a distance range of 2 to 3 mm. The nitinol wires of the extraction tools could be destroyed completely by IR laser irradiation at pulse energies E(P) > 1200 mJ, depending on the fiber core diameter used. VIS lasers were solely able to set visible damage to guidewires without any disruption of nitinol wires. Ho:YAG laser induced damage to endourologic tools is significantly higher compared with the impact of the FREDDY or the FLPD-laser. Because complete disruption of guidewires and stone extraction tools occurred, a safety clearance must be kept between the fiber tip and the endourologic tool during Ho:YAG stone disintegration. If disruption is intended, such as in the case of basket-retrieval problems, it can easily be performed with Ho:YAG irradiation.

Catheter-guided percutaneous heartworm removal using a nitinol basket in dogs with caval syndrome

Carval syndrome is a severe heartworm infection where the worms have migrated to the right atrium and vena cava; this condition is associated with a myriad of clinical signs. Several non-surgical and interventional methods are currently used for mechanical worm removal. However, the success rate and complications related to these methods are heavily dependent on methodology and retrieval devices used. In this study, we developed a catheter-guided heartworm removal method using a retrieval basket that can easily access pulmonary arteries and increase the number of worms removed per procedure. With this technique, we successfully treated four dogs with caval syndrome.

A Novel Use for the Nitinol Stone Retrieval Basket: The Removal of a Catheter Tip from the External Iliac Artery

A Novel Use for the Nitinol Stone Retrieval Basket: The Removal of a Catheter Tip from the External Iliac Artery