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Laparoscopic treatment of common bile duct stones. Phantom experiments using electrohydraulic and pulsed dye laser lithotripsy. 1993

H Raestrup, and E Kanehira, and U Weiss, and H O Werner, and T Mötzung, and K Manncke, and G Buess
Department of General Surgery, Eberhard-Karls-University, Tuebingen, Germany.

To evaluate the feasibility of laparoscopic transcystic lithotripsy of common bile duct stones, a phantom model comprising bovine liver and biliary tract tissue integrated within a laparoscopic trainer was built. A 9 French cholangioscope was introduced via the cystic duct into the common bile duct in which a human gall stone of known composition had been introduced. Lithotripsy was performed using either a laser or electrohydraulic probe passed through the working channel of the cholangioscope following which the stone fragments were manipulated into the duodenum through the papilla of Vater using the choledochoscope. A total of 20 lithotripsies with each energy form were performed. Lithotripsy was successful in breaking the stones into fragments smaller than 6 mm. The energy expenditure was comparable with a mean of 49 J for laser lithotripsy (range 9 to 159 J), and 53 J (range 16 to 160 J) for electrohydraulic wave lithotripsy. The lithotripsy time measured from introduction of the cholangioscope until its removal was a mean of 30 minutes for electrohydraulic wave lithotripsy and 41 minutes for dye laser lithotripsy. This difference was statistically significant. Macroscopic tissue damage to the common bile duct wall was not observed following any procedure. An additional experiment was performed to evaluate damage that could be caused to the wall of the common bile duct. Both electrohydraulic shock wave and pulsed dye laser lithotripsy without optical feedback regulation caused severe tissue defects when there was tissue contact or distance less than 2 mm. With optical feedback regulation however, no tissue damage was induced by laser lithotripsy.(ABSTRACT TRUNCATED AT 250 WORDS)

UI MeSH Term Description Entries
D008096 Lithotripsy The destruction of a calculus of the kidney, ureter, bladder, or gallbladder by physical forces, including crushing with a lithotriptor through a catheter. Focused percutaneous ultrasound and focused hydraulic shock waves may be used without surgery. Lithotripsy does not include the dissolving of stones by acids or litholysis. Lithotripsy by laser is LITHOTRIPSY, LASER. ESWL (Extracorporeal Shockwave Lithotripsy),Electrohydraulic Shockwave Lithotripsy,Extracorporeal Shockwave Lithotripsy,Litholapaxy,Noninvasive Litholapaxy,Percutaneous Ultrasonic Lithotripsy,Ultrasonic Lithotripsy,ESWLs (Extracorporeal Shockwave Lithotripsy),Electrohydraulic Shockwave Lithotripsies,Extracorporeal Shockwave Lithotripsies,Litholapaxies,Litholapaxies, Noninvasive,Litholapaxy, Noninvasive,Lithotripsies,Lithotripsies, Electrohydraulic Shockwave,Lithotripsies, Extracorporeal Shockwave,Lithotripsies, Percutaneous Ultrasonic,Lithotripsies, Ultrasonic,Lithotripsy, Electrohydraulic Shockwave,Lithotripsy, Extracorporeal Shockwave,Lithotripsy, Percutaneous Ultrasonic,Lithotripsy, Ultrasonic,Noninvasive Litholapaxies,Percutaneous Ultrasonic Lithotripsies,Shockwave Lithotripsies, Electrohydraulic,Shockwave Lithotripsies, Extracorporeal,Shockwave Lithotripsy, Electrohydraulic,Shockwave Lithotripsy, Extracorporeal,Ultrasonic Lithotripsies,Ultrasonic Lithotripsies, Percutaneous,Ultrasonic Lithotripsy, Percutaneous
D008099 Liver A large lobed glandular organ in the abdomen of vertebrates that is responsible for detoxification, metabolism, synthesis and storage of various substances. Livers
D008953 Models, Anatomic Three-dimensional representation to show anatomic structures. Models may be used in place of intact animals or organisms for teaching, practice, and study. Anatomic Models,Models, Surgical,Moulages,Models, Anatomical,Anatomic Model,Anatomical Model,Anatomical Models,Model, Anatomic,Model, Anatomical,Model, Surgical,Moulage,Surgical Model,Surgical Models
D008961 Models, Structural A representation, generally small in scale, to show the structure, construction, or appearance of something. (From Random House Unabridged Dictionary, 2d ed) Model, Structural,Structural Model,Structural Models
D010535 Laparoscopy A procedure in which a laparoscope (LAPAROSCOPES) is inserted through a small incision near the navel to examine the abdominal and pelvic organs in the PERITONEAL CAVITY. If appropriate, biopsy or surgery can be performed during laparoscopy. Celioscopy,Laparoscopic Surgical Procedures,Peritoneoscopy,Surgical Procedures, Laparoscopic,Laparoscopic Assisted Surgery,Laparoscopic Surgery,Laparoscopic Surgical Procedure,Procedure, Laparoscopic Surgical,Procedures, Laparoscopic Surgical,Surgery, Laparoscopic,Surgical Procedure, Laparoscopic,Celioscopies,Laparoscopic Assisted Surgeries,Laparoscopic Surgeries,Laparoscopies,Peritoneoscopies,Surgeries, Laparoscopic,Surgeries, Laparoscopic Assisted,Surgery, Laparoscopic Assisted
D002417 Cattle Domesticated bovine animals of the genus Bos, usually kept on a farm or ranch and used for the production of meat or dairy products or for heavy labor. Beef Cow,Bos grunniens,Bos indicus,Bos indicus Cattle,Bos taurus,Cow,Cow, Domestic,Dairy Cow,Holstein Cow,Indicine Cattle,Taurine Cattle,Taurus Cattle,Yak,Zebu,Beef Cows,Bos indicus Cattles,Cattle, Bos indicus,Cattle, Indicine,Cattle, Taurine,Cattle, Taurus,Cattles, Bos indicus,Cattles, Indicine,Cattles, Taurine,Cattles, Taurus,Cow, Beef,Cow, Dairy,Cow, Holstein,Cows,Dairy Cows,Domestic Cow,Domestic Cows,Indicine Cattles,Taurine Cattles,Taurus Cattles,Yaks,Zebus
D003131 Combined Modality Therapy The treatment of a disease or condition by several different means simultaneously or sequentially. Chemoimmunotherapy, RADIOIMMUNOTHERAPY, chemoradiotherapy, cryochemotherapy, and SALVAGE THERAPY are seen most frequently, but their combinations with each other and surgery are also used. Multimodal Treatment,Therapy, Combined Modality,Combined Modality Therapies,Modality Therapies, Combined,Modality Therapy, Combined,Multimodal Treatments,Therapies, Combined Modality,Treatment, Multimodal,Treatments, Multimodal
D003135 Common Bile Duct The largest bile duct. It is formed by the junction of the CYSTIC DUCT and the COMMON HEPATIC DUCT. Choledochus,Bile Duct, Common,Common Bile Ducts,Duct, Common Bile
D005240 Feasibility Studies Studies to determine the advantages or disadvantages, practicability, or capability of accomplishing a projected plan, study, or project. Feasibility Study,Studies, Feasibility,Study, Feasibility
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man

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