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Title: Percutaneous transhepatic laser lithotripsy for intrahepatic cholelithiasis: A technical report.
Austin Authors: Lamanna, Anthony ;Maingard, Julian;Bates, Davina;Ranatunga, Dinesh G ;Goodwin, Mark D 
Affiliation: Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
School of Medicine, Deakin University, Geelong, Victoria, Australia
Interventional Radiology Service - Monash Imaging, Monash Health, Melbourne, Victoria, Australia
Interventional Radiology Service, Department of Radiology, Austin Health, Heidelberg, Victoria, Australia
Issue Date: Dec-2019 2019-09-23
Publication information: Journal of Medical Imaging and Radiation Oncology 2019; 63(6): 758-764
Abstract: Advances in interventional radiology have seen the adaptation of urological endoscopic laser techniques to treat biliary tract calculi. Percutaneous transhepatic biliary laser lithotripsy provides an effective alternative procedure for the management of intrahepatic or conventionally refractory choledocholithiasis which would otherwise require invasive and high-risk surgical intervention. Several small studies have validated the procedure for management in this subset of patients, with most achieving 100% calculi clearance with minimal complications. Most patients are suitable for percutaneous transhepatic biliary laser lithotripsy. Preprocedural imaging is useful for evaluating stone burden and planning percutaneous access. Holmium lasers are commonly used and act by vaporising water particles on and in the calculi, fragmenting the stone via thermal expansion. A series of catheters, wires, sheaths and dilators are used to allow introduction of the choledochoscope and laser so that calculi can be targeted. Percutaneous transhepatic biliary laser lithotripsy is often used in conjunction with balloon dredging and biliary stricture dilatation. Only experienced interventionalists should perform this procedure, and users should be aware of associated hazards. Repeat percutaneous transhepatic cholangiography is routinely performed to confirm eradication of stones. Treatment of biliary calculi and obstruction is important in preventing diseases such as cholangitis and cirrhosis. For patients unsuitable for conventional treatment, percutaneous transhepatic laser lithotripsy is a safe and effective alternative when performed by experienced interventional radiologists. Preprocedural planning is imperative to procedure success.
DOI: 10.1111/1754-9485.12952
ORCID: 0000-0003-0705-2252
PubMed URL: 31545020
Type: Journal Article
Subjects: cholangioscopy
holmium: YAG
intrahepatic cholelithiasis
percutaneous biliary lithotripsy
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