Summary
During laparoscopic cholecystectomy, a large stone burden may cause difficulty when extracting the gallbladder through the abdominal wall. Currently, the alternatives available to the surgeon include increasing the incision, removing stones singly, or utilizing complex fragmentation techniques like the pulsed dye laser [1]. We have employed an electromechanical rotary gallstone lithotrite (RGL) to fragment stones to an aspiratable size.
Initially, cholesterol spheres were pulverized in a latex balloon to demonstrate the efficacy of the device. Then, human gallstones were placed in the balloon and reduced to fragments less than or equal to 1 mm from initial sizes of 4–24 mm.
Human stones were then inserted in ex vivo porcine gallbladders in a controlled experiment and treated with the device. Ten out of 12 tests were completed within 30 s; one test required 49 s and one 105 s to achieve complete fragmentation. Blinded histological evaluation demonstrated that tissue abrasion caused by use of the device would not interfere with the diagnosis of unsuspected malignancy. Clinical trials have now commenced under the auspices of the hospital ethical committee.
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References
Berci G, Hamlin JA, Daykhovsky L, Paz-Partlow M (1990) Common bile duct laser lithotripsy GI Endosc 36: 137–138
Berci G, Sackier JM, Paz-Partlow M (1991) A new endoscopic treatment for symptomatic gallbladder disease: laparoscopic cholecystectomy. Gastrointest Endosc Clin North Am 1(1) 191–203
Bordelon BM, Hobday KA, Hunter JG (1992) Incision extension is the optimal method of difficult gallbladder extraction at laparoscopic cholecystectomy. Presented at the 9th Annual Congress of the Society of American Gastrointestinal Endoscopic Surgeons. Washington DC, April, 1992, Surg Endosc 6(2): 97–98
Dubois F, Berthelots G, Levard H (1989) Cholecystectomie par coelioscopie. Presse Med 18: 980–982
Miller FJ, Kensey KR, Nash JE (1989) Experimental percutaneous gallstone lithotripsy: results in swine. Radiology 170(3): 985–987
Perissat J, Collet D, Belliard R (1990) Gallstones: Laparoscopic treatment, cholecystectomy, cholecystostomy, and lithotripsy. Surg Endosc 4: 1–5
Reddick EJ, Olsen DO (1989) Laparoscopic laser cholecystectomy. Surg Endosc 3: 131–133
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Sackier, J.M., Hunter, J.G., Paz-Partlow, M. et al. The rotary gallstone lithotrite to aid gallbladder extraction in laparoscopic cholecystectomy. Surg Endosc 6, 235–238 (1992). https://doi.org/10.1007/BF02498810
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DOI: https://doi.org/10.1007/BF02498810