Use of the Nd:YAG Laser in Cholangioscopic Surgery

Abstract

In recent years cholangioscopy has become a widely used technique. By the introduction of the Nd:YAG laser this procedure has come to be used not only in endoscopy but has been aggressively applied in the treatment of biliary tract diseases. In this chapter we focus on the treatment of biliary tract calculi, using the Nd:YAG laser. In the treatment of hepatolithiasis, the most important point to be observed is that with whatever method of treatment used, bile duct calculi should leave no residual. As a means for attaining this goal various methods are reported: (1) lithotomy using a wire under fluoroscope¹; (2) treatment by various tools used in lithotomy²; (3) lithotomy by Dormia catheter³; and (4) lithotomy by steel catheter.⁴ There are also many reports on lithotomy under direct observation endoscopy.^5–7 In endoscopie lithotomy, the goal is to crush impacted calculi and calculi larger than the diameter of the fistula from which they are to be extracted and to extract these stones without any trauma. Since 1980 we have used the Nd:YAG laser as a means for lithotripsy in cholangioscopic lithotomy and previously reported on its value and safety.⁸ This chapter discusses recent progress in use of this method.