Biliary - Mechanical Lithotripsy
Comments: Mechanical lithotripsy provides a means to crush bile duct stones that are too large to be extracted from the bile duct intact. The principal of this technique requires first the ability to capture the stone in a wire basket which then can be winched down against a non-compressible wire sheath until the stone fragments.
As simple in concept as it may seem, the major difficulty with this technique lies in the ability to actually capture the stone within the basket. The best stone candidates are similar to the stone seen here: freely moving within a capacious bile duct, single in number, and round in shape. Adherent stones or those tightly stacked against multiple facetted stones may be very difficult to completely snare within the basket. A narrow duct further diminishes the success of stone capture by preventing the full deployment of the basket's wires.
Once the stone is captured, the wire sheath is advanced up to the stone over the plastic sheath, appearing here in the lower portion of the screen. The wires of the basket will be winched down against this spun wire sheath to crush the stone. Winching the captured stone down against the plastic sheath will split and ruin the end of the plastic sheath.
As the sheath is winched down on the captured stone, the fracturing can be seen fluoroscopically. Once fragmentation has occurred, the basket can then be redeployed and used to retrieve the stone fragments, by trolling the bile duct and dragging them out into the duodenum. The process should be repeated until the clearance of the bile duct can be confirmed.
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Peter B. Kelsey, M.D. Assistant Professor of Medicine Harvard Medical School Massachusetts General Hospital |
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Citation: Kelsey, PB (Apr 26 2007). Biliary - Mechanical Lithotripsy. The DAVE Project. Retrieved Sep, 6, 2010, from http://daveproject.org/viewfilms.cfm?film_id=617 Times viewed since Feb 2006: 7443 |
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