Flashlamp exited pulsed dye laser and electrohydraulic lithotripsy: in vitro study on tissue effects

Intracorporal lithotripsy has gathered momentum in the management of gallstone disease due to the increasing sophistication of technical equipment for the percutaneous, as well as the retrograde-endoscopic route. Laser-induced shock wave lithotripsy (LISL) and electrohydraulic lithotripsy (EHL) have proved feasible by allowing reliable fragmentation of biliary calculi. Evaluation of therapeutic risks, e.g., effects of accidental irradiation of the gallbladder wall, has been performed in small sample sizes only. We investigated the effects of LISL and EHL on multiple sets of human and porcine gallbladders under in vitro conditions. Gallbladders were freshly harvested, mounted, and immersed in different mediums (normal saline, blood, bile). They were swiftly exposed to LISL (Pulsolith¿) and EHL (Lithotron EL 23¿) under differing experimental conditions (energy setting, pulse mode, exposition time, medium, probe pressure) and subjected to standard procedures for morphometric evaluation (Bioquant¿). Tissue effects were described by the depth (d) and width (w) of the cratered lesions, as well as the extension of the damage in the surrounding tissue(s). Serial cuts of the exposed areas yielded 894 section for morphometric analysis. Multivariate analysis of variance (MANOVA) revealed a significant effect of laser energy (p[d] less than 0.002, p[w] < 0.05, p[s] < 0.05), medium (p[d] less than 0.03, p[w] < 0.001, p[s] < 0.04, and exposition time (p[d] less than 0.001, p[s] < 0.001) on the degree of tissue lesion.(ABSTRACT TRUNCATED AT 250 WORDS)