[Focusing and targeting gallstones during extracorporeal shock waves lithotripsy]

The gallbladder lies at the junction of the medial segment of the left and right hepatic lobes. Besides the anatomic location, other factors may interfere with an ideal targeting of gallstones during extracorporeal shock waves treatment. Obesity, malnourishment, the respiratory cycle, the presence of intestinal gas, and colonic content may interfere with an adequate focalization. The use of a multipurpose device able to couple with the anterior abdominal wall like the Lithostar Plus permits to perform the procedure with the patient in supine, oblique or intercostal position. Varying the position permits to avoid interferences due to intestinal gas or intestinal content. The movements of the patients which produce a missing image can be easily refocussed. Technical ability, experience and a good machine permits a successful rate of gallstone fragmentation.