Endoscopic Salivary Stone Fragmentation with Pneumatic Lithotripsy in a Simulation Model

Area of Science:

• Otolaryngology
• Endourology
• Biomedical Engineering

Background:

• Sialolithiasis, or salivary stones, commonly affects salivary glands, causing pain and swelling.
• Current treatment options for salivary stones can be invasive, necessitating surgical intervention.
• Endoscopic techniques offer a minimally invasive approach to salivary stone management.

Purpose of the Study:

• To evaluate the efficacy of intracorporeal pneumatic lithotripsy for endoscopic fragmentation and removal of human salivary stones.
• To assess the feasibility of adapting nephrolithiasis technology for sialolithiasis treatment in a simulated setting.

Main Methods:

• A laboratory simulation model of the submandibular gland was utilized.
• A flexible nitinol probe, integrated with a CO2-driven pneumatic lithotripter, was deployed via sialendoscope.
• Human salivary stones in 3D-printed models were disrupted, and fragments were removed using basket retrieval, irrigation, and suction.

Main Results:

• Successful fragmentation and endoscopic removal were achieved for 7 out of 8 salivary stones.
• Procedure duration (average 32 minutes) and pneumatic pulses (average 98) correlated with stone density and volume.
• One stone demonstrated resistance to fragmentation, preventing complete removal.

Conclusions:

• Intracorporeal pneumatic lithotripsy, adapted from nephrolithiasis management, is a viable technique for ex vivo simulation of sialolithiasis treatment.
• This study demonstrates the potential of modified endoscopic pneumatic technology for salivary stone management.