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Updated: Jan 22, 2026
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A Two-Step Method for Percutaneous Transhepatic Choledochoscopic Lithotomy
Published on: September 13, 2022
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Percutaneous transhepatic Laser lithotripsy for intrahepatic cholelithiasis
A Lamanna1, J Maingard2, J Tai3
1Interventional Radiology Service, Department of Radiology, Austin Hospital, Melbourne, Australia.
Diagnostic and Interventional Imaging
|July 2, 2019
Summary
Percutaneous transhepatic biliary laser lithotripsy (PTBLL) is an effective treatment for intrahepatic stones when ERCP fails. While PTBLL shows high technical success, recurrence of stones can occur, necessitating careful patient selection.
Area of Science:
- Hepatobiliary Surgery
- Interventional Radiology
- Gastroenterology
Background:
- Intrahepatic cholelithiasis poses treatment challenges, especially when endoscopic retrograde cholangiopancreatography (ERCP) is not feasible.
- Many patients with intrahepatic stones have complex anatomy or multiple/large stones, complicating ERCP.
- Previous hepatobiliary surgery is common in patients with intrahepatic calculi.
Purpose of the Study:
- To evaluate the technical success, complications, and long-term outcomes of percutaneous transhepatic biliary laser lithotripsy (PTBLL).
- To assess PTBLL as an alternative treatment for intrahepatic cholelithiasis unresponsive to ERCP.
- To analyze patient data for efficacy and safety of PTBLL in challenging cases.
Main Methods:
- Retrospective review of 12 patients undergoing PTBLL for intrahepatic cholelithiasis.
- HolmiumYAG 2100nM Laser used for lithotripsy via percutaneous transhepatic biliary access.
- Analysis of patient files for technical success, complications, and long-term outcomes.
Main Results:
- 100% fragmentation success rate and 92% first-pass stone fragment extraction.
- 92% of patients had prior hepatobiliary surgery; 75% had multiple stones.
- One major complication (cholangitis); 40% recurrence of stones at a mean of 31 months.
Conclusions:
- PTBLL is an effective and safe alternative for intrahepatic biliary calculi when ERCP is not suitable.
- High technical success rates reported, but long-term surveillance is important due to stone recurrence.
- PTBLL offers a viable solution for complex intrahepatic stone disease.
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