[Laser lithotripsy in the treatment of bile duct calculi]

Currently more than 90% of all common bile duct stones can be removed non-surgically by means of endoscopic sphincterotomy, stone extraction and mechanical lithotripsy. For impacted, very large or very hard concrements intracorporeal shock wave lithotripsy by means of pulsed lasers represents a clinically newly established treatment procedure. Most clinical experience exists using the pulsed dye laser applied cholangioscopically via the endoscopic-retrograde or percutaneous-transhepatic route. The development of commercially available fine-caliber-endoscopes allows a relatively easy access to the stone compared to conventional mother-baby-scope-systems. A new stone-tissue-detection-system (STDS) in combination with a rhodamine-6G dye laser is promising for "blind" laser-lithotripsy using standard ERCP- or balloon catheters or a special lithotriptor basket. After successful conclusion of our in vitro and animal studies concerning the STD system we report on 18 patients with giant common bile duct stones using STDS in combination with a Rhodamin-6G dye laser.