Gallstone removal with a modified cholecystoscope: an alternative to cholecystectomy in the high-risk patient

Symptomatic gallstones in patients who are at high risk from or who wish to avoid anesthesia may be difficult to treat, especially if the gallstones are unsuitable for oral dissolution or lithotripsy. We describe our experience with a minimally invasive surgical method of gallstone extraction under thoracic epidural or intercostal anesthesia.

Eight-one patients who were either at high risk from or did not wish to undergo general anesthesia or those who wished to conserve their gallbladder underwent percutaneous cholecystolithotomy with a modified cholecystoscope. Of these patients, 63 (78 percent) were in American Society of Anesthesiology grades III and IV and 28 (35 percent) had thick-walled, diseased gallbladders.

Gallstones were completely cleared in 66 (81 percent) patients and complete symptom relief was obtained in more than 95 percent of these patients. There were no deaths or serious complications.

Percutaneous cholecystolithotomy under regional anesthesia is an effective means of gallstone treatment in selected high-risk patients.