Lithotomy of retained biliary stones by YAG laser with a choledochofibroscope. Report of 3 cases

Retention of biliary stones is the most common troublesome situation in the field of biliary surgery. Post-operative choledochofibroscopy is a useful and effective method for treatment of retained stones, but incarcerated large retained stones, stones located at the peripheral duct or associated with biliary strictures are still main challenges in post-operative choledochofibroscopy. Incarcerated stones can be crushed by 3-arm, w-shaped or penetrating forceps. YAG laser beam can be used for fragmentation of giant and/or incarcerated stones through T-tube or PTBD fistula. Quartz fiber carrying a laser beam (0.6mm in diameter) can pass into a small hepatic or stricture duct through a small basket channel such as CHF-4B. Incarcerated left IHD stones (Cases 1 and 2) and retained giant distal CBD stone (Case 3) are destroyed successfully by YAG laser with a choledochofibroscope through a T-tube fistula. Lithotomy by YAG laser with choledochoscopy is effective and safe if the laser catheter can directly attack the stones.