Safety assessment of the contact electropulse lithotripsy for the biliary tract in choledocholithiasis
Abstract
Background. The issue of choosing the most appropriate minimally
invasive lithotripsy technique that would be safe for surrounding tissues is
still urgent. One such method is the contact biliary electropulse
lithotripsy.
The aim of this work is to
assess the safety of contact electrical impulse lithotripsy.
Material and methods. Stage 1: impact of an electric pulse electrode on
gallbladder wall. Stage 2: contact lithotripsy performance in a liquid medium
in vitro. For lithotripsy, we used an electric pulse unit with a pulse
energy range of 0.05 to 1.0 J, a frequency of 0.5-5.0 Hz, and a
single pulse repetition mode. The control group is an intact gallbladder.
The impact was carried out with 3 procedures in three groups, divided on
the basis of power modes. The concrements were divided into 3 groups
depending on composition. Each group underwent contact electrical impulse
lithotripsy at all studied power modes. We assessed damage to gallbladder
wall, histological examination at the light-optical level of the
"crushing spark" impact site; degree of destruction, nature
migration of concrement parts, power mode at which maximal crushing
occurs.
Results. Visual examination of gallbladder wall in all study groups with the impact
of an electric pulse discharge showed a small scab area; gallbladder wall
perforation was not detected in all groups. With gallstones crushed in an
aqueous medium with an electric pulse electrode using the original device
developed, their complete fragmentation occurred, regardless of
their composition.
Conclusion. Use of electrical impulses for gallstone lithotripsy in choledocholithiasis
is an effective and safe method, since even if a "crushing spark"
hits the choledoch wall, the risk of developing its perforation and
associated complications is minimal. When bile duct stones are crushed with electrical
impulse lithotripsy, their complete fragmentation occurs without migration and
possible injury to the surrounding tissues.
Keywords:electropulse lithotripsy, obstructive jaundice, choledocholithiasis
Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
For citation: Semichev E.V., Podgornov V.F., Kokorin A.S. Safety
assessment of the contact electropulse lithotripsy for the biliary tract in
choledocholithiasis. Clinical and Experimental Surgery. Petrovsky Journal. 2021;
9 (3): 67-73. DOI: https://doi.org/10.33029/2308-1198-2021-9-3-67-73 (in Russian)
References
1. Pronina G.M., Bystrovskaya E.V., Il’chenko A.A., Orlova
Yu.N, Selezneva E.Ya. Assessment of the effectiveness of litholytic therapy in patients
with cholelithiasis. Meditsinskiy sovet [Medical Council]. 2012; (9): 34–6. (in
Russian)
2. Schirmer B.D., Edlich R.F., Winters K.L.
Cholelithiasis and cholecystitis. J Long Term Eff Med Implants. 2005; 15 (3):
329–38.
3. Merzlikin N.V., Podgornov V.F., Semichev E.V., Bushlanov
P.S., Talacheva V.D. Methods for the treatment of choledocholithiasis.
Byulleten’ sibirskoy meditsiny [Bulletin of
Siberian Medicine]. 2015; 14 (4): 99–109. (in Russian)
4. Sun H., Tang H., Jiang S., et al. Gender and metabolic
differences of gallstone diseases. World J Gastroenterol. 2009; 15 (15):
1886–91.
5. Nichitailo M.E., Grubnik V.V., Kovalchuk A.L., et
al. Minimally invasive surgery for bile duct pathology. Kiev: Zdorov’ya, 2005:
424 p. (in Russian)
6. Shapovalyants S.G., Myl’nikov A.G., Pan’kov A.G., Ardasenov
T.B., et al. Recurrent choledocholithiasis diagnosis, prevention and treatment.
Eksperimental’naya i klinicheskaya gastoenterologiya [Experimental and Clinical Gastroenterology]. 2012; (4): 32–8. (in Russian)
7. Binmoeller K.F., Bruckner M., Thonke F., et al. Treatment
of difficult bile duct stones using mechanical, electrohydraulic and extracorporeal shock wave lithotripsy. Endoscopy.
1993; 25: 201-6.
8. Blind PJ., Lundmark M. Management
of bile duct stones: lithotripsy by laser, electrohydraulic, and
ultrasonic techniques. Eur J Surg. 1998; 164: 403-9.
9. Tarasenko S.V., Bryantsev E.M.,
Marakhovsky S.L., Kopeykin A.A. Complications of endoscopic transpapillary
interventions in patients with benign bile duct diseases. Annaly
khirurgicheskoy gepatologii [Annals of Surgical Hepatology]. 2010; 15 (1):
21-6. (in Russian)
10. Strakhov A.V., Gordetsov A.S.
Determination of the chemical composition of gallstones in patients
with cholelithiasis using the method of infrared
spectrometry. Sovremennye tekhnologii v meditsine [Modern Technologies in
Medicine]. 2012; (2): 86-90. (in Russian)
11. Aslanov A.M., Yalovega G.E.,
Kolmakova T.S., Brzhezinskaya M.M. Trace element composition
and ultrastructure of various types of gallstones. Sovremen-nye problemy
nauki i obrazovaniya [Modern Problems of Science and Education]. 2015;
(3): 132-132. (in Russian)
12. Aslanov A.M., Kolmakova T.S.,
Tenchurin R.Sh. Features of the elemental composition of stones of
the biliary system and bile in patients with cholelithiasis. Fundamental'nye
issledovaniya [Fundamental Researches]. 2014; (4-1): 17-21. (in Russian)