Safety assessment of the contact electropulse lithotripsy for the biliary tract in choledocholithiasis

• Evgeny V. Semichev
• Podgornov V.F.
• Kokorin A.S.

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

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