The first experience of laser lithotripsy in sialolithiasis

Abstract

Relevance. The current limits of endoscopic removal of sialolithes are limited to 3-5mm, larger sialolithes require crushing, but an effective and safe technology has not yet been found. The solution to this problem is primarily related to the technologies of shock wave lithotripsy. Currently, various methods of lithotripsy using extracorporeal and intracorporeal sources are described in the literature. The positive experience of urological laser lithotripsy served as the basis for our study of the possibilities of using the thule laser device FiberLase U2 for the fragmentation of sialolithes. Materials and Methods. The study included 16 clinical observations of patients diagnosed with sialolithiasis who underwent sialoendoscopy with additional application of the technique of intra-c urrent crushing of the concretion with a thule laser device FiberLase U2 with subsequent extraction of fragments. Results and Discussion. Sialolithes were fragmented in all 16 clinical cases, regardless of shape and structure. Large fragments were removed using basket traps and endoscopic forceps. In 9 out of 16 observations, the operation ended with the complete removal of the stone and all its visible fragments (until the duct was completely cleaned). In 7 patients, fragments remained in the duct, which could not be removed. During the crushing process, we observed an undesirable effect of retrograde migration of the stone with a pulse impact, as well as the resulting suspension of small fragments and air bubbles complicated the visibility and the operation process. Also, in 3 cases, when the stone was destroyed, the laser beam hit the duct wall, which was accompanied by weak bleeding and for a while hindered endoscopic visibility and required active irrigation. Conclusion. At the first time, the technology of thule laser lithotripsy was used that made possible the destruction of sialolithes and remove stones larger than 5 mm. This approach expands the limits of endoscopic surgery of sialolithiasis. At the same time, there is a number of important problems that require further study and improvement of the method.

Keywords

• sialoendoscopy
• sialolith
• lithotripsy
• salivary stone disease
• extraction of sialolith