1992 Volume 34 Issue 3 Pages 546-554
During laparoscopic cholecystectomy, the resected gallbladder (GB) containing a large stone can not be pulled out through the trocher-punctured opening. To overcome this difficulty, we have employed the utility of the ultrasonic lithotriptor to fragment such a stone. 1) The neck of the GB was pulled up through the trocher-punctured opening and the nephroscope was inserted into the GB through an incision made at the neck. Then, ultrasonic lithotripsy of the incarcerated stone in the detached GB was perf omed under TV monitoring. 2) As the lithotriptor and suction pump were powerful, even a hard cholesterol stone was easily fragmented and rapidly aspirated out of the GB. The nephroscope gave a clean visual field because of its irrigation system. 3) Four cases of cholesterol stone (diameter : 25-36mm) and three cases of mixed stone (diameter: 19-22mm) were successfully managed by this method and the removal of the GB was completed without widening the opening by an additional incision. The time required for this procedure in the four patients with cholesterol stone and in the three patients with mixed stone were 18-50minutes (mean : 35minutes) and 13-30minutes (mean 2lminutes), respectively. In coclusion, we believe that this method is easy and holds less tissue trauma and more potential of reducing recovery time compaired with other means of fragmentation or incision enlargement.
