A review of technical and clinical aspects of biliary laser lithotripsy

Objective: This paper reviews the current use of laser techniques for the t reatment of biliary stones. Background data: Biliary stones may pose a spec ial problem when access to them is limited, when previous attempts of remov al have failed, or when a less invasive option than surgery is needed. The availability of various laser sources and the adaptation of the technology for safe use in the biliary system make the use of laser energy for stone f ragmentation possible. Methods: Current literature is reviewed concerning t he use of laser for biliary lithotripsy, including experimental data and ex perience with human series. Technology, indications, alternatives, and cumu lative world experience are discussed. Conclusions: Recent technical advanc es have made the use of laser energy for fragmentation of biliary calculi p ossible. It is a valid option for treatment of "difficult" stones, when oth er methods have failed or as a primary treatment in certain situations. The technical complexity and the high cost limit its use for specialized cente rs.