1046 A Multi-Specialty Approach to the Management of CBD Stones: Utilising a High-Power Holmium Laser to Perform Laser Lithotripsy of a Complex Common Bile Duct Stone

Abstract

Laser Lithotripsy is a therapeutic technique commonly used for the treatment of urological stones. This report presents the case of a patient with a common bile duct (CBD) stone refractory to traditional management approaches including ERCP, internal and external drains. A plan was made for the patient to undergo laser lithotripsy of their CBD stone in a multi-disciplinary procedure. A high-power Holmium laser, operated by a Urology Consultant, was used to perform percutaneous fragmentation of the CBD stone. An Interventional Radiologist was also scrubbed to assist with access. The Upper GI Surgeon had also been involved in the planning of the case and was on standby should there be a need to proceed to further surgical intervention at this time. Intra-operatively, good progress was made in reducing the size of the stone, however due to the stone’s composition complete fragmentation could not be achieved. There is a current plan to bring the patient back for a further attempt and complete fragmentation.

Whilst this approach has been described in the literature and is likely to become more common in practice, it is a newly emerging approach for the trust and presents some important considerations for future practice. This case demonstrates the value of transferable skills and multi-specialty approaches to the management of surgical pathologies which fail standard treatment strategies. It also highlights the power of innovation in surgery to continue to find new ways to treat common and important pathologies.