Mechanical lithotripsy In 1982, Riemann et al,first introduced mechanical lithotripsy (ML). ML is currently the most widely used technique for fragmentation of stones. Contemporary lithotripter baskets have a high breaking strengths and have improved the success rate of ML for extraction of large CBD stones (> 2 cm) to well over 90% without serious complications. Broadly speaking, there are two types of baskets for ML. The type of basket used depends on whether lithotripsy is done on an elective (“through the scope”) basis or on an emergent basis (salvage device) for basket impaction The ‘through the scope’ model is typically a three-layer system with the basket, inner plastic sheath, and an outer metal sheath The stone is captured with the …show more content…
Unfortunately the failure rate is high especially in patients with stones greater than 2.8 cm in diameter. In a retrospective study the size of the stone was the only factor that significantly affected the success or failure of bile duct clearance. In this study of 162 patients, the cumulative probability of bile duct clearance ranged from > 90% for stones with a diameter less than 10 mm to 68% for those greater than 28 mm in diameter the rate of complications associated with ML to be around 3.6%[]. Among the spectrum of complications, basket impaction or fracture of the basket wire are uniquely associated with ML. Non-surgical interventions that have been utilized in this setting include extension of sphincterotomy, awaiting spontaneous passage of the impacted basket and stone after successful stent placement, use of a second lithotripter, extracorporeal shock wave lithotripsy (ESWL), laser lithotripsy, electrohydraulic lithotripsy, and transhepatic lithotripsy and stone dislodgement. Other complications include broken handle and perforation or injury to the bile duct In about 10% of the patients ML proves to be cumbersome, protracted and ineffectivewherein one has to resort to other methods such as electrohydraulic, or laser lithotripsy for stone fragmentation and subsequent removal. Electrohydraulic …show more content…
The pulsed laser energy utilized in stone fragmentation is in contrast to the continuous laser energy used in tumor ablation. LL is typically performed perorally under cholangioscopic or fluoroscopic guidance or by the transhepatic approach. As with EHL, LL under direct visualization using a cholangioscope is often preferred to avoid damage to the ductal wall A recent innovation worth mentioning is the introduction of a double-lumen basket which allows passage of a laser probe for effective laser lithotripsy after the stone is captured by the basket.For a selected group of patients, this technique was shown to be feasible and effective, and the authors hope that continuous improvements in designs and construction materials would further enhance the success rate of this device Extracorporeal shockwave
...h a type of surgery called Cholecystectomy. The Non-Surgical approaches are used only in specific situations such as when a patient’s condition prevents using an anesthetic. In such cases, Oral dissolution therapy is used.
They can be enumerated as difficult entry to the right hypochondrium owing to the adhesions, difficulty in exposure can also arise due to diseased gallbladder and Liver ,acutely inflamed and tense gallbladder ,gallbladder packed with stones ,thick walled gallbladder ,fibrotic gallbladder ,gallbladder mass and abnormality can also arise due to anomalous anatomy of hepatobiliary system like situs inversus, malposition of the gallbladder, arterial anomalies and short cystic duct, a huge stone impacted in the cystic duct, Hartmann’s pouch adherent to the common hepatic duct and anomalous insertion of the cystic duct.
One or more gallstones erode into the gastrointestinal tract, creating a cholecystenteric fistula, most commonly between the gallbladder and the duodenum. Gallstones less than 2 to 2.5 cm generally pass into the intestine without causing obstruction while stones 5 cm or larger are more likely to impact usually at the distal ileum, the narrowest part of the small bowel. Other reported sites of impaction include proximal ileum, jejunem, colon, and rarely the duodenum or stomach (bouveret’s syndrome). [11] In our case, a large, approximately 5 cm, gallstone was found impacted at the jejunum while a smaller stone was found impacted at a Meckel’s
At the moment, the main objective for scientists and engineers is to develop surgery into a minimal invasive method and nanote...
A procedure known as “shockwave lithotripsy” (SWL) may be used in cases where the kidney stones are in the small and medium growth stage. This requires the patient to be put under anesthesia whilst sound waves of certain intensity are directed on the stone. The waves crush the stones whilst minimizing pressure to the surrounding muscles. The resulting stone fragments are then washed out of the urinary tract. The patient experiences limited pain when this fluid is discharged from the body.
The second procedure I was fortunate to observe was an esophagogastroduodenoscopy (EGD). The operation was performed with local anesthesia to the throat or sedation. The same type of scope was utilized, but instead of inserting through the rectum, the scope was inserted through the mouth. This procedure allowed the doctor to inspect the lining of the esophagus, stomach, and duodenum. Like the scope above, the doctor extracted biopsies, inflated the gastrointestinal tract, and cleansed the walls utilizing the scope. (Lewis, Dirksen, Heitkemper, & Bucher, 2014, p.
A kidney stone or crystal forms when the urine is supersaturated in regard to a stone forming material, meaning the urine contains a higher concentration of stone material than it can dissolve. There are several factors that can contribute to supersaturation, such as urine volume, pH, and the amount of solute excretion (Worcester and Coe 2009). There are numerous types of stones that can form depending on what material in the urine is in excess. The most common types of stones are calcium kidney stones with calcium oxalate (CaOx) causing 80% of all calcium stones and calcium phosphate (CaP) causing 15% of calcium stones (Sakhaee et al. 2012). Calcium oxalate stones are usually found in patients as white deposits on their papillae, or Randall’s plaques. The stone begins as a deposit of calciu...
Urolithiasis is the process of forming stones in the kidney, bladder, and/or urinary tract.1 1,200 to 1,400 per 100,000 people will develop a urinary stone each year. Urinary stones are formed when there is a decrease in urine volume or an excess of stone forming substances are present. The use of diagnostic imaging plays a vital role in the diagnostic and treatment processes of a stone in the urinary track. This paper will discuss the signs, symptoms, diagnosis, treatment, and prognosis of Urolithiasis.
Laparoscopic cholecystectomy is the removal of the gallbladder. This is a less invasive way to remove the gallbladder. This surgery uses a laparoscope, which is a camera used to see the inside of the body and three other small incisions are made. With open surgery, incisions are made in the right upper part of abdomen in five to eight inch long incisions. Most laparoscopic cholecystectomies are same day surgery, have smaller incisions, and patients experience less pain after surgery and have a quicker recovery.
Furthermore, the circulating person should have kept the bowl liner inside the theatre until the operation’s completed, and the final count was undertaken and everything that was accounted for at the beginning of the case were out. The local trust policy (c) (2012) states that at no time should laundry, orange-bagged clinical waste, and non- clinical waste containers including suction liners leave the theatre. In line with the infection control standard precautions, the fluid that was taken in the sluice should have been sucked via suction tubing to the suction liner. The NICE (2012) guideline states that health- care-associated infections are caused by wide range of microorganisms. These are often carried by the patients themselves, and have taken advantage of a route into the body provided by an invasive device or procedure.
The laser procedure is much faster than the surgical operations. Moreover, regular visits are also not required to derive benefit of the treatment.
...f the clamps on the tubing to allow the IV solution to run freely. Slowly, decrease the flow of the solution to the appropriate rate as ordered by the physician. Using a small gauze pad, wipe away any excess blood or fluid on the surface of the skin. Then, using the pre-torn pieces of tape, secure the catheter hub and the IV tubing to the patient’s skin. Take extra caution not to kink the tubing. Once everything is secured, recheck the IV solution’s flow and then attend to the rest of your patients needs.
Erbium or YAG laser which is of precise wave length penetrates into the skin. As the scattering of the YAG lasers are less, the normal skin is left unaffected.
Kidney stones they say “is as old as malady”. Due to the fact that it was found in mummies of over 700years ( kidney analysis). Remedies for kidney stones could be achie...
Laser therapy has been accepted widely by the general public and the medical professionals for its extensive benefits. This therapy precisely targets the affected area, minimizes the use of general anesthesia, encourages shorter hospital stay and improves the patient outcomes. These benefits have lead to its increased use and importance worldwide.