Abstract
Objective: To evaluate the technical feasibility of percutaneous transhepatic cholangioscopic laser lithotripsy and to assess the initial outcomes and the safety profile of this procedure in a clinical case series.
Methods: A series of 33 patients diagnosed with hepatolithiasis who were indicated for and underwent the PTCSL intervention at Hue Central Hospital between June 2025 and June 2026. The technique was performed in two stages: percutaneous transhepatic biliary drainage (PTBD) to establish a percutaneous tract into the biliary system, followed by Holmium laser lithotripsy via this tract 1 to 3 weeks later.
Results: The mean age of the study cohort was 55.2 ± 10.5 years, with females comprising 54.5% (18/33 cases). Notably, 90.9% (30/33 cases) of the patients had a complex history of prior biliary interventions, predominantly ERCP (45.5%, 15/33 cases), left hepatectomy (36.4%, 12/33 cases), and bilioenteric anastomosis (27.3%, 9/33 cases). Regarding feasibility and initial outcomes, the success rate of percutaneous transhepatic tract creation was 100% (33/33 cases). The complete stone clearance rate reached 81.8% (27/33 cases). The majority of the patients required a single intervention session (84.8%, 28/33 cases), whereas 5 cases required two lithotripsy sessions (9.1%). Regarding safety, the early complication rate was 18.2% (6/33 cases), which included 2 cases of mild, self-limiting hemobilia, 3 cases of post-procedural fever, and 1 case of biliary tract perforation. All complications were successfully managed with conservative medical treatment (Clavien-Dindo grades I and II), with no severe complications (grade III or higher) or mortality observed.
Conclusion: Percutaneous transhepatic cholangioscopic laser lithotripsy for hepatolithiasis demonstrates high technical feasibility and yields favorable initial outcomes, with most patients requiring only a single-stage intervention. The technique exhibits a robust safety profile; early complications were mild and effectively controlled through conservative management. This represents an optimal minimally invasive solution, offering excellent indications and high efficacy specifically for patients with recurrent hepatolithiasis who have a history of multiple prior biliary surgeries
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| Published | 20-10-2026 | |
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| Issue | Vol. 18 No. 6 (2026) | |
| Section | Original article | |
| DOI | 10.38103/jcmhch.18.6.11 | |
| Keywords | sỏi đường mật trong gan, tán sỏi laser, xuyên gan qua da, nội soi đường mật, PTCSL hepatolithiasis, laser lithotripsy, percutaneous transhepatic |
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