Biliary lithotripsy with a mechanical lithotripter.

A simple device for easy and safe mechanical disintegration of hard and large (1-2.5 cm in diameter) biliary calculi, the mechanical lithotripter, has been designed for use with a Dormia or similar type of basket. This device is capable of generating a steady increase in tension in the basket wires, which in turn breaks up the calculus. It may be introduced through a T-tube tract or by a percutaneous transhepatic approach. The lithotripter has been successfully tested in vitro with ten mixed gallstones obtained soon after cholecystectomy and has been successfully employed in six patients with biliary calculi, three with T tubes and three without. In the latter three patients, a percutaneous transhepatic biliary procedure was performed to enable introduction of the lithotripter. There were no complications.