Electromagnetic tracking system-assisted ultrasound guidance for percutaneous transhepatic one-step biliary fistulation combined with rigid choledochoscopy in the treatment of hepatolithiasis.

INTRODUCTION

The electromagnetic tracking system (EMTS) has been increasingly applied in many disciplines. However, its value in percutaneous transhepatic lithotomy has yet to be reported. This study aims to evaluate the clinical application value of an electromagnetic tracking system in assisting with ultrasound-guided percutaneous transhepatic one-step biliary fistulation (PTOBF) combined with rigid choledochoscopy for hepatolithiasis.

METHODS

The clinical data of 19 patients with hepatolithiasis were analyzed retrospectively. These patients underwent PTOBF combined with rigid choledochoscopy for the treatment of hepatolithiasis.

RESULTS

A total of 19 cases of hepatolithiasis were successfully performed PTOBF combined with rigid choledochoscopy under tracheal intubation and general anesthesia. EMTS-assisted US-guided PTOBF was successfully completed in 18 patients, with a puncture success rate of 94.7% (18/19) and a dilatation success rate of 100.00% (19/19). Five cases percutaneous located in left bile duct while 14 cases in right bile duct, with an overall one-time puncture success rate of 84.2% (16/19). The mean intraoperative blood loss was 6.00 ± 2.63 mL, the mean puncture time was 43.79 ± 65.57 s, and the mean postoperative hospitalization was 4.63 ± 1.86 days. The rates of out-of-plane puncture were 73.7% (14/19), and the initial stone clearance rate was 68.42% (13/19). The incidence of postoperative complications was 10.52% (2/19), including one cases of pleural efusion and one case of bile leakage which recovered after treatment. During a mean follow-up period of 59.26 ± 12.91 days (range 35 to 77 days), no complications or deaths were observed.

CONCLUSIONS

EMTS-assisted US guidance for PTOBF combined with rigid choledochoscopy appears to be a minimally invasive, safe, and effective method for the treatment of hepatolithiasis, offering clinical application value. Furthermore, the integration of EMTS and US simplifies and facilitates the operation. Future comparative studies with larger sample sizes are necessary to confirm the reliability of its therapeutic outcomes.