Flexible Percutaneous Laser Lithotripsy: Evaluating Efficacy and Safety in Western Populations

Flexible percutaneous laser lithotripsy achieves high technical success for Western patients with intrahepatic stones, including those with surgically altered biliary anatomy.

The technique enables direct visualization and targeted laser fragmentation where endoscopic approaches are limited, offering a minimally invasive option that directly addresses ductal clearance challenges in complex intrahepatic lithiasis.

In a multicenter clinical series of Western patients with intrahepatic stones—including cases with altered biliary anatomy and prior endoscopic failure—procedures were performed under image-guided flexible cholangioscopic control. The primary efficacy metric was complete ductal clearance confirmed by endoscopic visualization or cross-sectional imaging; the reported cohort-level result was 100% ductal clearance, supporting feasibility in patients with complex biliary anatomy.

Procedural workflow emphasized percutaneous access with tract planning to accommodate flexible cholangioscopy and laser delivery. Operators used laser fragmentation under fluoroscopic and endoscopic guidance rather than chemical dissolution, with session staging as needed, consideration of tract diameter for scope and instrument passage, and adjunctive cholangiography to define and clear residual fragments. Operator notes underline predictable equipment needs and reproducible steps that support training and adoption.

Safety data in the series showed a minor complication rate of 11.4% and no major adverse events. Reported minor events were transient and manageable—predominantly brief febrile responses and access-site issues—hospital stays were short, and additional interventions were infrequent, yielding a low-morbidity profile in appropriately selected patients.