# Thulium laser-assisted laparoscopic management of intrahepatic stones in recurrent pyogenic cholangitis: A case report and review of minimally invasive approaches

## TL;DR

This case report explores using thulium laser technology in a minimally invasive surgery to treat intrahepatic stones in a patient with recurrent pyogenic cholangitis.

## Contribution

First reported use of thulium laser lithotripsy for intrahepatic stones in recurrent pyogenic cholangitis.

## Key findings

- Laparoscopic choledochoscopy with thulium laser lithotripsy successfully fragmented and extracted intrahepatic stones.
- The procedure was completed with minimal blood loss and no intraoperative complications.
- The patient remained asymptomatic with normal liver function at 6-month follow-up.

## Abstract

Recurrent pyogenic cholangitis (RPC) presents significant management challenges, particularly when complicated by large intrahepatic stones. While thulium laser technology has demonstrated excellent results in urological stone treatment, its application in biliary stones remains relatively unexplored. We present a novel approach utilizing laparoscopic choledochoscopy with thulium laser lithotripsy for managing intrahepatic stones in RPC.

A 65-year-old female presented with a two-year history of recurrent right upper quadrant pain, fever, and jaundice. Diagnostic imaging revealed multiple large intrahepatic stones without any liver atrophy or mass lesions. After initial ERCP for acute cholangitis management, the patient underwent laparoscopic choledochoscopy with thulium laser lithotripsy. The procedure included stone fragmentation, extraction, and choledochoduodenostomy for long-term biliary drainage. The procedure was successfully completed with minimal blood loss and no intraoperative complications. At 6-month follow-up, the patient remained asymptomatic with normal liver function, despite small retained stones.

This approach combines the benefits of minimally invasive surgery with advanced laser technology. Thulium laser offers potential advantages over conventional lithotripsy methods, including enhanced precision and reduced risk of bile duct injury. The successful outcome in this case suggests that this technique may be a viable option for complex hepatolithiasis in RPC.

Laparoscopic choledochoscopy with thulium laser lithotripsy represents a promising minimally invasive option for managing intrahepatic stones in RPC. While our case demonstrates technical feasibility, long-term follow-up and larger studies are needed to fully evaluate its efficacy.

•First reported case of thulium laser lithotripsy for intrahepatic stones in recurrent pyogenic cholangitis•Novel combination of laparoscopic choledochoscopy and thulium laser technology demonstrates successful stone fragmentation.•Minimally invasive approach achieved with minimal blood loss and no intraoperative complications•Technique offers potential advantages over conventional methods, including enhanced precision and reduced tissue damage

First reported case of thulium laser lithotripsy for intrahepatic stones in recurrent pyogenic cholangitis

Novel combination of laparoscopic choledochoscopy and thulium laser technology demonstrates successful stone fragmentation.

Minimally invasive approach achieved with minimal blood loss and no intraoperative complications

Technique offers potential advantages over conventional methods, including enhanced precision and reduced tissue damage