# Intracorporeal lithotripsy of salivary stones: in vitro comparison of different methods

## TL;DR

This study compares the effectiveness and safety of three methods for breaking salivary stones in a lab setting.

## Contribution

The study introduces electrokinetic lithotripsy as a potential alternative to existing methods for salivary stone treatment.

## Key findings

- Electrokinetic lithotripsy was more effective than laser lithotripsy but less effective than pneumatic lithotripsy.
- Laser lithotripsy caused the least propulsion but the most tissue damage in a gelatin model.
- Laser lithotripsy perforated the parotid duct fastest compared to other methods.

## Abstract

Intracorporeal lithotripsy is a gland-preserving treatment option for sialolithiasis. Laser lithotripsy (LL) and pneumatic lithotripsy (PL) are the only two methods currently approved, the latter being no longer available. Electrokinetic lithotripsy (EKL) is a promising alternative used for the treatment of ureteral stones. The aim of this study is to compare efficacy and therapeutical safety of EKL with LL and PL.

StoneBreaker® (PL), Lithotron EL 27 Compact (EKL) and Ho:YAG laser Auriga (LL) were assessed using in vitro setups with human salivary stones, casted and tumbled stones. Efficacy was measured by the number of impulses and time taken until fragmentation. Parameters for therapeutical safety were number of impulses until perforation, propulsion, duct widening, number of tears and tear length.

Efficacy of EKL was higher than LL but lower than PL. The fragmentation of casted stones took 01:50 ± 00:28 min with PL, 02:49 ± 00:37 min with EKL and 05:12 ± 00:58 min with LL (Mann–Whitney-U test p < 0.01). LL caused the lowest propulsion (0.0 ± 0 cm, n = 20); the highest propulsion was observed for PL (3.5 ± 0.7 cm, n = 20). In the gelatin setup, LL induced the most extensive damage (damage index: 5.9 ± 2.9, n = 15). LL was the fastest to cause perforation in the parotid duct (1 ± 0 impulses until perforation, n = 10).

Efficacy and safety of EKL are between those of LL and PL. Therefore, clinical testing of EKL seems to be justified.

The online version contains supplementary material available at 10.1007/s00405-025-09268-1.