Fragmentation of biliary calculi with tunable dye lasers.

The feasibility of using lasers to fragment biliary calculi was examined in vitro. Flashlamp-pumped tunable dye lasers were coupled to small-diameter flexible quartz fibers that were placed in direct contact with biliary calculi. The minimum laser energy necessary to damage a calculus was measured for wavelengths between 450 and 700 nm and for pulse durations between 0.8 and 360 microseconds. This threshold energy increased with increasing wavelength but was not significantly affected by pulse duration. Cholesterol stones had uniformly higher thresholds than pigmented ones. When a repetitively pulsed laser was used, complete fragmentation required fewer than 500 pulses and fragments were predominantly less than 2 mm. The pulsed dye laser can effectively fragment biliary calculi when transmitted through a small-diameter quartz fiber and may be useful as a tool for fragmenting retained common duct stones.