Clinical usefulness of transpapillary removal of common bile duct stones by frequency doubled double pulse Nd:YAG laser

AIM: To study the efficacy and the safety of laser lithotripsy without direct visual control by using a balloon catheter in patients with bile duct stones that could not be extracted by standard technique. METHODS: The seventeen patients (7 male and 10 female; mean age 67.8 years) with difficult common bile duct (CBD) stones were not amenable for conventional endoscopic maneuvers such as sphincterotomy and mechanical lithotripsy were included in this study. Laser wavelengths of 532 nm and 1064 nm as a double pulse were applied with pulse energy of 120 mJ. The laser fiber was advanced under fluoroscopic control through the ERCP balloon catheter. Laser lithotripsy was continued until the fragment size seemed to be less than 10 mm. Endoscopic extraction of the stones and fragments was performed with the use of the Dormia basket and balloon catheter. RESULTS: Bile duct clearance was achieved in 15 of 17 patients (88%). The mean number of treatment sessions was 1.7 ± 0.6. Endoscopic stone removal could not be achieved in 2 patients (7%). Adverse effects were noted in three patients (hemobilia, pancreatitis, and cholangitis). CONCLUSION: The Frequency Doubled Double Pulse Nd:YAG (FREDDY) laser may be an effective and safe technique in treatment of difficult bile duct stones.

Management hepatolithiasis with operative choledochoscopic FREDDY laser lithotripsy combined with or without hepatectomy

BACKGROUND: Hepatolithiasis is very common in East Asia. It is benign in nature, but has a high recurrence rate. It is likely to lead to biliary cirrhosis and increase the risk of cholangiocarcinoma. Hence, the treatment of hepatolithiasis is difficult but vital. In this report, we present a novel approach to manage hepatolithiasis using the choledochoscopic Frequency-Doubled Double pulse Nd:YAG (FREDDY) laser lithotripsy combined with or without hepatectomy. METHODS: Between July 2009 and October 2012, 45 patients underwent choledochoscopic FREDDY laser lithotripsy combined with or without hepatectomy (laser lithotripsy group). Fortyeight patients underwent a traditional operation (traditional method group) from January 2009 to June 2009. Comparative analysis was made of demographic and clinical characteristics of the two groups. RESULTS: The final stone clearance rate of the laser lithotripsy group was 93.3%, whereas that of the traditional method group was 85.4% (P=0.22). In the laser lithotripsy group, 2 patients experienced hemobilia and 3 patients had acute cholangitis. In the traditional method group, 3 patients had intraoperative hemorrhage, 1 patient had bile leakage, 6 patients had acute cholangitis, and 1 patient died of liver failure. Moreover, the operative time in the traditional method group was significantly longer than that in the laser lithotripsy group (P=0.01). The mean hospital stay of the patients in the traditional method group was longer than that in the laser lithotripsy group (9.8 vs8.2 days, P=0.17). Recurrent intrahepatic bile duct stones were not found during the follow-up period in the two groups. CONCLUSION: Operative choledochoscopic FREDDY laser lithotripsy combined with or without hepatectomy may be an effective and safe treatment for hepatolithiasis.

Carrier-envelope-phase effect in nonsequential double ionization of Ar atoms by few-cycle laser pulses

A classical ensemble method is used to investigate nonsequential double ionization（NSDI） of Ar atoms irradiated by linearly polarized few-cycle laser pulses. The correlated-electron momentum distribution（CMD） exhibits a strong dependence on the carrier-envelope phase（CEP）. When the pulse duration is four cycles, the CMD shows a cross-like structure, which is consistent with experimental results. The CEP dependence is more notable when the laser pulse duration is decreased to two cycles and a special L-shaped structure appears in CMD. Recollision time of returning electrons greatly depends on CEP, which plays a significant role in accounting for the appearance of this structure.

A proposed approach for detecting terahertz pulses by using double few-cycle laser pulses with opposite carrier envelope phases

Previous research shows that few-cycle laser（FCL） pulses with low energy and without a bias field can be used to coherently detect terahertz（THz） pulses. As we know, it is very difficult to stabilize the carrier envelope phase（CEP） of FCL pulses, i.e., there are some random fluctuations for the CEP. Here we theoretically investigate the influence of such instability on the accuracy of THz detection. Our results show that although there is an optimum CEP for THz detection, the fluctuations of the CEP will lead to terrible thorns on the detected THz waveform. In order to solve this problem, we propose an approach using two few-cycle laser pulses with opposite CEPs, i.e., their CEPs are differed by π.