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Percutaneous Nephrolithotomy by laser – An advanced step to replace open surgery method

Update: October, 26/2021 - 10:38

Assoc. Prof. PhD. Doctor. Pham Duc Huan, Director of the Center for Gastroenterology - Hepatology (Vinmec Times City Hospital) with a team of doctors at the centre are treating many cases of acute gallstone disease at present. The treatment method of Percutaneous Nephrolithotomy by laser, applied by the Center for Gastroenterology - Hepatology, is a breakthrough with a minimally invasive technique, preserving the gallbladder, resulting in preserving the digestive function and helping patients with a fast recovery process.

The medical procedure is less painful, does not leave scars, and leads to a fast recovery.

Gallstones is a common disease with the morbidity rate in the community ranging from 10-15%. The current traditional treatment method is open surgery to cut the gallbladder and open the bile duct to remove stones to drain the biliary tract, causing pain, and many complications as well as leaving many sequelae having an impact on patient’s health and quality of life, while the rate of recurrence and re-surgery remain high.

One of the typical cases is a Korean patient. Mr. Lee D., 53 years old, who was hospitalised with dozens of stones in his gallbladder and main biliary tract. The large stone size has caused biliary obstruction, acute pancreatitis, if he is not treated immediately, it can result in necrotising pancreatitis, septic shock of the biliary tract, and the patient’s life could be in danger. The treatment became more complicated when Mr. Lee experienced a total gastrectomy 10 years ago.

Image of the endoscope and laser tip inserted into the gallbladder and bile duct, all stones are crushed and adsorbed out.

Normally, in similar cases, it is necessary to conduct open surgery to cut the gallbladder and open the bile duct to remove stones, and drain the biliary tract – it is a method causing pain and complications, while it is easy for stones to be missed for removal and there is a recurrence of disease. Under the direction of Assoc. Prof. PhD. Pham Duc Huan, Director of the Center for Gastroenterology - Hepatobiliary (Vinmec Times City Hospital), doctors have applied the method of Percutaneous Nephrolithotomy by laser. The patient underwent a smooth surgery with a skin incision of 3mm where the endoscope and laser tip are inserted. All stones of the gallbladder and bile duct were crushed and adsorbed out.

According to Assoc. Prof. PhD. Pham Duc Huan, the method of Percutaneous Nephrolithotomy by laser allows access and dissolution of stones at all locations of the biliary tract, including stones in the smallest hepatic ducts that cannot be removed by open surgery. Assoc. Prof. PhD. Pham Duc Huan said: “This is a minimally invasive method, patients almost feel painless, have few complications, and can recover fast, therefore, it shortens the hospital stay and reduces costs for patients."

After the intervention, Mr. Lee D. recovered quickly and he left hospital after a week of treatment. Cholangioscopy and cholangiography showed that there were no stones in the gallbladder and bile duct, and drainage from biliary tract to the intestine is good.

Assoc. Prof. PhD. Pham Duc Huan examines patient Lee D. in the room after surgery.

Similarly, patient M. has undergone four open surgeries to remove stones and patient Le Van H. was hospitalised with severe pain due to recurrent stones. The results of hepatobiliary resonance imaging showed that there were many stones in the small branches in the liver, stones in the common hepatic duct and the bile duct. After hundreds of stones were crushed and sucked out, both patients were completely free of stones and left the hospital after only three days of treatment with very good health and spirit.

The technique is complicated but appropriate to the characteristics of gallstone pathology of the Vietnamese people

Director of the Center is Assoc. Prof. PhD. Doctor. Pham Duc Huan, who is former Director of Hanoi Medical University Hospital, former Head of Gastrointestinal Surgery Department, Vietnam - Germany Friendship Hospital which is a leading expert in Viet Nam in digestive surgery and laparoscopic surgery. He has successfully performed more than 1,000 laparoscopic surgeries for colorectal cancer, more than 1,000 laparoscopic surgeries for esophageal cancer, more than 500 laparoscopic surgeries for partial and total gastrectomy, etc.

Assoc. Prof. PhD. Doctor. Pham Duc Huan is the leading expert in digestive surgery, laparoscopic surgery in Viet Nam.

With a team of leading experts in gastrointestinal surgery, radiological interventions and modern equipment, Center for Gastroenterology - Hepatobiliary and Imaging Diagnosis Department, Vinmec Times City International Hospital is one of few medical centres in Viet Nam that have mastered the technique of “Percutaneous Nephrolithotomy by laser”. This is a minimally invasive technique with only one small skin incision to insert the catheter into the biliary tract, insert the endoscope and laser tip, all stones will be crushed and sucked out. The patient is fully awake during the medical procedure, has little pain, there are no scars left, and the patient can recover very quickly.

Doctors performed a smooth intervention with a skin incision of 3mm to insert the endoscope and laser tip.

According to Assoc. Prof. PhD. Doctor. Pham Duc Huan, Percutaneous Nephrolithotomy by laser is a difficult technique, so very few hospitals in Viet Nam can perform it.

Because the structure of the biliary system and the blood vessels in the liver is very complex and closely related to each other, the doctor must have a thorough understanding of the biliary and vascular system of the liver. In particular, doctors must have good experience and skills in biliary intervention, as well as skills in Percutaneous Nephrolithotomy by laser. In addition, it is necessary to have a full range of modern facilities and equipment.

Assoc. Prof. PhD. Doctor. Pham Duc Huan said: “It can be considered that Percutaneous Nephrolithotomy by laser is a breakthrough, opening up new prospects in the treatment of gallstone pathology. This method is especially valuable for patients suffering from gallstones in Viet Nam with the characteristics of very complex gallstones, in many locations, combining both inside and outside the liver, gallstones combined with stones in the bile duct. At the moment, at Vinmec Times City, Percutaneous Nephrolithotomy by laser has almost completely replaced open surgery."

Center for Gastroenterology - Hepatobiliary (Vinmec Times City International Hospital) is the leading medical facility in the examination and treatment of gastrointestinal diseases. The outstanding strength of the Center is a team of experienced experts, mastering complex techniques (the focus is on laparoscopic surgery, minimally invasive robotic surgery), applying advanced technology, and providing perfect services, creating a breakthrough in the quality of treatment.

 

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