The Broken Stone Basket: Configuration and Technique for Removal*

Abstract

Purpose : We investigated the ease of breakage of endoscopic stone baskets with the holmium:yttrium–aluminum-garnet (YAG) laser and their resultant configuration. More importantly, possible safe methods of retrieval were evaluated. Materials and Methods : Endoscopic stone baskets from Bard (Platinum Class™ 2.4F Flat and 3.0F Helical Wire), Cook (3.2F Captura™, 3.2F Atlas™, 3.0F N-Circle™, 4.5F N-Force™), and Microvasive (2.4F Zero Tip™, 3.0F Gemini™, 3.0F Segura™) were broken once using the holmium:YAG laser. The energy (kJ) required to break one of the wires was recorded. Configuration was documented using photographs. Baskets were disassembled and assessed for extraction through a 7F open-ended catheter, an 8F/10F set, and a 20F peel-away sheath. Results : Tipless baskets (N-Circle, Zero Tip) broke the easiest (range 0.02–0.03 kJ). Tipped baskets (Segura, Platinum Class Flat and Helical, Gemini, Captura, N-Force, Atlas) were more resistant, but all broke within the range (0.06–0.78 kJ) typically used for intracorporeal lithotripsy. Broken segments of wire tended to protrude outward, with tipless baskets having less change in configuration than tipped baskets. Tipless baskets could easily be pulled into any of the extracting devices, whereas tipped baskets could not. Conclusions : Baskets break at typical holmium:YAG intracorporeal lithotripsy energy settings. Tipless baskets break easiest and assume a safer configuration. Tipless baskets are extracted easily through a 7F openended catheter, 8F/10F set, or 20F sheath, while tipped baskets are unable to be extracted through any of these.