Extraction of Stone
- Once the stone is located by usual means proceed as following:
- Place the Extraction Basket’s distal tip above the stone to be removed.
- Push the basket completely out of the catheter and pull the basket down to the stone.
- If necessary, rotate the basket or move the catheter up and down in short and quick moves in order to facilitate to place the basket wires around the stone.
- Pull the handle back until the stone is fixed in the basket and pull the device toward the endoscope until the stone is extracted.
Excessive traction should be avoided to prevent damage the endoscope.
Emergency lithotripsy
- In case a stone gets stuck inside of an Extraction Basket proceed as following:
- With the help of a cutting plier, cut the catheter and tracking wire of the basket as close as possible to the handle of the device, just before the shrinking tube.
- Dispose the handle and pull gently the catheter over the cut wire 1-2cm to ensure the wire is protected and can not damage the endoscope.
- While keeping both tracking wire and catheter inside of the patient, gently remove the endoscope. Ensure not to move the catheter up or down while removing the endoscope.
- Once the endoscope is completely removed, remove the plastic catheter and replace it by the short and thick metallic spiral (Ref. GF641).
- Once the spiral reaches the stone, push the tracking wire through the lithotripsy handle spiral entrance until a slight tension can be felt.
- Lock the lithotripsy handle at the locking system.
- Gently begin to rotate the wheel until the stone gets crushed. When applying rotation on the wheel, allow some delays so that the mechanical force is perfectly transferred to the distal end of the spiral before repeating a new rotation (at least 40 seconds)
- Remove the device from the patient.
It is essential to keep the spiral as straight as possible to avoid friction between the tracking wire and the spiral. Any friction could lead to break the tracking wire and cause the procedure to fail.
Do not rotate the wheel quickly as this may lead to break the tracking wire and cause the procedure to fail.
Lithotripsy through the working channel (for baskets GF265GW, GF266GW, GF267GW only)
How to use the lithotripsy basket with a guide wire
This model of basket can be introduced into the bile duct directly or over a previously positioned guide wire. To do so, please follow the instructions below:
- Loosen the sealing cap at the Y-adapter.
- Remove the basket pulling it from its handle (without unscrewing it) from the distal outer teflon tube.
- Insert the teflon tube over the guide wire through the working channel of the endoscope until the metallic tip of the tube reaches a position behind the stone to be crushed.
- With the teflon tube in position, remove the guide wire from the proximal end of the teflon tube.
- With two fingers, squeeze the basket and introduce it through the proximal end of the teflon tube until the rigid part of the wire along with the handle reach the teflon tube.
- Slowly expose the basket and catch the aimed stone to be crushed.
Changing the Teflon tube for the metal spiral
For crushing the stone it is necessary to change the Teflon tube for the fitted metal spiral. These action makes a stable counter-pressure during the crushing procedure possible.
- Loosen the sealing cap at the Y-adapter.
- Remove the Teflon tube completely and carefully out of the endoscope, sliding it over the traction cable.
- Insert the metal spiral’s distal end by sliding it over the traction cable into the operating channel until it reaches the basket with the stone inside.
Handle Assembling
- Keep the locking system in the open position
- Push the traction cable tip through the spiral entrance to the winding cylinder orifice.
- Push the handle over the traction cable until it couples to the spiral tip and insert the spiral tip in the spiral entrance until resistance is felt (excessive force should be avoided).
- Push the spiral straighten to the basket.
- To release the tracking wire, place the locking system in the close position.
Crushing the Stone
- Turn the manual wheel at the handle, until the stone is crushed. When applying rotation on the wheel, allow some delays so that the mechanical force is perfectly transferred to the distal end of the spiral before repeating a new rotation (at least 40 seconds)
A lithotripsy has no guarantee of total success! If the stone to be crushed is very hard the basket might be torn because of the force applied on it. In this case the stone along with the torn basket should be surgically removed.
The lithotripsy should be interrupted immediately if the stone crushing could not be achieved.