| Chemical cholecystectomy has been considered as a new method to treat cholecystolithiasis. According to microwave biological effect, we have designed and manufactured the bipolar antenna to obliterate the cystic duct and instilled sclerosants into the gallbladder lumen to create the gallbladder ablation and utilized laparoscopic guided technique to perform chemical cholecystectomy both in pigs and patients.Material and Methods:1, 1.8-2.0mm in diameter, bipolar, flexible microwave electrode was designed to occlude the cystic duct in 18 rabbits. Thermal model test was made to evaluate the effect of the antenna and to evaluate the coagulating conditions. Animals were randomly divided into 3 groups (each group N=6). Group 1, 30mA-20s. Group 2, 50mA-10s; Group 3, 70mA-6s. Through surgical cholecystotomy, the antenna was inserted into the proximal cystic duct for various coagulation treatments.2, 25 New Zealand white rabbits were randomly divided into: Group A (N=5, Saline), Group B (N=10, Ethanol) and Group C (N=10, Ethanol + TFA). After ligating the proximal cystic duct with silk ligature, Saline or Sclerosants was instilled into the gallbladder for 20 minutes. A half number of gallbladders in Groups B and C were drained by cutting the gallbladder fundus.3, 4 Chinese mini-pigs were induced of a pneumoperitoneum. The Laparoscope was inserted into the cavity at the min-point of the linea alba to find out the gallbladder, then made a mini-incision at a point that was ascertained by the viewing telescope to be the nearest to the gallbladder fundus. The gallbladder fundus was pulled out of the cavity by forceps. After measuring the gallbladder basic pressures, proximal cystic duct was coagulated 1 to 5 times at different segments. A drainage catheter was placed in the gallbladder and Sclerosants injected into the lumen for 25 minutes under the pressure measurement control.4, 31 patients underwent chemical ablation of the gallbladder by knowing the experimental purpose of this treatment. Under epidural anesthesia a 2-3 cm laparotomy was performed and cholecystoscope was introduced into the gallbladder lumen, gallstones or gallbladder polyps were removed, the cystic duct was occluded by microwave thermal coagulation, sclerosants and then was instilled to obliterating the gallbladder. These 4 procedures were completed primarily in one session.Results:1, the microwave coagulum shaped ellipsoid. Cholecystography showed that the cystic ducts were occluded after coagulation. Histologically, microwave technique induced the coagulated cystic duct permanently at follow up 2-4 weeks. In group 1, the cystic duct epithelial regeneration occurred and surrounding liver damage was limited, whilst in Groups 2 and 3 no epithelial regeneration was observed and injury to the liver was mild to moderate. Microwave generated on 50 mA-10 s to occlude the Rabbit's cystic duct is more effective and less injurious.2, two kinds of sclerosants were successful at 2-6 weeks in denuding the gallbladder mucosa, promoting fibrosis of the gallbladder wall and obliterating the gallbladder lumen. There was no mucosal regeneration except 2 cases with purulent gallbladder in non drainage group. Only hepatic cells degeneration appeared in the area near the gallbladder bed, but the changes of serum ALT, AST and Bilirubin were not significant (P>0.05). The degree of hepatic cell degeneration in group B correlated closely with that in group C (P>0.05).3, Laparoscopic-guided technique of percutaneous chemical cholecystectomy is convenient, direct and reliable. Pig 1 had a complete cystic duct occlusion which was confirmed by cholecystography 3 hours after coagulation. Gallbladder pressures after coagulation were higher than that of before treatment in Pig 2, 3, and 4. Complete gallbladder ablation was induced in only one pig, others showed hydrops of the atrophic gallbladders. Mucosa remains and mural fibrosis were present at histological examinations. There was no evidence of liver damage or biliary obstruction.4, 31 patients underwent chemical ablati...
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