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Comparison of the ablation rates, fissures and fragments produced with 150???μm and 272???μm laser fibers with superpulsed thulium fiber laser: an in vitro study
摘要： Introduction Holmium:YAG(Ho:YAG) is currently the standard for lithotripsy. Superpulsed Thulium Fiber Laser(TFL) has been evaluated as an alternative for lithotripsy, using laser fibers with core-diameters(CDF) down to 50 μm and additional available settings suitable for “dusting” technique. This in-vitro study compared ablation rates, fissures and fragments’ size with 150μmCDF or 272μmCDF with different laser settings using TFL and Ho:YAG. Methods 150CDF and 272CDF were compared using three settings for TFL “fine dusting”(FD:0.15 J/100 Hz); “dusting”(D:0.5 J/30 Hz); “fragmentation”(Fr:1 J/15 Hz) and Ho:YAG(D and Fr). An experimental setup consisting of immerged 10 mm cubes of artificial hard(H) or soft(S) stone phantoms was used with a 20 s’ lasing time and a spiral trajectory, in contact mode. Fragments (acquired through sieves) and stones were observed under optical microscopy before three-dimensional scanning to measure fragments and fissures(DOF) mean diameters and ablation volumes. Results Ablation volumes in with 150CDF-TFL and 272CDF-TFL were higher than those for 272CDF-Ho:YAG in both “dusting” (twofold and threefold) and “fragmentation”(1,5-fold and twofold). “Fine dusting” ablation rates with 150CDF-TFL and 272CDF-TFL were respectively at least 1,5-fold and twofold higher than those for 272CDF-Ho:YAG in “dusting”. 150CDF produced significantly smaller DOF than 272CDF in all settings against S and H except in fragmentation. 150CDF produced lower fragments’ diameter than 272CDF in all settings except dusting. Conclusion These preliminary studies demonstrate that at equal settings and CDF, TFL ablation rates are at least two-fold higher than those with Ho:YAG. 150CDF produces smaller fissures and fragments (that meets the definition of “dusting” lithotripsy) than 272CDF and higher ablation volumes than Ho:YAG.
关键词： Laser,Lithotripsy,Endourology,Thulium fiber laser
更新于2025-09-23 15:21:01
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Temperature changes during laser lithotripsy with Ho:YAG laser and novel Tm-fiber laser: a comparative in-vitro study
摘要： Aim The aim of this study was to compare the thermal effects of Ho:YAG and Tm-fiber lasers during lithotripsy in an in-vitro model via real-time temperature measurement. Methods We compared a Ho:YAG laser (pav up to 100 W, Lumenis, Yokneam, Israel) and a superpulse Tm-fiber laser (SP TFL, pav up to 40 W, NTO IRE-Polus, Fryazino, Russia), both equipped with 200 μm bare-ended fibers. The following settings were used: 0.2 J, 40 Hz (nominal pav 8 W). Power meter FieldMaxII-TO (Coherent, Santa Clara, CA, USA) was used to verify output laser power (pav). Each laser was fired for 60 s in two setups: (1) thermos-insulated (quasi-adiabatic) cuvette; (2) actively irrigated setup with precise flow control (irrigation rates 0, 10, 35 mL/min). Results Power measurements performed before the test revealed a 10% power drop in Ho:YAG (up to 7.2 ± 0.1 W) and 6.25% power drop in SP TFL (up to 7.5 ± 0.1). At the second step of our experiment, irrigation reduced the respective temperatures in the same manner for both lasers (e.g., at 35 mL/s SP TFL ? 1.9 °C; for Ho:YAG laser ? 2.8 °C at 60 s). Conclusion SP TFL and Ho:YAG lasers are not different in terms of volume-averaged temperature increase when the same settings are used in both lasers. Local temperature rises may fluctuate to some degree and differ for the two lasers due to varying jet streaming caused by non-uniform heating of the aqueous medium by laser light.
关键词： Ho:YAG laser,Laser lithotripsy,Thermal effect,Thulium fiber laser,In-vitro
更新于2025-09-23 15:19:57
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“VaporTunnel” ureteroscopic holmium laser lithotripsy: Intraoperative and early postoperative outcomes
摘要： “VaporTunnel” ureteroscopic holmium laser lithotripsy: Intraoperative and early postoperative outcomes. A prospective trial was conducted for patients undergoing holmium laser lithotripsy for ureteral stones. Patients were randomly assigned to have holmium laser lithotripsy with or without Vapor Tunnel technology. All procedures were performed by four experienced urologists. Quanta Cyber Ho 100 W generator with 365 μ fiber was used for all cases. Demographic data, stone parameters, perioperative complications and success rates were compared. The degree of stone retropulsion was graded on a Likert scale from zero-no retropulsion to 3-maximum retropulsion. Results: A total of 80 patients were included in the study (40 per each group). Both groups were comparable in terms of age, and pre-operative stone size (1.2 vs. 1.1 cm, p > 0.05). When compared with the Regular mode, Vapor Tunnel Technology was associated with significantly lower fragmentation time (20.4 vs. 16.1 min, p < 0.05) and total procedural time (49 vs. 35.7 min, p < 0.05). However, there were no significant differences in terms of total energy applied to the stones (9.9 vs. 10.7 KJ, p > 0.05). Vapor Tunnel technology was associated with significantly less retropulsion. There was no significant difference between both modes in terms of intraoperative complications. The success rate at the end of 1 month was comparable between both groups (92.3 vs. 88.3%, p > 0.05). Discussion: Vapor Tunnel technology is associated with significantly lower fragmentation and procedural times. The reduced fragmentation time is a result of the significantly lower retropulsion of the stones during laser lithotripsy; thus improving stone fragmentation efficiency.
关键词： holmium laser lithotripsy,intraoperative,VaporTunnel,ureteroscopic,postoperative outcomes
更新于2025-09-23 15:19:57
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Double-Blind Prospective Randomized Clinical Trial Comparing Regular and Moses Mode of Holmium Laser Lithotripsy
摘要： Objective: To compare Regular and Moses modes of holmium laser lithotripsy during ureteroscopy in terms of fragmentation/pulverization and procedural times in addition to perioperative complications. Patients and methods: After obtaining ethics approval, a prospective double‐blinded randomized trial was conducted for patients undergoing holmium laser lithotripsy during retrograde ureteroscopy. Patients were randomly assigned to either Regular or Moses modes. Patients and surgeons were blinded to the laser mode. Lumenis 120W generator with 200 Moses D/F/L fibers were used. Demographic data, stone parameters, peri‐ operative complications and success rates were compared. The degree of stone retropulsion was graded on a Likert scale from zero‐no retropulsion to 3‐maximum retropulsion. Results: A total of 72 patients were included in the study (36 per each arm). Both groups were comparable in terms of age, and pre‐operative stone size (1.4 vs. 1.7 cm, p>0.05). When compared with the Regular mode, Moses mode was associated with significantly lower fragmentation/pulverization time (21.1 vs. 14.2 min; p=0.03) and procedural time (50.9 vs. 41.1 min, p=0.03). However, there were no significant differences in terms of lasing time (7.4 vs. 6.1 min, p>0.05) and total energy applied to the stones (11.1 vs. 10.8 KJ, p>0.05). Moses mode was associated with significantly less retropulsion (mean grade was 1.0 vs. 0.5, p=0.01). There were no significant differences between both modes in terms of intra‐operative complications (11.1% vs. 8.3%, p>0.05), with one patient requiring endo‐ureterotomy for stricture in the Moses group. Success rate at the end of 3 months was comparable between both groups (83.3% vs. 88.4%, p> 0.05). Conclusion: Moses technology was associated with significantly lower fragmentation/pulverization and procedural times. The reduced fragmentation/pulverization time seen using Moses technology could be explained by the significantly lower retropulsion of stones during laser lithotripsy.
关键词： technology assessment,ureteroscopy,randomized clinical trial,holmium laser,Laser lithotripsy,outcomes assessment
更新于2025-09-19 17:13:59
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Exploiting the aiming beam to increase the safety of laser lithotripsy: Experimental evaluation of light reflection and fluorescence
摘要： In Holmium laser lithotripsy, usually, the surgeon is guided by a visible beam superimposing the infrared (IR) treatment radiation. It has been shown that a green aiming beam excites stone autofluorescence. This fluorescence signal can be used for calculi detection to check the correct fiber position before triggering the IR laser, thus preventing damage to soft tissue and application devices. However, also the directly reflected green light from the fiber tip gives valuable information on fiber position and its surface condition. Materials and Methods: An external fiber‐fiber‐coupling‐box (fiber core diameter 365 μm) for pulsed holmium laser radiation (2.1 μm) was set up containing a green diode laser module (520 nm, average power on the sample <0.5 mW) and optics and detectors for measuring the reflected light of this aiming beam as well as the fluorescence excited with it. Measurements were done via a lock‐in technique with more than 20 human calculi samples and porcine calix in vitro. After the implementation of automatic data storage signals during ongoing in vitro lithotripsy procedures were recorded with the fiber positioned on tissue, stone, or in/on medical equipment (working channel of an endoscope, stone retrieval basket). Results: Stone fluorescence signals measured were a factor of 7 to >100 higher than those of tissue. Stone fluorescence was detectable in “non‐contact mode” with a linear signal decrease over a distance up to ~1 mm in front of the fiber tip (core diameter 365 μm) and with severely damaged fibers (max. decrease: 75% with pinched off fiber). Reflection signals of the fiber tip surface in air and water surrounding decreased significantly when the fiber was damaged; measured ratios of intact to damaged fiber found in the air were (5–17):1 and in water (1.6–3.7):1. Surfaces in front of the fiber aggravated the evaluation of fiber condition due to reflections but enabled to detect, for example, the working channel of a flexible endoscope in combination with the (missing) fluorescence signal. Conclusions: Autofluorescence induced by a green aiming beam can be exploited for stone detection in laser lithotripsy. A reflection measurement can give further information on fiber condition and position. Implementing this kind of safety features for an automatic block of IR laser emission in case of weak or missing fluorescence and un‐normal reflections can assist the surgeon by avoiding tissue perforation, and damage to medical devices such as endoscopes.
关键词： Holmium laser,feedback control,urolithiasis,fluorescence,laser lithotripsy,urinary calculi
更新于2025-09-19 17:13:59
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a??Vapor Tunnela??: Advantages of a New Setting Option for Urgent Holmium Laser Lithotripsy with Cyber-Ho
摘要： Introduction: The vapor tunnel (VT) technology is a result of the pulse modulation during holmium laser emission: it consists of a single specific long pulse, using the minimum peak power in accordance with selected output settings. The first part of the pulse creates a vapor channel, whereas the remaining energy is discharged immediately after, passing straight through the previously created tunnel. This particular emission allows to reduce stone retropulsion. We herein present the outcomes of this new technology in the treatment of ureteral stones in an urgent setting. Materials and Methods: In total, 210 patients with ureteral stones, renal colic, and indication to undergo urgent stone lithotripsy, according to the inclusion criteria presented by Picozzi et al.,1 were randomly assigned to holmium laser lithotripsy with or without the VT technology (105 patients per group). The 100 W Cyber-Ho laser generator (Quanta System) was used for all cases performed with the VT; the 35 W Litho laser generator was used for all regular dusting mode (RDM) procedures. A 365 lm fiber was used in both groups. Energy and frequency settings were 1 J and 12 Hz in both groups. All procedures were performed by three experienced urologists. After the procedures, a ureteral stent was always positioned and removed 20 days later. We compared dusting time, total procedural time, and stone retropulsion, graded on a Likert scale from 0 (no retropulsion) to 3 (maximum retropulsion). We also compared postoperative ureteral lesions with the Posturetroscopic Lesion Scale (PULS),2 the success rates of the two techniques based on stone-free rate at 1 month (defined as absence or presence of maximum 1 mm stone fragments at a computed tomography -scan) and postoperative ureteral strictures. The study was approved by our institutional review board and patients signed the informed consent. Results: The RDM and VT groups were comparable in terms of age and mean preoperative stone size (1.1 vs 1.0 cm, p > 0.05). The VT technology was associated with significantly lower (p > 0.05) dusting time (15.3 vs 9.7 minutes), total procedural time (37.2 vs 25.7 minutes), total delivered energy (19.9 vs 7.7 kJ), and retropulsion (Likert score 3 vs 0). Patients in the RDM group required stone fragments’ retrieval with a Tipless Basket (Kobot Filter; RocaMed) and presented a higher rate of PULS-1 ureteral lesions than the VT group: 37 (35.2%) vs 8 (7.6%) patients p < 0.05. Whereas the VT setting allowed complete dusting of the stones. We registered six cases (5.7%) of postoperative ureteral strictures in the RDM group vs no cases in the VT group, p < 0.05. Stone-free rate at 1 month was comparable between the two groups (88.6 vs 93.4%, p < 0.05). Conclusions: The VT technology is associated with significantly lower dusting time and total procedural time, because of reduced retropulsion of the stone, which makes it more precise, quicker, and easier to perform. It also allows complete dusting, with no need for fragments’ retrieval, reducing ureteral lesions, because of scratches on the ureteral wall. These features make VT an excellent setting option in an urgent setting, when the ureteral wall is more vulnerable.
关键词： vapor tunnel,ureteral calculi,laser lithotripsy,holmium laser
更新于2025-09-19 17:13:59
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Re: Safety of a Novel Thulium Fibre Laser for Lithotripsy: An In Vitro Study on the Thermal Effect and Its Impact Factor
摘要： Peng et al present for the first time data regarding the temperature rise following activation of a thulium fibre laser (TFL) for lithotripsy. In an in vitro setting, the thermal effect of TFL was evaluated at different laser power settings and irrigation rates with the safety temperature threshold set to 43°C. Without irrigation, laser power >10 W caused an increase in temperature above this safety threshold. When low-flow irrigation (15 ml/min) was used, only laser power of 30 W exceeded the safety threshold. Higher flow rates prevented a rise in temperature above the threshold for any of the laser settings tested.
关键词： Thermal Effect,Thulium Fibre Laser,Lithotripsy,Safety Temperature Threshold
更新于2025-09-19 17:13:59
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Pulse Modulation for Holmium Laser: Vapor Tunnela??Virtual Basketa??Bubble Blast
摘要： Introduction: New pulse modulations for holmium laser (vapor tunnel, virtual basket, and bubble blast) have been introduced, seeking energy optimization and better ef?ciency for stone lithotripsy. We aim to assess vapor tunnel, virtual basket, and bubble blast effects for stone lithotripsy during ureteroscopy and retrograde intra-renal surgery. Materials and Methods: Seven patients (10 stones) were treated using a 100 W holmium laser generator (Cyber Ho; Quanta System). Three, 272, 372, and 550 lm, ?bers were used. The settings used were 0.3–1.2 J/15–50 Hz, combined with short, medium, and long pulse length. Vapor tunnel, virtual basket, and bubble blast modulations were used during lithotripsy. Results: A smaller retropulsion and a more ef?cient ablation were observed with long pulse in combination with vapor tunnel and virtual basket effects, compared with regular mode fragmentation. No patient presented Clavien III/IV complications. The vapor tunnel technology consists in a long pulse, using the minimum peak power in accordance with selected output settings. The pulse creates a vapor tunnel, the remaining energy passes straight through the previously created tunnel, generating an elliptical shape bubble allowing less retropulsion. Virtual basket is composed of a double pulse emission. The time duration separating the two pulses is chosen so that the second pulse is emitted from the distal tip of the ?ber when the bubble size, and the corresponding amount of displaced ?uid, is at a maximum. The virtual basket emission mode combines a low retropulsion with a fragment suction effect. Bubble blast is a high-energy pulse resulting in the generation of a strong mechanical effect. The physical principle is that the ?rst pulse generates a spherical bubble, the second pulse is emitted after the complete collapse of the ?rst bubble generating a second bubble with bigger volume than the ?rst pulse. This translates theoretically into a frontal and lateral increasing of the shock wave effects on the target. Conclusion: New pulse modulations vapor tunnel, virtual basket, bubble blast lead to retropulsion reduction, lithotripsy optimization, and theoretically to a shorter stone ablation time. Large clinical trials are needed to con?rm their ef?ciency, advantages, and limitations.
关键词： virtual basket,ureteroscopy,bubble blast,vapor tunnel,holmium,laser lithotripsy
更新于2025-09-19 17:13:59
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Management von Urethralsteinen beim Hund mittels pneumatischer und laserenergetischer Lithotripsie
摘要： Objective Description of clinical experience with two different lithotripsy modalities for treatment of urethral stones in dogs. Material and methods Retrospective analysis (October 2016 – November 2017) of medical records from dogs with urinary stones that underwent transurethral pneumatic or laser lithotripsy. Results In 28 male and 5 female dogs, either pneumatic lithotripsy (39 %) or laser lithotripsy (61 %) was performed. In the urethra, stone free rates of 100 % in females and over 85 % in males could be achieved using either fragmentation modality. In 3 of 28 (11 %) male dogs, after fragmentation of urethral stones, urethral patency was impaired because of endoscopically suspected polypoid urethritis requiring urethrostomy. In 8 out of 28 (29 %) male dogs and in 1 of 5 (20 %) female dogs, an additional lithocystotomy was necessary to achieve stone-free status in the lower urinary tract. Conclusion and clinical relevance Transurethral pneumatic or laser lithotripsy of urinary stones is a successful procedure in dogs. Major pathological conditions of the urethral mucosa may require further surgical or interventional methods for the restoration of a functional urethra.
关键词： pneumatic lithotripsy,laser lithotripsy,Urethra,urolithiasis
更新于2025-09-16 10:30:52
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What is the optimum lithotripsy method for high density stones during mini-PNL? Laser, ballistic or combination of both
摘要： Percutaneous nephrolithotomy (PNL) is the primary treatment option for renal stones > 20 mm in diameter. Mini-PNL gained popularity with its minimally invasive nature. The aim of this study was to compare the efficiency of ballistic and laser lithotripsy with the combined use of both techniques. Data of 312 patients underwent mini-PNL for renal stones with Hounsfield Unit > 1000 was investigated retrospectively. We identified 104 patients underwent combined ballistic and laser lithotripsy. Propensity score technique was used to create the laser and ballistic lithotripsy groups. Groups were matched on stone size, stone density, and Guy’s stone score. Primary end point of the study was to compare the stone free rate (SFR), complication rates, and duration of surgery. Mean age of the population was 49.4 ± 6.1, stone size was 24.6 ± 6.3 mm, and stone density was 1215 ± 89 HU. The groups were similar for age, stone size, stone density, and Guy’s stone score. The SFR and the complication rates of the 3 groups were similar (p = 0.67). The duration of the surgery was shorter in the combined group (46.1 ± 6.3 min) compared to the laser lithotripsy (54.5 ± 6.6 min) and ballistic lithotripsy (57.2 ± 6.9 min) groups. Both laser and ballistic lithotripsy are effective methods for stone fragmentation during mini-PNL. Combined use of both methods has the potential to improve the fragmentation rates and diminish the operative times in case of high density stones.
关键词： Mini-PNL,Percutaneous nephrolithotomy,Laser lithotripsy,Kidney stone,Ballistic lithotripsy
更新于2025-09-16 10:30:52