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Keller EX, Kronenberg P, Tailly T, Corrales M, Juliebø-Jones P, Pietropaolo A, Somani B, De Coninck V. Laser accessories: surgical fibers, strippers, cleavers, and protective glasses. Curr Opin Urol 2022; 32:330-338. [PMID: 35256579 DOI: 10.1097/mou.0000000000000977] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This review provides most recent findings and developments relating to surgical laser fibers, strippers, cleavers, and protective glasses. RECENT FINDINGS The smallest core diameter that can be used with Holmium:YAG lasers is 200 μm. Smaller core diameter fibers can be used with the Thulium fiber laser and offer better flexibility and lower risk of fracture, at the risk of greater burnback effect. Misleading discrepancies between the true diameter of laser fibers and their packaging labels must be considered. Fiber tip degradation from the burnback occurs within few minutes, thus questioning the need for time-consuming fiber tip reprocessing with fiber strippers and special cleaving tools. This shortcoming also applies to instrument-protecting ball-tip fibers. Cleavage of fiber tips through their protective jackets ('coated tips') is a cheaper alternative for instrument protection, additionally offering better visual control of the fiber tip. Third-generation side-firing greenlight laser fibers are still prone to rapid deterioration. Laser eyewear does not seem necessary for Holmium:YAG applications, whereas laser-specific protective glasses should be worn for greenlight laser applications. SUMMARY With better understanding of laser accessories, practicing urologists may tailor their practice to reach optimal efficacy and safety for Holmium:YAG, Thulium fiber laser and Greenlight laser applications.
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Affiliation(s)
- Etienne Xavier Keller
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, Arnhem, The Netherlands
| | - Peter Kronenberg
- Department of Urology, Hospital CUF Descobertas, Lisbon, Portugal
- Progress in Endourology, Technology and Research Association (PETRA), Paris, France
| | - Thomas Tailly
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, Arnhem, The Netherlands
- Department of Urology, University Hospital Ghent, Ghent, Belgium
| | - Mariela Corrales
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Sorbonne Université, Service d'Urologie, AP-HP, Hôpital Tenon, Paris, France
| | - Patrick Juliebø-Jones
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, Arnhem, The Netherlands
- Department of Urology, University Hospital Southampton, Southampton, UK
| | - Amelia Pietropaolo
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, Arnhem, The Netherlands
- Department of Urology, University Hospital Southampton, Southampton, UK
| | - Bhaskar Somani
- Progress in Endourology, Technology and Research Association (PETRA), Paris, France
- Department of Urology, University Hospital Southampton, Southampton, UK
| | - Vincent De Coninck
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, Arnhem, The Netherlands
- Department of Urology, AZ Klina, Brasschaat, Belgium
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Taratkin M, Azilgareeva C, Corrales M, Teoh JYC, Allenov S, Inoyatov J, Ali S, Rivas JG, Markovina I, Enikeev D. Superpulse thulium fiber laser lithotripsy: an in vitro comparison of 200 μm and 150 μm laser fibers. World J Urol 2021; 39:4459-4464. [PMID: 34392390 DOI: 10.1007/s00345-021-03800-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 08/02/2021] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To investigate the thermal effects, stone retropulsion and ablation rate of SuperPulse Thulium-fiber laser (SP TFL) with two different surgical fibers of 200 and 150 μm in diameter. METHODS SP TFL (NTO IRE-Polus, Fryazino, Russia) performance with 200 and 150 μm fibers (NTO IRE-Polus, Fryazino, Russia) was evaluated. Before each test, the laser fiber was cleaved, and the power measurement was taken to verify the actual laser output power. To compare the laser fibers in well-controlled environments, a number of setups were used to assess retropulsion, ablation efficacy, fiber burnback, energy transmission, and safety. RESULTS Power measurements performed before each test revealed a 4.7% power drop for a 200 μm fiber SP TFL (14.3 ± 0.5 W) and 7.3% power drop for a 150 μm fiber SP TFL (13.9 ± 0.5 W) versus the nominally indicated power (15.0 W). Retropulsion with the TFL was minimal and comparable between fibers. We found no clinically relevant temperature differences between SP TFL with either 200 or 150 μm fibers. The ablation efficacy tended to be comparable under most parameters. Yet, we did observe a decreased diameter of residual fragments after the ablation with a 150 μm fiber. CONCLUSION The smaller fiber (150 μm) is not inferior to 200 μm fiber in terms of fiber burnback, retropulsion, safety, and ablation rate. Moreover, it has the potential to decrease the diameter of fragments during lithotripsy, which may facilitate dusting during RIRS.
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Affiliation(s)
- Mark Taratkin
- Institute for Urology and Reproductive Health, Sechenov University, 2/1 Bolshaya Pirogovskaya St., Moscow, 119991, Russia
| | - Camilla Azilgareeva
- International School "Medicine of the Future", Sechenov University, Moscow, Russia
| | - Mariela Corrales
- GRC #20 Lithiase Urinaire, Sorbonne University, Hôpital Tenon, Paris, France
| | - Jeremy Yuen-Chun Teoh
- Department of Surgery, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - Sergey Allenov
- Institute for Urology and Reproductive Health, Sechenov University, 2/1 Bolshaya Pirogovskaya St., Moscow, 119991, Russia
| | - Jasur Inoyatov
- Institute for Urology and Reproductive Health, Sechenov University, 2/1 Bolshaya Pirogovskaya St., Moscow, 119991, Russia
| | - Stanislav Ali
- Institute for Urology and Reproductive Health, Sechenov University, 2/1 Bolshaya Pirogovskaya St., Moscow, 119991, Russia
| | - Juan Gomez Rivas
- Department of Urology, Clinico San Carlos University Hospital, Madrid, Spain
| | - Irina Markovina
- Institute of Linguistics and Intercultural Communication, Sechenov University, Moscow, Russia
| | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, 2/1 Bolshaya Pirogovskaya St., Moscow, 119991, Russia.
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Comparison of Holmium:YAG and Thulium Fiber Lasers on the Risk of Laser Fiber Fracture. J Clin Med 2021; 10:jcm10132960. [PMID: 34209375 PMCID: PMC8268355 DOI: 10.3390/jcm10132960] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/19/2021] [Accepted: 06/25/2021] [Indexed: 02/07/2023] Open
Abstract
Objectives: To compare the risk of laser fiber fracture between Ho:YAG laser and Thulium Fiber Laser (TFL) with different laser fiber diameters, laser settings, and fiber bending radii. METHODS: Lengths of 200, 272, and 365 μm single use fibers were used with a 30 W Ho:YAG laser and a 50 W Super Pulsed TFL. Laser fibers of 150 µm length were also tested with the TFL only. Five different increasingly smaller bend radii were tested: 1, 0.9, 0.75, 0.6, and 0.45 cm. A total of 13 different laser settings were tested for the Ho:YAG laser: six fragmentation settings with a short pulse duration, and seven dusting settings with a long pulse duration. A total of 33 different laser settings were tested for the TFL. Three laser settings were common two both lasers: 0.5 J × 12 Hz, 0.8 J × 8 Hz, 2 J × 3 Hz. The laser was activated for 5 min or until fiber fracture. Each measurement was performed ten times. Results: While fiber failures occurred with all fiber diameters with Ho:YAG laser, none were reported with TFL. Identified risk factors of fiber fracture with the Ho:YAG laser were short pulse and high energy for the 365 µm fibers (p = 0.041), but not for the 200 and 272 µm fibers (p = 1 and p = 0.43, respectively). High frequency was not a risk factor of fiber fracture. Fiber diameter also seemed to be a risk factor of fracture. The 200 µm fibers broke more frequently than the 272 and 365 µm ones (p = 0.039). There was a trend for a higher number of fractures with the 365 µm fibers compared to the 272 µm ones, these occurring at a larger bend radius, but this difference was not significant. Conclusion: TFL appears to be a safer laser regarding the risk of fiber fracture than Ho:YAG when used with fibers in a deflected position.
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Heckscher D, Zeng J, Samolis P, Sander MY, Wason SE, Wang DS. The Effect of Holmium Laser Fiber Bending Radius on Power Delivery During Flexible Ureteroscopy. J Endourol 2020; 34:682-686. [PMID: 32216458 DOI: 10.1089/end.2019.0814] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Flexible ureteroscopy is a mainstay of upper urinary tract stone treatment. Holmium laser lithotripsy is a particularly common and notable technique for the dusting and fragmenting of renal stones. During ureteroscopy, optical fibers are subject to sharp bends in pursuit of stones, particularly those at the lower pole. Following from principles of fiber optics, subjecting these fibers to sharp bending angle has the potential to reduce the efficiency of power transmission at the fiber tip. Due to the potential implications this hypothesis could have on endourological practice and research, we aimed to explore the potential impact of fiber bending on end-fiber power output. Materials and Methods: Using a highly sensitive oscilloscope and a urological holmium laser, we assessed the end-fiber power output under a variety of bending conditions. To ensure maximal confidence in our results, the maximal bending conditions explored substantially exceeded any condition, which could occur during ureteroscopic surgery. Results: We found evidence that bending radius alone has a clinically insignificant impact on the light power transmission in the fiber. At certain bending conditions, we observed a clinically unimportant but statistically significant reduction in power transmission. This was verified using two commonly used delivery fiber types exposed to 8-second bursts for each bending condition.
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Affiliation(s)
- Dylan Heckscher
- Department of Urology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Junjie Zeng
- Department of Electrical and Computer Engineering, BU Photonics Center, Boston University, Boston, Massachusetts, USA
| | - Panagis Samolis
- Department of Electrical and Computer Engineering, BU Photonics Center, Boston University, Boston, Massachusetts, USA
| | - Michelle Y Sander
- Department of Electrical and Computer Engineering, BU Photonics Center, Boston University, Boston, Massachusetts, USA.,Division of Materials Science and Engineering, Boston University, Boston, Massachusetts, USA
| | - Shaun E Wason
- Department of Urology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - David S Wang
- Department of Urology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
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Lu P, Chen K, Wang Z, Song R, Zhang J, Liu B, Zeng G, Wang Z, Zhang W, Gu M. Clinical efficacy and safety of flexible ureteroscopic lithotripsy using 365 μm holmium laser for nephrolithiasis: a prospective, randomized, controlled trial. World J Urol 2019; 38:481-487. [PMID: 31030229 DOI: 10.1007/s00345-019-02776-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 04/18/2019] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To compare the clinical efficacy and safety between the FURL with 365 μm and 200 μm holmium laser for treating nephrolithiasis. MATERIALS AND METHODS A prospective randomized controlled trial was performed including analysis of data from 200 patients with nephrolithiasis. A total of 180 patients were randomized into two groups according to 1:1 ratio. In the 365 μm holmium laser group, kidney stones were disintegrated into less than 2 mm fragments with a 365 µm holmium laser fiber with the settings of 30-45 W under direct visualization; in the control group, the conventional 200 μm holmium laser was used. Descriptive statistics and logistic regression analyses tested the association among operation time, stone-free rate (SFR) and incidence of complications. RESULTS Operation time in the FURL with 365 μm laser was significantly shortened and no significance was observed in the complication rate. Stone size and location were identified as two major confounding factors for the operation time and SFR. Moreover, the FURL using 365 μm laser showed less operation time for renal stones with the diameter between 1 and 2 cm, stones located in lower calyx and multiple calculi; stones larger than 2 cm and/or located in lower pole inclined to present better SFR using the FURL with 365 μm laser. CONCLUSIONS The FURL combined with 365 μm holmium laser is safer and highly efficacious for the management of nephrolithiasis when compared to conventional FURL procedures, especially for those located in lower pole and larger than 2 cm.
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Affiliation(s)
- Pei Lu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Keliang Chen
- Department of Urology, Ningbo First Hospital, Ningbo, 315000, China
| | - Zijie Wang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Rijin Song
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Jiexiu Zhang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Bianjiang Liu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Guohua Zeng
- Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510230, China
| | - Zengjun Wang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Wei Zhang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
| | - Min Gu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
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6
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Knudsen BE. Laser Fibers for Holmium:YAG Lithotripsy: What Is Important and What Is New. Urol Clin North Am 2019; 46:185-191. [PMID: 30961852 DOI: 10.1016/j.ucl.2018.12.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Holmium:YAG laser is currently the dominant lithotripter used during retrograde intrarenal surgery. The laser energy is delivered to the target via flexible optical laser fibers. The performance characteristics of laser fibers vary. The diameter, flexibility, resistance to fracture with bending, and tip configuration are all important factors that contribute to a fiber's overall performance. Understanding these characteristics assists the end user with proper fiber selection for procedures.
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Affiliation(s)
- Bodo E Knudsen
- Department of Urology, The Eye and Ear Institute, 915 Olentangy River Road, Third Floor, Columbus, OH 43212, USA.
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Forbes CM, Rebullar KA, Teichman JMH. Comparison of flexible ureteroscopy damage rates for lower pole renal stones by laser fiber type. Lasers Surg Med 2018; 50:798-801. [PMID: 29603760 DOI: 10.1002/lsm.22822] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Laser lithotripsy, often used during ureteronephroscopy (URNS), requires the Ho:YAG optical fiber transmit energy via total internal reflection (TIR). In critical lower pole deflections, energy may refract into the cladding causing fiber failure and scope damage. New optical fiber technology aims to have increased tolerance for high degrees of flexion. We compared two brands of laser fibers with sub-300 micron cores (Sureflex, Boston Flexiva) to determine failure rates and scope repair costs. METHODS A retrospective cohort study comparing these two fibers for patients at a single academic institution who underwent flexible URNS with laser lithotripsy was performed from September 2013 to October 2015. Preoperative imaging was evaluated for stone burden and location. Intraoperative variables were collected, including energy use, lower pole lasering, laser fiber malfunction, and scope damage. The primary outcome was scope damage caused by laser fiber malfunction. Secondary outcome was scope repair costs. Fisher's exact test and two tailed t-tests were used. RESULTS Of 223 subjects, 143 met inclusion criteria, and 8 had laser fiber failure. All failures occurred with the Sureflex fiber (8 of 63, 13%) vs the Boston Flexiva fiber (0 of 80, 0%) (P < 0.01). Malfunctions occurred in 8 of 79 lower pole stone applications versus 0 of 64 non-lower pole stone laser applications (P < 0.01). No other risk factor was different between fiber cohorts, except energy setting. Scope repair cost averaged $9155 CDN, yielding an average repair cost per case of $1144 CDN for the Sureflex versus $0 for the Boston fiber (P < 0.01). CONCLUSIONS Both optical fibers perform well in non-lower pole locations. However, the challenge for laser fibers in lower pole URNS is to maintain TIR. Fiber failure reflects an inability to maintain reflection and is not based on energy used or stone burden. The Boston Flexiva laser fiber has fewer failures, resulting in $0 repair cost per case, compared to the Sureflex fiber in URNS with an average repair cost of $1144 CDN per case. Lasers Surg. Med. 50:798-801, 2018. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
- Connor M Forbes
- Department of Urologic Sciences, University of British Columbia, British Columbia, Canada
| | - Karla A Rebullar
- Department of Urologic Sciences, University of British Columbia, British Columbia, Canada
| | - Joel M H Teichman
- Department of Urologic Sciences, University of British Columbia, British Columbia, Canada
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Abstract
Since the introduction of ESWL, PNL and URS during the early 1980s the application rate of ESWL has declined while those of PNL and URS have increased. This is mainly due to the facts that instruments and techniques for Intracorporeal Lithotripsy (IL) have made a continuous progress. This review shows that today an array of options for IL within the entire urinary tract is available to treat stones in a perfect minimal invasive way. At the same time further improvements of IL are already visible.
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Haddad M, Emiliani E, Rouchausse Y, Coste F, Berthe L, Doizi S, Buttice S, Somani B, Traxer O. Impact of laser fiber tip cleavage on power output for ureteroscopy and stone treatment. World J Urol 2017; 35:1765-1770. [DOI: 10.1007/s00345-017-2053-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 05/25/2017] [Indexed: 10/19/2022] Open
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10
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Comparison of laser fiber passage in ureteroscopic maximum deflection and their influence on deflection and irrigation: Do we really need the ball tip concept? World J Urol 2016; 35:313-318. [DOI: 10.1007/s00345-016-1873-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 06/02/2016] [Indexed: 12/23/2022] Open
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Bourdoumis A, Christopoulos P, Raj N, Fedder A, Buchholz N. A Comparative in Vitro Study of Power Output Deterioration over Time Between Ho:YAG Laser Fibers from Different Manufacturers as a Function of Deflection and Power Input. Curr Urol 2016; 9:12-8. [PMID: 26989365 DOI: 10.1159/000442844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 05/21/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To investigate the performance of laser fibers from 6 major manufacturers in vitro and to identify the effect of time and angulations (180° and 0°) on fiber power output. MATERIALS AND METHODS Overall, 36 single-use fibers were used. Each was tested with an energy input of 0.8, 1.4 and 2.0 Joules. A power detector measured power output after 1, 5, 10 and 15 minutes for three 15-minute cycles of continuous use. For the first 2 cycles, the fiber was bent to 180° with the use of a pre fabricated mould. Analysis of the data was performed by ANOVA and Tukey's test when the results were significant amongst groups. Statistical significance was deemed p < 0.05. RESULTS No fiber fracture occurred. There was no significant difference in output at 15 minutes of continuous use at 0° and 180°. The reduction in energy output at the 15th minute of continuous use at 180° was not significant for any fiber type or initial input. Only output differences between the fibers proved to be significant (p = 0.001). CONCLUSION Fiber fracture and decline in performance is not due to deflection and continuous use. Frictional forces that occur between the fiber tip and the stone fragments may be responsible.
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Affiliation(s)
- Andreas Bourdoumis
- Locum Consultant Urological Surgeon, Torbay Hospital, South Devon Healthcare NHS Foundation Trust, Torbay, UK
| | | | - Nirmal Raj
- Department of Medical Physics, Royal London Hospital, Barts Health NHS Trust, London
| | | | - Noor Buchholz
- Sobeh's Vascular & Medical Center Dubai, Dubai, the United Arab Emirates
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12
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Shin RH, Lautz JM, Cabrera FJ, Shami CJ, Goldsmith ZG, Kuntz NJ, Kaplan AG, Neisius A, Simmons WN, Preminger GM, Lipkin ME. Evaluation of Novel Ball-Tip Holmium Laser Fiber: Impact on Ureteroscope Performance and Fragmentation Efficiency. J Endourol 2016; 30:189-94. [DOI: 10.1089/end.2015.0300] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Richard H. Shin
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Jaclyn M. Lautz
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina
| | - Fernando J. Cabrera
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Constandi John Shami
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina
| | | | - Nicholas J. Kuntz
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Adam G. Kaplan
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Andreas Neisius
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina
- Department of Urology, University Medical Center Mainz, Mainz, Germany
| | - Walter Neal Simmons
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina
| | - Glenn M. Preminger
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Michael E. Lipkin
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina
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Akar EC, Knudsen BE. Evaluation of 16 New Holmium:Yttrium-Aluminum-Garnet Laser Optical Fibers for Ureteroscopy. Urology 2015; 86:230-5. [DOI: 10.1016/j.urology.2015.04.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 03/28/2015] [Accepted: 04/08/2015] [Indexed: 10/23/2022]
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14
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Kronenberg P, Traxer O. Are We All Doing It Wrong? Influence of Stripping and Cleaving Methods of Laser Fibers on Laser Lithotripsy Performance. J Urol 2015; 193:1030-5. [DOI: 10.1016/j.juro.2014.07.110] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Peter Kronenberg
- Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
- Université Paris 6, Pierre et Marie Curie-Hôpital Tenon (OT), Paris, France
| | - Olivier Traxer
- Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
- Université Paris 6, Pierre et Marie Curie-Hôpital Tenon (OT), Paris, France
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15
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Kronenberg P, Traxer O. The truth about laser fiber diameters. Urology 2015; 84:1301-7. [PMID: 25432821 DOI: 10.1016/j.urology.2014.08.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 07/14/2014] [Accepted: 08/12/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To measure the various diameters of laser fibers from various manufacturers and compare them with the advertised diameter. METHODS Fourteen different unused laser fibers from 6 leading manufacturers with advertised diameters of 200, 270, 272, 273, 365, and 400 μm were measured by light microscopy. The outer diameter (including the fiber coating, cladding, and core), cladding diameter (including the cladding and the fiber core), and core diameter were measured. Industry representatives of the manufacturers were interviewed about the diameter of their fibers. RESULTS For all fibers, the outer and cladding diameters differed significantly from the advertised diameter (P <.00001). The outer diameter, which is of most practical relevance for urologists, exhibited a median increase of 87.3% (range, 50.7%-116.7%). The outer, cladding, and core diameters of fibers with equivalent advertised diameters differed by up to 180, 100, and 78 μm, respectively. Some 200-μm fibers had larger outer diameters than the 270- to 273-μm fibers. All packaging material and all laser fibers lacked clear and precise fiber diameter information labels. Of 12 representatives interviewed, 8, 3, and 1 considered the advertised diameter to be the outer, the cladding, and the core diameter, respectively. Representatives within the same company frequently gave different answers. CONCLUSION This study suggests that, at present, there is a lack of uniformity between laser fiber manufacturers, and most of the information conveyed to urologists regarding laser fiber diameter may be incorrect. Because fibers larger than the advertised laser fibers are known to influence key interventional parameters, this misinformation can have surgical repercussions.
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Affiliation(s)
- Peter Kronenberg
- Urology Department, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal.
| | - Olivier Traxer
- Urology Department, Université Paris 6 Pierre et Marie Curie, Hôpital Tenon, Paris, France
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16
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Patel AP, Knudsen BE. Optimizing use of the holmium:YAG laser for surgical management of urinary lithiasis. Curr Urol Rep 2014; 15:397. [PMID: 24532341 DOI: 10.1007/s11934-014-0397-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The holmium:yttrium aluminum garnet (Ho:YAG, holmium) laser is an intracorporeal lithotrite that is widely used in the surgical management of urinary lithiasis. The Ho:YAG laser is capable of fragmenting urinary stones of all compositions while maintaining a wide margin of safety. The 2140-nm wavelength of energy is transmitted from the generator to the stone using specialized silica optical fibers. The effectiveness of the laser can be impacted by the type of laser fiber used, the pulse energy and frequency settings, and the composition of the stone. This paper provides an overview of Ho:YAG laser fibers utilized for lithotripsy during ureteroscopy. We will also review current data regarding optimal energy settings and discuss our experience with different fragmentation techniques.
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Affiliation(s)
- Abhishek P Patel
- Department of Urology, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Suite 2000, Columbus, OH, 43210-1228, USA
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Kronenberg P, Traxer O. Update on lasers in urology 2014: current assessment on holmium:yttrium-aluminum-garnet (Ho:YAG) laser lithotripter settings and laser fibers. World J Urol 2014; 33:463-9. [PMID: 25185524 DOI: 10.1007/s00345-014-1395-1] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 08/26/2014] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The purpose of the study was to review the existing literature on holmium:yttrium-aluminum-garnet laser lithotripsy regarding lithotripter settings and laser fibers. METHODS An online search of current and past peer-reviewed literature on holmium laser lithotripsy was performed on several databases, including PubMed, SciElo, and Google Scholar. Relevant studies and original articles about lithotripter settings and laser fibers were examined, and the most important information is summarized and presented here. RESULTS We examine how the choice of lithotripter settings and laser fibers influences the performance of holmium laser lithotripsy. Traditional laser lithotripter settings are analyzed, including pulse energy, pulse frequency, and power levels, as well as newly developed long-pulse modes. The impact of these settings on ablation volume, fragment size, and retropulsion is also examined. Advantages of small- and large-diameter laser fibers are discussed, and controversies are highlighted. Additionally, the influence of the laser fiber is examined, specifically the fiber tip preparation and the lithotripter settings' influence on tip degradation. CONCLUSIONS Many technical factors influence the performance of holmium laser lithotripsy. Knowing and understanding these controllable parameters allows the urologist to perform a laser lithotripsy procedure safely, efficiently, and with few complications.
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Shin RH, Lipkin ME, Preminger GM. Disposable devices for RIRS: where do we stand in 2013? What do we need in the future? World J Urol 2014; 33:241-6. [PMID: 25074553 DOI: 10.1007/s00345-014-1368-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Accepted: 07/18/2014] [Indexed: 10/25/2022] Open
Abstract
PURPOSE Disposable devices for retrograde intrarenal surgery (RIRS) form a significant part of the urologist's armamentarium for the endoscopic management of urologic diseases. Herein, we provide an overview of the literature regarding the advances and controversies of these devices. METHODS A PubMed search was used to identify the literature discussing the subject of disposable devices for RIRS. Articles published between 2012 and 2013 were considered. RESULTS Ureteral access implements including access sheaths, wires, and dilators are an area of both improvement and controversy regarding their proper use. The safety, effectiveness, and limitations of lithotrites continue to be refined. Stone retrieval devices are undergoing persistent miniaturization, and their use may prove to be cost effective. The debate over perioperative stenting remains, while symptom management is explored. A cost-effective option for disposable flexible ureteroscopy shows promise. CONCLUSIONS While rapid advances in technology and knowledge continue, continual improvements are necessary. Disposable equipment needs persistent refinement and possible miniaturization. More efficient fragment retrieval devices are needed. Durability of laser fibers and safety within ureteroscopes needs to be improved. Reducing stent morbidity remains an ongoing challenge. Lastly, costs need to be reduced by the further development of disposable flexible ureteroscopes and in the recyclability of disposable devices to improve availability worldwide.
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Affiliation(s)
- Richard H Shin
- Division of Urologic Surgery, Comprehensive Kidney Stone Center, Duke University Medical Center, Room 1573 White Zone, Box 3167, Durham, NC, 27710, USA
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Chapman R, Somani B, Robertson A, Healy S, Kata S. Decreasing Cost of Flexible Ureterorenoscopy: Single-use Laser Fiber Cost Analysis. Urology 2014; 83:1003-5. [DOI: 10.1016/j.urology.2013.12.019] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 11/04/2013] [Accepted: 12/13/2013] [Indexed: 11/25/2022]
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