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Vergamini LB, Ito W, Choi B N, Du HE, Sardiu ME, Neff D, Duchene DA, Molina WR, Whiles BB. Holmium:yttrium-aluminium-garnet laser with MOSES technology is more efficient than thulium fibre laser in supine mini-percutaneous nephrolithotomy. BJU Int 2024; 134:276-282. [PMID: 38797721 DOI: 10.1111/bju.16392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
OBJECTIVES To address the paucity of literature comparing outcomes achieved with utilisation of the high-power holmium:yttrium-aluminium-garnet (Ho:YAG) laser with MOSES technology vs those achieved with the thulium fibre laser (TFL) in mini-percutaneous nephrolithotomy (PCNL). METHODS A retrospective review was performed of patients undergoing supine mini-PCNL between August 2021 and May 2023. Exclusion criteria were urinary diversion, simultaneous utilisation of >1 laser platform, use of any other form of fragmentation, and ureteric stones. The Ho:YAG platform (Lumenis Pulse P120H™ with MOSES technology, 120W; Boston Scientific®) and the TFL (Soltive SuperPulsed Thulium Fibre [SPTF], 60W; Olympus®) were compared. Data on stone-free rate (SFR) were determined by computed tomography performed on the first postoperative day and presented as absence of stone fragments, no fragments larger than 2 mm, or no fragments larger than 4 mm. RESULTS A total of 100 patients met the inclusion criteria, 51 mini-PCNLs with the Ho:YAG laser and 49 with the SPTF laser. No significant differences in demographics or stone characteristics were detected between the two groups. The Ho:YAG laser utilised less energy and time, resulting in higher ablation efficiency (P < 0.05) and less total operating time (P < 0.05). Overall, there was no difference in SFR in any category between the Ho:YAG group and the SPTF group (no fragments: relative risk [RR] 0.81, 95% confidence interval [CI] 0.59-1.12, P = 0.21; fragments <2 mm: RR 0.86, 95% CI 0.67-1.10, P = 0.23; fragments <4 mm: RR 0.96, 95% CI 0.80-1.15, P = 0.67). CONCLUSIONS Although we observed an equivalent postoperative SFR, this study supports a shorter operating time and greater intra-operative laser efficiency with the Ho:YAG laser over the SPTF laser in mini-PCNL.
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Affiliation(s)
- Lucas B Vergamini
- Department of Urology, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Willian Ito
- Department of Urology, UT Southwestern, Dallas, Texas, USA
| | - Nicholas Choi B
- School of Medicine, University of Kansas, Kansas City, Kansas, USA
| | - Holly E Du
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Mihaela E Sardiu
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Donald Neff
- Department of Urology, The University of Kansas Health System, Kansas City, Kansas, USA
| | - David A Duchene
- Department of Urology, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Wilson R Molina
- Department of Urology, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Bristol B Whiles
- Department of Urology, The University of Kansas Health System, Kansas City, Kansas, USA
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Kose E, Bostanci Y, Gulsen M, Sahin F, Kalayci O, Ozden E, Yakupoglu YK, Sarikaya S. Monitoring Intrarenal temperature changes during Ho: YAG laser lithotripsy in patients undergoing retrograde intrarenal surgery: a novel pilot study. Urolithiasis 2024; 52:86. [PMID: 38869637 DOI: 10.1007/s00240-024-01592-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 06/06/2024] [Indexed: 06/14/2024]
Abstract
Ho: YAG laser lithotripsy is widely used for urinary stone treatment, but concerns persist regarding its thermal effects on renal tissues. This study aimed to monitor intrarenal temperature changes during kidney stone treatment using retrograde intrarenal surgery with Ho: YAG laser. Fifteen patients were enrolled. Various laser power settings (0.8 J/10 Hz, 1.2 J/12 Hz) and irrigation modes (10 cc/min, 15 cc/min, 20 cc/min, gravity irrigation, and manual pump irrigation) were used. A sterile thermal probe was attached to a flexible ureterorenoscope and delivered into the calyceal system via the ureteral access sheath. Temperature changes were recorded with a T-type thermal probe with ± 0.1 °C accuracy. Laser power significantly influenced mean temperature, with a 4.981 °C difference between 14 W and 8 W laser power (p < 0.001). The mean temperature was 2.075 °C higher with gravity irrigation and 2.828 °C lower with manual pump irrigation (p = 0.038 and p = 0.005, respectively). Body mass index, laser power, irrigation model, and operator duty cycle explained 49.5% of mean temperature variability (Adj. R2 = 0.495). Laser power and operator duty cycle positively impacted mean temperature, while body mass index and specific irrigation models affected it negatively. Laser power and irrigation rate are critical for intrarenal temperature during Ho: YAG laser lithotripsy. Optimal settings and irrigation strategies are vital for minimizing thermal injury risk. This study underscores the need for ongoing research to understand and mitigate thermal effects during laser lithotripsy.
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Affiliation(s)
- Ertugrul Kose
- Department of Urology, Gazi State Hospital, Ilkadım, Samsun, Turkey.
| | - Yakup Bostanci
- Department of Urology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Murat Gulsen
- Department of Urology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Fevzi Sahin
- Department of Mechanical Engineering, Faculty of Engineering, Ondokuz Mayıs University, Samsun, Turkey
| | - Onur Kalayci
- Department of Urology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Ender Ozden
- Department of Urology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | | | - Saban Sarikaya
- Department of Urology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
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Æsøy MS, Juliebø-Jones P, Beisland C, Ulvik Ø. Temperature Measurements During Flexible Ureteroscopic Laser Lithotripsy: A Prospective Clinical Trial. J Endourol 2024; 38:308-315. [PMID: 38185920 DOI: 10.1089/end.2023.0660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024] Open
Abstract
Objective: The primary aim of the study was to explore intrarenal temperatures (IRTs) during flexible ureteroscopic laser lithotripsy (FURSL). The secondary aim was to investigate the correlation between temperatures and renal pelvis anteroposterior diameter (APD). Materials and Methods: From February 2023 to June 2023, 10 patients with an indwelling nephrostomy tube (NT) undergoing FURSL were enrolled in the study. Sheathless FURSL was performed using gravitational irrigation (23°C) at 60 cm. A sterile K-type thermocouple was inserted through the NT. Temperatures were recorded for 120 seconds with continuous laser activation and for another 60 seconds after deactivation. Thulium fiber laser delivered energy using a 150 μm fiber and incremental power settings of 5, 10, 20, and 30 W. The laser was deactivated whenever the IRT reached 43°C. Results: IRT correlated directly to power settings. Each time the power settings were increased, the temperature rose significantly. The increase in average peak temperature was 2.6°C between 5 and 10 W (p < 0.001), 3.4°C between 10 and 20 W (p < 0.001), and 2.5°C between 20 and 30 W (p < 0.001). Temperatures reached 43°C in three patients applying 20 W and in eight patients applying 30 W. The shortest activation-time until threshold was 12 and 28 seconds with 30 and 20 W settings, respectively. When reaching 43°C, temperatures remained above this threshold for an additional 29 seconds on average. There was a significant correlation between IRT and renal APD. For example, when 10 W was applied in the setting of APD ≤20 mm, the recorded temperature was on average 2.3°C higher compared with APD >20 mm, with the same power settings applied, p < 0.001. Conclusion: During FURSL, IRT correlates directly with power settings and is inversely correlated with renal pelvic APD. Using a sheathless approach, power settings ≥20 W should arguably be avoided, especially in the context of a nondilated renal pelvis. ClinicalTrials: The study was registered on ClinicalTrials.gov (NCT05677425).
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Affiliation(s)
- Mathias Sørstrand Æsøy
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine (K1), University of Bergen, Bergen, Norway
| | - Patrick Juliebø-Jones
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine (K1), University of Bergen, Bergen, Norway
| | - Christian Beisland
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine (K1), University of Bergen, Bergen, Norway
| | - Øyvind Ulvik
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine (K1), University of Bergen, Bergen, Norway
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Tonyali S, von Bargen MF, Ozkan A, Gratzke C, Miernik A. The heat is on: the impact of excessive temperature increments on complications of laser treatment for ureteral and renal stones. World J Urol 2023; 41:3853-3865. [PMID: 38010538 PMCID: PMC10693507 DOI: 10.1007/s00345-023-04652-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 09/21/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVE Technological advancements in the field of urology have led to a paradigm shift in the management of urolithiasis towards minimally invasive endourological interventions, namely ureteroscopy and percutaneous nephrolithotomy. However, concerns regarding the potential for thermal injury during laser lithotripsy have arisen, as studies have indicated that the threshold for cellular thermal injury (43 °C) can be exceeded, even with conventional low-power laser settings. This review aims to identify the factors that contribute to temperature increments during laser treatment using current laser systems and evaluate their impact on patient outcomes. MATERIALS AND METHODS To select studies for inclusion, a search was performed on online databases including PubMed and Google Scholar. Keywords such as 'temperature' or 'heat' were combined with 'lithotripsy', 'nephrolithotomy', 'ureteroscopy', or 'retrograde intrarenal surgery', both individually and in various combinations. RESULTS Various strategies have been proposed to mitigate temperature rise, such as reducing laser energy or frequency, shortening the duration of laser activation, increasing the irrigation fluid flow rate, and using room temperature or chilled water for irrigation. It is important to note that higher irrigation fluid flow rates should be approached cautiously due to potential increases in intrarenal pressure and associated infectious complications. The utilization of a ureteral access sheath (UAS) may offer benefits by facilitating irrigation fluid outflow, thereby reducing intrapelvic pressure and intrarenal fluid temperature. CONCLUSION Achieving a balance between laser power, duration of laser activation, and irrigation fluid rate and temperature appears to be crucial for urologists to minimize excessive temperature rise.
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Affiliation(s)
- Senol Tonyali
- Department of Urology, Faculty of Medicine, University of Freiburg Medical Center, Hugstetter Str. 55, 79106, Freiburg, Germany.
| | - Maximilian Ferry von Bargen
- Department of Urology, Faculty of Medicine, University of Freiburg Medical Center, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Arif Ozkan
- Department of Urology, Koc University Hospital, Istanbul, Turkey
| | - Christian Gratzke
- Department of Urology, Faculty of Medicine, University of Freiburg Medical Center, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Arkadiusz Miernik
- Department of Urology, Faculty of Medicine, University of Freiburg Medical Center, Hugstetter Str. 55, 79106, Freiburg, Germany
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Marom R, Dau JJ, Hall TL, Ghani KR, Louters MM, Kim HJ, Khajeh NR, Roberts WW. Thermal Safety Boundaries for Laser Power and Irrigation Rate During Ureteroscopy: In Vivo Porcine Assessment With a Ho:YAG Laser. Urology 2023; 180:81-85. [PMID: 37482102 DOI: 10.1016/j.urology.2023.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/30/2023] [Accepted: 07/10/2023] [Indexed: 07/25/2023]
Abstract
OBJECTIVE To map thermal safety boundaries during ureteroscopy (URS) with laser activation in two in vivo porcine subjects to better understand the interplay between laser power, irrigation rate, and fluid temperature in the collecting system. METHODS URS was performed in two in vivo porcine subjects with a prototype ureteroscope containing a thermocouple at its tip. Up to 6 trials of 60 seconds laser activation were carried out at each selected power setting and irrigation rate. Thermal dose was calculated for each trial, and laser power-irrigation rate parameter pairs were categorized based on number of trials that exceeded a thermal dose of 120 equivalent minutes. RESULTS The collecting fluid temperature was increased with greater laser power and slower irrigation rate. In the first porcine subject, 25 W of laser power could safely be applied if irrigation was at least 15 mL/min, and 48 W with at least 30 mL/min. Intermediate values followed a linear curve between these bounds. For the second subject, where the calyx appeared larger, 15 W laser power required 9 mL/min irrigation, 48 W required 24 mL/min, and intermediate points also followed a near-linear curve. CONCLUSION This study validates previous bench research and provides a conceptual framework for selection of safe laser lithotripsy settings and irrigation rates during URS with laser lithotripsy. Additionally, it provides insight and guidance for future development of thermal mitigation strategies and devices.
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Affiliation(s)
- Ron Marom
- Department of Urology, University of Michigan, Ann Arbor, MI.
| | - Julie J Dau
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - Timothy L Hall
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI
| | | | | | - Hyung Joon Kim
- Department of Urology, Konyang University College of Medicine, Daejeon, South Korea
| | | | - William W Roberts
- Department of Urology, University of Michigan, Ann Arbor, MI; Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI
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Panthier F, Pauchard F, Traxer O. Retrograde intra renal surgery and safety: pressure and temperature. A systematic review. Curr Opin Urol 2023; 33:308-317. [PMID: 37140545 DOI: 10.1097/mou.0000000000001102] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
PURPOSE OF REVIEW Retrograde intra renal surgery (RIRS) with laser lithotripsy represents the gold-standard to treat renal stones up to 20 mm. Controlling intraoperative parameters such as intrarenal pressure (IRP) and temperature (IRT) is mandatory to avoid complications. This article reviews advances in IRP and IRT over the last 2 years. RECENT FINDINGS We conducted a PubMed/Embase search and reviewed publications that include temperature and pressure during RIRS. Thirty-four articles have been published which met the inclusion criteria. Regarding IRP, a consensus has emerged to control IRP during RIRS, in order to avoid (barotraumatic and septic) complications. Several monitoring devices are under evaluation but none of them are clinically approved for RIRS. Ureteral access sheath, low irrigation pressure and occupied working channel help to maintain a low IRP. Robotic systems and suction devices would improve IRP intraoperative management and monitoring. IRT determinants are the irrigation flow and laser settings. Low power settings(<20 W) with minimal irrigation flow (5-10 ml/min) are sufficient to maintain low IRT and allows continuous laser activation. SUMMARY Recent evidence suggests that IRP and IRT are closely related. IRP depends on inflow and outflow rates. Continuous monitoring would help to avoid surgical and infectious complications. IRT depends on the laser settings and the irrigation flow.
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Affiliation(s)
- Frédéric Panthier
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université
- PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, Paris, France
- Progressive Endourological Association for Research and Leading Solutions (PEARLS)
| | - Felipe Pauchard
- Progressive Endourological Association for Research and Leading Solutions (PEARLS)
- Urology Department, Hospital Naval Almirante Nef, Viña del Mar, Chile
| | - Olivier Traxer
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université
- Progressive Endourological Association for Research and Leading Solutions (PEARLS)
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Emiliani E, Kanashiro A, Angerri O. Lasers for stone lithotripsy: advantages/disadvantages of each laser source. Curr Opin Urol 2023; 33:302-307. [PMID: 36927702 DOI: 10.1097/mou.0000000000001092] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
PURPOSE The purpose of this article was to make a narrative review of the literature in search of all articles regarding thulium:yttrium-aluminium-garnet (YAG), thulium laser fiber (TFL) and holmium:YAG (Ho:YAG) for lithotripsy from 2020 to 2023. A selection of articles of special interest and best evidence was made in order to give a better perspective on their advantages and disadvantages. RECENT FINDINGS New Ho:YAG technologies of as high power, high frequency and pulsed modulations have shown promising results for lithotripsy by reducing retropulsion with good ablation efficiency. High peak power makes it particularly good for percutaneous nephrolithotomy. High intrarenal temperatures and correct setting are still concerning points.TFL has arrived to be one of the main players in flexible ureteroscopy. Being highly efficient and quick, and by producing micro-dusting the laser is quickly heading to become a gold standard. The new pulsed Thulium YAG is the newest laser. For now, only in-vitro studies show promising results with efficient lithotripsy. As the peak power lies between Ho:YAG and TFL it may be able to adequately perform when needing and low power lithotripsy. SUMMARY Several new technologies have been developed in the last years for stone lithotripsy. All being efficient and safe if well used. Different advantages and disadvantages of each laser must be taken into consideration to give each laser the proper indication.
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Affiliation(s)
- Esteban Emiliani
- Fundació Puigvert. Autonomous University of Barcelona. Barcelona, Spain
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Wu Z, Wei J, Sun C, Huangfu Q, Wang B, Huang G, Qi K, Jiang Z, Zhu W, Wen J. Temperature changes of renal calyx during high-power flexible ureteroscopic Moses holmium laser lithotripsy: a case analysis study. Int Urol Nephrol 2023:10.1007/s11255-023-03611-3. [PMID: 37145376 DOI: 10.1007/s11255-023-03611-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/21/2023] [Indexed: 05/06/2023]
Abstract
PURPOSE The risk of thermal damage increases with the introduction of high-power lasers during holmium laser lithotripsy. This study aimed to quantitatively evaluate the temperature change of renal calyx in the human body and the 3D printed model during high-power flexible ureteroscopic holmium laser lithotripsy and map out the temperature curve. METHODS The temperature was continuously measured by a medical temperature sensor secured to a flexible ureteroscope. Between December 2021 and December 2022, willing patients with kidney stones undergoing flexible ureteroscopic holmium laser lithotripsy were enrolled. High frequency and high-power settings (24 W, 80 Hz/0.3 J and 32 W, 80 Hz/0.4 J) were performed for each patient with room temperature (25 °C) irrigation. In the 3D printed model, we studied more holmium laser settings (24 W, 80 Hz/0.3 J, 32 W, 80 Hz/0.4 J and 40 W, 80 Hz/0.4 J) with warmed (37 °C) and room temperature (25 °C) irrigation. RESULTS Twenty-two patients were enrolled in our study. With 30 ml/min or 60 ml/min irrigation, the local temperature of the renal calyx did not reach 43 °C in any patient under 25 °C irrigation after 60 s laser activation. There were similar temperature changes in the 3D printed model with the human body under the irrigation of 25 °C. Under the irrigation of 37 °C, the temperature rise slowed down, but the temperature in the renal calyces was close to or even exceeded the 43 °C at the setting of 32 W, 30 ml/min and 40 W, 30 ml/min after continuing laser activation. CONCLUSION In the irrigation of 60 ml/min, the temperature in the renal calyces can still be maintained within a safe range after continuous activation of a holmium laser up to 40 W. However, continuous activation of 32 W or higher power holmium laser in the renal calyces for more than 60 s in the limited irrigation of 30 ml/min can cause excessive local temperature, in such situation room temperature perfusion at 25 ℃ may be a relatively safer option.
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Affiliation(s)
- Zhiyue Wu
- Department of Urology, School of Medicine, The Fourth Affiliated Hospital, Zhejiang University, Yiwu, Zhejiang, China
| | - Jingchao Wei
- Department of Urology, School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | - Chengfang Sun
- Department of Urology, School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | - Qi Huangfu
- Department of Urology, School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | - Bohan Wang
- Department of Urology, School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | - Guangyi Huang
- Department of Urology, School of Medicine, The Fourth Affiliated Hospital, Zhejiang University, Yiwu, Zhejiang, China
| | - Kai Qi
- Department of Urology, School of Medicine, The Fourth Affiliated Hospital, Zhejiang University, Yiwu, Zhejiang, China
| | - Zeping Jiang
- Department of Urology, School of Medicine, The Fourth Affiliated Hospital, Zhejiang University, Yiwu, Zhejiang, China
| | - Wuan Zhu
- Department of Urology, School of Medicine, The Fourth Affiliated Hospital, Zhejiang University, Yiwu, Zhejiang, China
| | - Jiaming Wen
- Department of Urology, School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China.
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9
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Assessing critical temperature dose areas in the kidney by magnetic resonance imaging thermometry in an ex vivo Holmium:YAG laser lithotripsy model. World J Urol 2023; 41:543-549. [PMID: 36543945 PMCID: PMC9947089 DOI: 10.1007/s00345-022-04255-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
PURPOSE We aimed to assess critical temperature areas in the kidney parenchyma using magnetic resonance thermometry (MRT) in an ex vivo Holmium:YAG laser lithotripsy model. METHODS Thermal effects of Ho:YAG laser irradiation of 14 W and 30 W were investigated in the calyx and renal pelvis of an ex vivo kidney with different laser application times (tL) followed by a delay time (tD) of tL/tD = 5/5 s, 5/10 s, 10/5 s, 10/10 s, and 20/0 s, with irrigation rates of 10, 30, 50, 70, and 100 ml/min. Using MRT, the size of the area was determined in which the thermal dose as measured by the Cumulative Equivalent Minutes (CEM43) method exceeded a value of 120 min. RESULTS In the calyx, CEM43 never exceeded 120 min for flow rates ≥ 70 ml/min at 14 W, and longer tL (10 s vs. 5 s) lead to exponentially lower thermal affection of tissue (3.6 vs. 21.9 mm2). Similarly at 30 W and ≥ 70 ml/min CEM43 was below 120 min. Interestingly, at irrigation rates of 10 ml/min, tL = 10 s and tD = 10 s CEM43 were observed > 120 min in an area of 84.4 mm2 and 49.1 mm2 at tD = 5 s. Here, tL = 5 s revealed relevant thermal affection of 29.1 mm2 at 10 ml/min. CONCLUSION We demonstrate that critical temperature dose areas in the kidney parenchyma were associated with high laser power and application times, a low irrigation rate, and anatomical volume of the targeted calyx.
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10
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Louters MM, Kim HJ, Dau JJ, Hall TL, Ghani KR, Roberts WW. Characterization of Fluid Dynamics and Temperature Profiles During Ureteroscopy with Laser Activation in a Model Ureter. J Endourol 2022; 36:1593-1598. [PMID: 35904397 DOI: 10.1089/end.2022.0275] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Introduction: Ureteral thermal injury has been reported in patients following ureteroscopy with laser lithotripsy due to overheating of fluid within the ureter. Proper understanding of this risk necessitates knowing the volume of fluid available to absorb laser energy. This can be approximated as the volume of fluid that mixes during laser activation, since energy transfer through fluid is dominated by convection. Objectives of this study were to determine the volume of fluid that mixes during laser activation at different irrigation rates and to characterize the temporal/spatial temperature distribution in a model ureter. Methods: The model ureter consisted of a plastic tube-160 mm length and 5.3 mm inner diameter. Irrigation was first applied with clear, then dyed, deionized water at rates from 8 to 40 mL/min. The laser was activated at 20 W (0.5 J/40 Hz). The distances the dyed fluid propagated were measured and volumes calculated. Temperatures were recorded from six thermocouples-five embedded within the tube and one affixed to the ureteroscope. Thermal dose was calculated using the Dewey and Sapareto methodology. Results: The volume of total fluid mixing in the model ureter was ≤1.26 ± 0.10 cm3, consistent with a sharp temperature increase after laser activation from -5 to 25 mm from the ureteroscope tip. With irrigation rates ≤12 mL/min, calculated thermal dose within the model ureter exceeded the threshold of tissue injury and extended greater distances along the ureter with lower irrigation rates. Conclusion: The volume of total fluid mixing within the model ureter was found to be small thus conferring a greater risk of ureteral thermal injury. A thermocouple positioned near the tip of the ureteroscope reasonably approximates temperature in front of the ureteroscope. Until temperature sensors are incorporated into ureteroscopic systems, laser power settings should be carefully selected to minimize risk of ureteral thermal injury.
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Affiliation(s)
- Marne M Louters
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Hyung Joon Kim
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Julie J Dau
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Timothy L Hall
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Khurshid R Ghani
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - William W Roberts
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
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Wollin DA. EDITORIAL COMMENT. Urology 2022; 170:58. [DOI: 10.1016/j.urology.2022.07.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
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12
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Peteinaris A, Tsaturyan A, Pantazis L, Farsari E, Martinez BB, Pagonis K, Adamou C, Vagionis A, Natsos A, Liatsikos E, Kallidonis P. Factors affecting the irrigation fluid temperature during laser lithotripsy: in vitro experimental study. Urology 2022; 170:53-59. [PMID: 36115430 DOI: 10.1016/j.urology.2022.07.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/21/2022] [Accepted: 07/31/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To investigate the effect of the diameter of laser fiber, pelvis volume, presence and type of the stone on irrigation fluid temperature rise. MATERIAL AND METHODS A 20ml syringe, 12/14 ureteral access sheath(UAS), a dual-lumen catheter and a thermocouple were used. The 12/14Fr UAS(Cook Ireland Ltd., Limerick, Ireland) and the Thermocouple(SE001, Pico Technologies, Cambridgeshire, UK) were inserted in the syringe. The syringe was closed allowing outflow from the UAS with rate at 10ml/min. The Quanta Ho 150W(Quanta System, Samarate, Italy) laser was used and fired with 10W(2Jx5Hz), 20W(2 × 10 Hz), 40W(2 × 20 Hz), 60W(2 × 30 Hz). These power settings were tested in different conditions: fibers(200µm, 365µm and 550µm), volumes(5ml, 10ml and 20ml) and artificial stones(soft, hard). The laser was activated for 30 seconds and reactivation was performed when the temperature reached below 26 0C. RESULTS For all trials 60W of energy resulted in higher temperature rise. No differences were observed when different fibers were used. The highest temperatures (up to 80 0C) for 60W were reported in 5ml syringe and the lowest (<45 0C) with 20ml. The maximal temperature of >59°C was recorded for the power of 60W(1Jx60Hz). The temperature exceeded 43 0C when power settings >40W were applied. CONCLUSION Increasing the overall power, increases the irrigation fluid temperature significantly. The smaller the volume of the pelvis, the greater the temperature elevation. The fiber size did not affect the temperature increase pattern. The presence of artificial stones was associated with the absorption of energy emitted by the laser.
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Affiliation(s)
| | | | | | - Ergina Farsari
- Plasma Technology Laboratory, Department of Chemical Engineering, University of Patras, Patras, Greece
| | | | | | | | | | | | - Evangelos Liatsikos
- Department of Urology, University of Patras, Patras, Greece; Department of Urology, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
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Tsaturyan A, Peteinaris A, Pantazis L, Farsari E, Pagonis K, Adamou C, Vagionis A, Natsos A, Liatsikos E, Kallidonis P. The effect of prolonged laser activation on irrigation fluid temperature: an in vitro experimental study. World J Urol 2022; 40:1873-1878. [PMID: 35445335 DOI: 10.1007/s00345-022-04000-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/18/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To investigate the effect of prolonged laser activation on irrigation fluid temperature by varying the power settings flow rate (10-30 ml/min). MATERIALS AND METHODS An experimental study using a 20 ml syringe, 12/14 ureteral access sheath, a dual-lumen catheter and a thermocouple was performed. The laser was fired with 12 W (0.3 J × 40 Hz), 40 W (1 J × 40 Hz), 60 W (1.5 J × 40 Hz) using Quanta Ho 150 W (Quanta System, Samarate, Italy). All trials were performed with fluid outflow rate of 10, 20 and 30 ml/min with the fixed fluid volume at 10 ml. RESULTS Continuous laser activation for 10 min with the outflow rate of 10 ml/min using only 12 W resulted to continuous temperature rise to as high as 83 °C. Similar rise of temperatures were observed for 40 W and 60 W with 10 ml/min outflow rate with intermittent laser activation. With 20 and 30 ml/min outflow rates the maximum temperatures for all power settings were below the threshold (< 43 °C). However, the time to reach the same total emitted energy was 60% and 40% shorter 60 W and 40 W, respectively. CONCLUSION Our study found that continuous laser activation with as less as 12 W using 10 ml/min outflow rate increased the irrigation fluid temperature above the threshold only after 1 min. In the current experimental setup, with the fluid outflow rate of 20 and 30 ml/min safe laser activation with 60 W and 40 W (temperature < 43 °C) can be achieved reaching the same total emitted energy as with 12 W in significantly shorter time period.
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Affiliation(s)
- Arman Tsaturyan
- Department of Urology, University of Patras Medical School, Rio, 26500, Patras, Greece.
| | - Angelis Peteinaris
- Department of Urology, University of Patras Medical School, Rio, 26500, Patras, Greece
| | - Lampros Pantazis
- Department of Urology, University of Patras Medical School, Rio, 26500, Patras, Greece
| | - Ergina Farsari
- Plasma Technology Laboratory, Department of Chemical Engineering, University of Patras, Patras, Greece
| | - Konstantinos Pagonis
- Department of Urology, University of Patras Medical School, Rio, 26500, Patras, Greece
| | - Constantinos Adamou
- Department of Urology, University of Patras Medical School, Rio, 26500, Patras, Greece
| | - Athanasios Vagionis
- Department of Urology, University of Patras Medical School, Rio, 26500, Patras, Greece
| | - Anastasios Natsos
- Department of Urology, University of Patras Medical School, Rio, 26500, Patras, Greece
| | - Evangelos Liatsikos
- Department of Urology, University of Patras Medical School, Rio, 26500, Patras, Greece.,Department of Urology, Medical University of Vienna, Vienna, Austria.,Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Panagiotis Kallidonis
- Department of Urology, University of Patras Medical School, Rio, 26500, Patras, Greece
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Laser operator duty cycle effect on temperature and thermal dose: in-vitro study. World J Urol 2022; 40:1575-1580. [DOI: 10.1007/s00345-022-03967-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 02/14/2022] [Indexed: 11/26/2022] Open
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Dau JJ, Rezakahn Khajeh N, Hall TL, Roberts WW. Chilled irrigation for control of temperature elevation during ureteroscopic laser lithotripsy: in vivo porcine model. J Endourol 2021; 36:403-409. [PMID: 34569294 DOI: 10.1089/end.2021.0537] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Multiple studies have shown significant heating of fluid within the urinary collecting system with high-power laser settings. Elevated fluid temperatures may cause thermal injury and tissue damage unless appropriately mitigated. A previous in vitro study demonstrated that chilled (4 °C) irrigation slowed temperature rise, decreased plateau temperature, and lowered thermal dose during laser activation with high-power settings. We sought to evaluate the thermal effects of chilled, room temperature, and warmed irrigation during ureteroscopy with laser activation in an in vivo porcine model. MATERIALS AND METHODS Seven female Yorkshire cross pigs (45-55 kg) were anesthetized and positioned supine. Retrograde ureteroscopy was performed with a thermocouple affixed 5 mm from the distal end of the ureteroscope. In two pigs a holmium:YAG laser was activated for 60 seconds at irrigation rates of 8 ml/min, 12 ml/min, and 15 ml/min with chilled, room temperature, or warmed irrigation. In five pigs core body temperature was recorded for one hour with or without continuous chilled irrigation at 15 ml/min. RESULTS At irrigation rates ≥ 12 ml/min, temperature curves appeared uniformly offset, warmed > room temperature > chilled irrigation. The threshold of thermal tissue injury was reached during laser activation for all irrigation temperatures at 8 ml/min. The threshold was not reached with chilled irrigation at 12 ml/min or 15 ml/min, or with room temperature irrigation at 15 ml/min. The threshold was exceeded at all irrigation rates with warmed irrigation. There was no significant change in core body temperature after delivering chilled irrigation at 15 ml/min compared with no irrigation for 60 minutes. CONCLUSION Irrigation with chilled saline solution during ureteroscopic laser lithotripsy slows temperature rise, lowers peak temperature, and lengthens the time to thermal injury compared to irrigation with room temperature or warmed saline solutions. Core body temperature was not significantly impacted by chilled irrigation.
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Affiliation(s)
- Julie J Dau
- University of Michigan, 1259, Urology, 4432 Medical Sciences Bldg I, 1301 Catherine St, Ann Arbor, Michigan, United States, 48109-1382;
| | | | - Timothy L Hall
- University of Michigan, Biomedical Engineering, 2200 Bonisteel Blvd, Ann Arbor, Michigan, United States, 48109;
| | - William W Roberts
- University of Michigan, Urology, 3879 Taubman Center, 1500 East Medical Center Dr,, Ann Arbor, Michigan, United States, 48109-5330.,University of Michigan, Biomedical Engineering, Ann Arbor, Michigan, United States;
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