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Leng J, Liu J, Cheng G, Wang H, Quarrier S, Luo J, Jain R. Development of UroSAM: A Machine Learning Model to Automatically Identify Kidney Stone Composition from Endoscopic Video. J Endourol 2024. [PMID: 38753704 DOI: 10.1089/end.2023.0740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024] Open
Abstract
Introduction: Chemical composition analysis is important in prevention counseling for kidney stone disease. Advances in laser technology have made dusting techniques more prevalent, but this offers no consistent way to collect enough material to send for chemical analysis, leading many to forgo this test. We developed a novel machine learning (ML) model to effectively assess stone composition based on intraoperative endoscopic video data. Methods: Two endourologists performed ureteroscopy for kidney stones ≥ 10 mm. Representative videos were recorded intraoperatively. Individual frames were extracted from the videos, and the stone was outlined by human tracing. An ML model, UroSAM, was built and trained to automatically identify kidney stones in the images and predict the majority stone composition as follows: calcium oxalate monohydrate (COM), dihydrate (COD), calcium phosphate (CAP), or uric acid (UA). UroSAM was built on top of the publicly available Segment Anything Model (SAM) and incorporated a U-Net convolutional neural network (CNN). Discussion: A total of 78 ureteroscopy videos were collected; 50 were used for the model after exclusions (32 COM, 8 COD, 8 CAP, 2 UA). The ML model segmented the images with 94.77% precision. Dice coefficient (0.9135) and Intersection over Union (0.8496) confirmed good segmentation performance of the ML model. A video-wise evaluation demonstrated 60% correct classification of stone composition. Subgroup analysis showed correct classification in 84.4% of COM videos. A post hoc adaptive threshold technique was used to mitigate biasing of the model toward COM because of data imbalance; this improved the overall correct classification to 62% while improving the classification of COD, CAP, and UA videos. Conclusions: This study demonstrates the effective development of UroSAM, an ML model that precisely identifies kidney stones from natural endoscopic video data. More high-quality video data will improve the performance of the model in classifying the majority stone composition.
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Affiliation(s)
- Jixuan Leng
- University of Rochester, Rochester, New York, USA
| | - Junfei Liu
- University of Rochester, Rochester, New York, USA
| | - Galen Cheng
- University of Rochester Medical Center, Rochester, New York, USA
| | - Haohan Wang
- University of Illinois Urbana-Champaign, Champaign, Illinois, USA
| | - Scott Quarrier
- University of Rochester Medical Center, Rochester, New York, USA
| | - Jiebo Luo
- University of Rochester, Rochester, New York, USA
| | - Rajat Jain
- University of Rochester Medical Center, Rochester, New York, USA
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Ma Z, Hao Q, Wang H, Sun X, Li L. High power self-Q-switched Tm:YAP laser. OPTICS LETTERS 2024; 49:2429-2432. [PMID: 38691736 DOI: 10.1364/ol.518655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/28/2024] [Indexed: 05/03/2024]
Abstract
To the best of our knowledge, the output performance of a self-Q-switched Tm:YAP laser has been controlled by adjusting the cavity length for the first time. By using a concise concave-flat cavity, a pulsed laser emitting at 1993 nm is produced without any additional modulation device. Under a stable self-Q-switched mode, the maximum average output power of 9.76 W is achieved from the laser when the incident pump power is 28.78 W, corresponding to a slope efficiency of 36.9% and an optical-to-optical conversion efficacy of 33.9%. Also, the narrowest pulse width of 485 ns at 48.97 kHz is obtained from the laser with a single pulse energy of 199.3 µJ. As far as we know, this laser has the highest average power and narrowest pulse width compared to other self-Q-switched Tm:YAP lasers.
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Mishra A, Medairos R, Chen J, Soto-Palou F, Antonelli J, Preminger GM, Lipkin ME, Zhong P. Exploring optimal settings for safe and effective thulium fibre laser lithotripsy in a kidney model. BJU Int 2024; 133:223-230. [PMID: 37942684 PMCID: PMC10947524 DOI: 10.1111/bju.16218] [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] [Indexed: 11/10/2023]
Abstract
OBJECTIVES To explore the optimal laser settings and treatment strategies for thulium fibre laser (TFL) lithotripsy, namely, those with the highest treatment efficiency, lowest thermal injury risk, and shortest procedure time. MATERIALS AND METHODS An in vitro kidney model was used to assess the efficacy of TFL lithotripsy in the upper calyx. Stone ablation experiments were performed on BegoStone phantoms at different combinations of pulse energy (EP ) and frequency (F) to determine the optimal settings. Temperature changes and thermal injury risks were monitored using embedded thermocouples. Experiments were also performed on calcium oxalate monohydrate (COM) stones to validate the optimal settings. RESULTS High EP /low F settings demonstrated superior treatment efficiency compared to low EP /high F settings using the same power. Specifically, 0.8 J/12 Hz was the optimal setting, resulting in a twofold increase in treatment efficiency, a 39% reduction in energy expenditure per unit of ablated stone mass, a 35% reduction in residual fragments, and a 36% reduction in total procedure time compared to the 0.2 J/50 Hz setting for COM stones. Thermal injury risk assessment indicated that 10 W power settings with high EP /low F combinations remained below the threshold for tissue injury, while higher power settings (>10 W) consistently exceeded the safety threshold. CONCLUSIONS Our findings suggest that high EP /low F settings, such as 0.8 J/12 Hz, are optimal for TFL lithotripsy in the treatment of COM stones. These settings demonstrated significantly improved treatment efficiency with reduced residual fragments compared to conventional settings while keeping the thermal dose below the injury threshold. This study highlights the importance of using the high EP /low F combination with low power settings, which maximizes treatment efficiency and minimizes potential thermal injury. Further studies are warranted to determine the optimal settings for TFL for treating kidney stones with different compositions.
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Affiliation(s)
- Arpit Mishra
- Thomas Lord Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina
| | - Robert Medairos
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Junqin Chen
- Thomas Lord Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina
| | - Francois Soto-Palou
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Jodi Antonelli
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Glenn M. Preminger
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Michael E. Lipkin
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Pei Zhong
- Thomas Lord Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina
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Xiang G, Chen J, Ho D, Sankin G, Zhao X, Liu Y, Wang K, Dolbow J, Yao J, Zhong P. Shock waves generated by toroidal bubble collapse are imperative for kidney stone dusting during Holmium:YAG laser lithotripsy. ULTRASONICS SONOCHEMISTRY 2023; 101:106649. [PMID: 37866136 PMCID: PMC10623368 DOI: 10.1016/j.ultsonch.2023.106649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 10/09/2023] [Accepted: 10/12/2023] [Indexed: 10/24/2023]
Abstract
Holmium:yttrium-aluminum-garnet (Ho:YAG) laser lithotripsy (LL) has been the treatment of choice for kidney stone disease for more than two decades, yet the mechanisms of action are not completely clear. Besides photothermal ablation, recent evidence suggests that cavitation bubble collapse is pivotal in kidney stone dusting when the Ho:YAG laser operates at low pulse energy (Ep) and high frequency (F). In this work, we perform a comprehensive series of experiments and model-based simulations to dissect the complex physical processes in LL. Under clinically relevant dusting settings (Ep = 0.2 J, F = 20 Hz), our results suggest that majority of the irradiated laser energy (>90 %) is dissipated by heat generation in the fluid surrounding the fiber tip and the irradiated stone surface, while only about 1 % may be consumed for photothermal ablation, and less than 0.7 % is converted into the potential energy at the maximum bubble expansion. We reveal that photothermal ablation is confined locally to the laser irradiation spot, whereas cavitation erosion is most pronounced at a fiber tip-stone surface distance about 0.5 mm where multi foci ring-like damage outside the thermal ablation zone is observed. The cavitation erosion is caused by the progressively intensified collapse of jet-induced toroidal bubble near the stone surface (<100 μm), as a result of Raleigh-Taylor and Richtmyer-Meshkov instabilities. The ensuing shock wave-stone interaction and resultant leaky Rayleigh waves on the stone surface may lead to dynamic fatigue and superficial material removal under repeated bombardments of toroidal bubble collapses during dusting procedures in LL.
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Affiliation(s)
- Gaoming Xiang
- Thomas Lord Dept. of Mechanical Engineering and Materials Science, Duke University, Durham, NC 27708, USA; Current address: Optics and Thermal Radiation Research Center, Institute of Frontier and Interdisciplinary Science, Shandong University, Qingdao 266237, China
| | - Junqin Chen
- Thomas Lord Dept. of Mechanical Engineering and Materials Science, Duke University, Durham, NC 27708, USA
| | - Derek Ho
- Thomas Lord Dept. of Mechanical Engineering and Materials Science, Duke University, Durham, NC 27708, USA
| | - Georgy Sankin
- Thomas Lord Dept. of Mechanical Engineering and Materials Science, Duke University, Durham, NC 27708, USA
| | - Xuning Zhao
- Dept. of Aerospace and Ocean Engineering, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA
| | - Yangyuanchen Liu
- Thomas Lord Dept. of Mechanical Engineering and Materials Science, Duke University, Durham, NC 27708, USA
| | - Kevin Wang
- Dept. of Aerospace and Ocean Engineering, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA
| | - John Dolbow
- Thomas Lord Dept. of Mechanical Engineering and Materials Science, Duke University, Durham, NC 27708, USA
| | - Junjie Yao
- Dept. of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - Pei Zhong
- Thomas Lord Dept. of Mechanical Engineering and Materials Science, Duke University, Durham, NC 27708, USA.
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Fu L, Liang XX, Wang S, Wang S, Wang P, Zhang Z, Wang J, Vogel A, Yao C. Laser induced spherical bubble dynamics in partially confined geometry with acoustic feedback from container walls. ULTRASONICS SONOCHEMISTRY 2023; 101:106664. [PMID: 37931344 PMCID: PMC10633529 DOI: 10.1016/j.ultsonch.2023.106664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/09/2023] [Accepted: 10/26/2023] [Indexed: 11/08/2023]
Abstract
We investigated laser-induced cavitation dynamics in a small container with elastic thin walls and free or partially confined surface both experimentally and by numerical investigations. The cuvette was only 8-25 times larger than the bubble in its center. The liquid surface was either free, or two thirds were confined by a piston-shaped pressure transducer. Different degrees of confinement were realized by filling the liquid up to the transducer surface or to the top of the cuvette. For reference, some experiments were performed in free liquid. We recorded the bubble dynamics simultaneously by high-speed photography, acoustic measurements, and detection of probe beam scattering. Simultaneous single-shot recording of radius-time curves and oscillation times enabled to perform detailed investigations of the bubble dynamics as a function of bubble size, acoustic feedback from the elastic walls, and degree of surface confinement. The bubble dynamics was numerically simulated using a Rayleigh-Plesset model extended by terms describing the acoustically mediated feedback from the bubble's environment. Bubble oscillations were approximately spherical as long as no secondary cavitation by tensile stress occurred. Bubble expansion was always similar to the dynamics in free liquid, and the environment influenced mainly the collapse phase and subsequent oscillations. For large bubbles, strong confinement led to a slight reduction of maximum bubble size and to a pronounced reduction of the oscillation time, and both effects increased with bubble size. The joint action of breakdown-induced shock wave and bubble expansion excites cuvette wall vibrations, which produce alternating pressure waves that are focused onto the bubble. This results in a prolongation of the collapse phase and an enlargement of the second oscillation, or in time-delayed re-oscillations. The details of the bubble dynamics depend in a complex manner on the degree of surface confinement and on bubble size. Numerical simulations of the first bubble oscillation agreed well with experimental data. They suggest that the alternating rarefaction/compression waves from breakdown-induced wall vibrations cause a prolongation of the first oscillation. By contrast, liquid mass movement in the cuvette corners result in wall vibrations causing late re-oscillations. The strong and rich interaction between the bubble and its surroundings may be relevant for a variety of applications such as intraluminal laser surgery and laser-induced cavitation in microfluidics.
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Affiliation(s)
- Lei Fu
- Institute of Biomedical Photonics and Sensing, Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi' an 710049, China; Institute of Biomedical Optics, University of Luebeck, 23562 Luebeck, Germany
| | - Xiao-Xuan Liang
- Institute of Biomedical Optics, University of Luebeck, 23562 Luebeck, Germany
| | - Sijia Wang
- Institute of Biomedical Photonics and Sensing, Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi' an 710049, China
| | - Siqi Wang
- Zunyi Medical University, Zhuhai Campus, Zhuhai 519041, China
| | - Ping Wang
- Institute of Biomedical Photonics and Sensing, Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi' an 710049, China; State Key Laboratory of Transient Optics and Photonics, Chinese Academy of Sciences, Xi'an 710119, Shaanxi, China
| | - Zhenxi Zhang
- Institute of Biomedical Photonics and Sensing, Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi' an 710049, China
| | - Jing Wang
- Institute of Biomedical Photonics and Sensing, Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi' an 710049, China
| | - Alfred Vogel
- Institute of Biomedical Optics, University of Luebeck, 23562 Luebeck, Germany.
| | - Cuiping Yao
- Institute of Biomedical Photonics and Sensing, Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi' an 710049, China.
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Ventimiglia E, Robesti D, Bevilacqua L, Tondelli E, Oliva I, Orecchia L, Juliebø-Jones P, Pietropaolo A, De Coninck V, Esperto F, Tailly T, Ferretti S, Gauhar V, Somani B, Villa L, Keller EX, Salonia A, Traxer O, Kartalas Goumas I. What to expect from the novel pulsed thulium:YAG laser? A systematic review of endourological applications. World J Urol 2023; 41:3301-3308. [PMID: 37682286 DOI: 10.1007/s00345-023-04580-z] [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: 07/10/2023] [Accepted: 08/11/2023] [Indexed: 09/09/2023] Open
Abstract
INTRODUCTION Several preclinical studies about a novel pulsed-thulium:yttrium-aluminum-garnet (p-Tm:YAG) device have been published, demonstrating its possible clinical relevance. METHODS We systematically reviewed the reality and expectations for this new p-Tm:YAG technology. A PubMed, Scopus and Embase search were performed. All relevant studies and data identified in the bibliographic search were selected, categorized, and summarized. RESULTS Tm:YAG is a solid state diode-pumped laser that emits at a wavelength of 2013 nm, in the infrared spectrum. Despite being close to the Ho:YAG emission wavelength (2120 nm), Tm:YAG is much closer to the water absorption peak and has higher absorption coefficient in liquid water. At present, there very few evaluations of the commercially available p-Tm:YAG devices. There is a lack of information on how the technical aspects, functionality and pulse mechanism can be maximized for clinical utility. Available preclinical studies suggest that p-Tm:YAG laser may potentially increase the ablated stone weight as compared to Ho:YAG under specific condition and similar laser parameters, showing lower retropulsion as well. Regarding laser safety, a preclinical study observed similar absolute temperature and cumulative equivalent minutes at 43° C as compared to Ho:YAG. Finally, laser-associated soft-tissue damage was assessed at histological level, showing similar extent of alterations due to coagulation and necrosis when compared with the other clinically relevant lasers. CONCLUSIONS The p-Tm:YAG appears to be a potential alternative to the Ho:YAG and TFL according to these preliminary laboratory data. Due to its novelty, further studies are needed to broaden our understanding of its functioning and clinical applicability.
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Affiliation(s)
- Eugenio Ventimiglia
- Division of Experimental Oncology/Unit of Urology, URI-Urological Research Institute, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Via Olgettina 60, 20132, Milan, Italy.
- Young Academic Urologists (YAU), Urolithiasis and Endourology Working Party, Arnhem, The Netherlands.
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France.
| | - Daniele Robesti
- Division of Experimental Oncology/Unit of Urology, URI-Urological Research Institute, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Via Olgettina 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Luigi Bevilacqua
- Department of Urology, Istituto Clinico Beato Matteo, Vigevano, Italy
| | - Elena Tondelli
- Department of Urology, Istituto Clinico Beato Matteo, Vigevano, Italy
| | - Isabella Oliva
- Department of Urology, Istituto Clinico Beato Matteo, Vigevano, Italy
| | - Luca Orecchia
- Department of Urology, Istituto Clinico Beato Matteo, Vigevano, Italy
| | - Patrick Juliebø-Jones
- Young Academic Urologists (YAU), Urolithiasis and Endourology Working Party, Arnhem, The Netherlands
- Department of Urology, Haukeland University Hospital, Bergen, Norway
| | - Amelia Pietropaolo
- Young Academic Urologists (YAU), Urolithiasis and Endourology Working Party, Arnhem, The Netherlands
- Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, UK
| | - Vincent De Coninck
- Young Academic Urologists (YAU), Urolithiasis and Endourology Working Party, Arnhem, The Netherlands
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Department of Urology, AZ Klina, Brasschaat, Belgium
| | - Francesco Esperto
- Young Academic Urologists (YAU), Urolithiasis and Endourology Working Party, Arnhem, The Netherlands
- Department of Urology, University of Rome, Campus Bio-medico, Rome, Italy
| | - Thomas Tailly
- Department of Urology, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Stefania Ferretti
- Urology Department, Hospital and University of Modena, Modena, Italy
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Bhaskar Somani
- Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, UK
| | - Luca Villa
- Division of Experimental Oncology/Unit of Urology, URI-Urological Research Institute, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - Etienne Xavier Keller
- Young Academic Urologists (YAU), Urolithiasis and Endourology Working Party, Arnhem, The Netherlands
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URI-Urological Research Institute, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - Olivier Traxer
- Sorbonne Universite, 27063, GRC#20 Lithiase Urinaire, Hôpital Tenon, Paris, Île-de-France, France
| | - Ioannis Kartalas Goumas
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
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Houlihan I, Kang B, De S, Krishna V. Photonic Lithotripsy: Near-Infrared Laser Activated Nanomaterials for Kidney Stone Comminution. NANO LETTERS 2023; 23:5981-5988. [PMID: 37358929 PMCID: PMC10348310 DOI: 10.1021/acs.nanolett.3c01166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/20/2023] [Indexed: 06/28/2023]
Abstract
Near-infrared activated nanomaterials have been reported for biomedical applications ranging from photothermal tumor destruction to biofilm eradication and energy-gated drug delivery. However, the focus so far has been on soft tissues, and little is known about energy delivery to hard tissues, which have thousand-fold higher mechanical strength. We present photonic lithotripsy with carbon and gold nanomaterials for fragmenting human kidney stones. The efficacy of stone comminution is dependent on the size and photonic properties of the nanomaterials. Surface restructuring and decomposition of calcium oxalate to calcium carbonate support the contribution of photothermal energy to stone failure. Photonic lithotripsy has several advantages over current laser lithotripsy, including low operating power, noncontact laser operation (distances of at least 10 mm), and ability to break all common stones. Our observations can inspire the development of rapid, minimally invasive techniques for kidney stone treatment and extrapolate to other hard tissues such as enamel and bone.
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Affiliation(s)
- Ian Houlihan
- Biomedical
Engineering, Lerner Research Institute,
Cleveland Clinic, Cleveland Ohio 44195, United States
| | - Benjamin Kang
- Biomedical
Engineering, Lerner Research Institute,
Cleveland Clinic, Cleveland Ohio 44195, United States
| | - Smita De
- Urology, Glickman
Urology and Kidney Institute, Cleveland Clinic, Cleveland Ohio 44195, United States
- Urology,
Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland Ohio 44106, United States
| | - Vijay Krishna
- Biomedical
Engineering, Lerner Research Institute,
Cleveland Clinic, Cleveland Ohio 44195, United States
- Biomedical
Engineering, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland Ohio 44106, United States
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González-Sierra NE, Perez-Corte JM, Padilla-Martinez JP, Cruz-Vanegas S, Bonfadini S, Storti F, Criante L, Ramos-García R. Bubble dynamics and speed of jets for needle-free injections produced by thermocavitation. JOURNAL OF BIOMEDICAL OPTICS 2023; 28:075004. [PMID: 37484974 PMCID: PMC10362157 DOI: 10.1117/1.jbo.28.7.075004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/11/2023] [Accepted: 06/02/2023] [Indexed: 07/25/2023]
Abstract
Significance The number of injections administered has increased dramatically worldwide due to vaccination campaigns following the COVID-19 pandemic, creating a problem of disposing of syringes and needles. Accidental needle sticks occur among medical and cleaning staff, exposing them to highly contagious diseases, such as hepatitis and human immunodeficiency virus. In addition, needle phobia may prevent adequate treatment. To overcome these problems, we propose a needle-free injector based on thermocavitation. Aim Experimentally study the dynamics of vapor bubbles produced by thermocavitation inside a fully buried 3D fused silica chamber and the resulting high-speed jets emerging through a small nozzle made at the top of it. The injected volume can range from ∼ 0.1 to 2 μ L per shot. We also demonstrate that these jets have the ability to penetrate agar skin phantoms and ex-vivo porcine skin. Approach Through the use of a high-speed camera, the dynamics of liquid jets ejected from a microfluidic device were studied. Thermocavitation bubbles are generated by a continuous wave laser (1064 nm). The 3D chamber was fabricated by ultra-short pulse laser-assisted chemical etching. Penetration tests are conducted using agar gels (1%, 1.25%, 1.5%, 1.75%, and 2% concentrations) and porcine tissue as a model for human skin. Result High-speed camera video analysis showed that the average maximum bubble wall speed is about 10 to 25 m/s for almost any combination of pump laser parameters; however, a clever design of the chamber and nozzle enables one to obtain jets with an average speed of ∼ 70 m / s . The expelled volume per shot (0.1 to 2 μ l ) can be controlled by the pump laser intensity. Our injector can deliver up to 20 shots before chamber refill. Penetration of jets into agar of different concentrations and ex-vivo porcine skin is demonstrated. Conclusions The needle-free injectors based on thermocavitation may hold promise for commercial development, due to their cost and compactness.
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Affiliation(s)
| | - José Manuel Perez-Corte
- Instituto Nacional de Astrofísica, Óptica y Electrónica, Coordinación de Óptica, Puebla, México
| | | | - Samuel Cruz-Vanegas
- Instituto Nacional de Astrofísica, Óptica y Electrónica, Coordinación de Óptica, Puebla, México
| | - Silvio Bonfadini
- Istituto Italiano di Tecnologia, Center for Nano Science and Technology, Milano, Italy
| | - Filippo Storti
- Istituto Italiano di Tecnologia, Center for Nano Science and Technology, Milano, Italy
- Politecnico di Milano, Department of Physics, Milano, Italy
| | - Luigino Criante
- Istituto Italiano di Tecnologia, Center for Nano Science and Technology, Milano, Italy
| | - Rubén Ramos-García
- Instituto Nacional de Astrofísica, Óptica y Electrónica, Coordinación de Óptica, Puebla, México
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Kaygısız O, Aydın YM, Çiçek MÇ, Polat R, Coşkun B, Ocakoğlu G, Kılıçarslan H. The predictive factors that total laser energy consumed during retrograde intrarenal surgery (RIRS): stone area and density. Lasers Med Sci 2023; 38:128. [PMID: 37233820 DOI: 10.1007/s10103-023-03792-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 05/08/2023] [Indexed: 05/27/2023]
Abstract
Holmium: YAG (Ho: YAG) laser lithotripsy with flexible ureterorenoscopy can be used with high stone-free and low complication rates for renal stones. This study aimed to determine the factors affecting the total laser energy in cases with provided stone-free status after a single session of retrograde intrarenal surgery (RIRS). Data of 222 patients who underwent RIRS between October 2017 and March 2020 were evaluated retrospectively. After exclusion criteria, the study was carried out with 184 stone-free cases. All cases were performed without using a ureteral access sheath (UAS), and dusting was preferred as the lithotripsy method. The effects of age, gender, body mass index (BMI), previous RIRS history, previous shock wave lithotripsy (SWL) history, stone localization, number of stones, stone surface area, and stone density on total laser energy were analyzed. There was no significant correlation between total laser energy with gender, BMI, previous RIRS history, previous SWL history, stone localization, and the number of stones (p:0.347, p:0.482, p:0.119, p:0.167, p:0.907, p:0.933 respectively). There was a significant correlation between age and total laser energy (p = 0.032), but it was not observed when the effect of the stone surface area was removed (p = 0.354). There were significant correlations between total laser energy and stone surface area, stone density, and total laser time (p<0.001, p<0.001, and p <0.001, respectively). Stone area and stone density affect the total energy consumed during laser lithotripsy. Urologists should consider the stone area, stone density, and the power of the laser device to determine which surgical technic to prefer.
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Affiliation(s)
- Onur Kaygısız
- Department of Urology, Bursa Uludag University, Bursa, Turkey
| | | | | | - Rıdvan Polat
- Department of Urology, Bursa Uludag University, Bursa, Turkey
| | - Burhan Coşkun
- Department of Urology, Bursa Uludag University, Bursa, Turkey
| | - Gökhan Ocakoğlu
- Department of Biostatistics, Bursa Uludag University, Bursa, Turkey
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Nguyen D. Laser absorption coefficient of thulium fiber laser and holmium Yag laser: in what scale. World J Urol 2023; 41:1207-1208. [PMID: 36877267 DOI: 10.1007/s00345-023-04331-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 02/05/2023] [Indexed: 03/07/2023] Open
Affiliation(s)
- Dong Nguyen
- Binh Dan Hospital, Ho Chi Minh City, Viet Nam.
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11
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Xiang G, Li D, Chen J, Mishra A, Sankin G, Zhao X, Tang Y, Wang K, Yao J, Zhong P. Dissimilar cavitation dynamics and damage patterns produced by parallel fiber alignment to the stone surface in holmium:yttrium aluminum garnet laser lithotripsy. PHYSICS OF FLUIDS (WOODBURY, N.Y. : 1994) 2023; 35:033303. [PMID: 36896246 PMCID: PMC9986958 DOI: 10.1063/5.0139741] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/09/2023] [Indexed: 06/18/2023]
Abstract
Recent studies indicate that cavitation may play a vital role in laser lithotripsy. However, the underlying bubble dynamics and associated damage mechanisms are largely unknown. In this study, we use ultra-high-speed shadowgraph imaging, hydrophone measurements, three-dimensional passive cavitation mapping (3D-PCM), and phantom test to investigate the transient dynamics of vapor bubbles induced by a holmium:yttrium aluminum garnet laser and their correlation with solid damage. We vary the standoff distance (SD) between the fiber tip and solid boundary under parallel fiber alignment and observe several distinctive features in bubble dynamics. First, long pulsed laser irradiation and solid boundary interaction create an elongated "pear-shaped" bubble that collapses asymmetrically and forms multiple jets in sequence. Second, unlike nanosecond laser-induced cavitation bubbles, jet impact on solid boundary generates negligible pressure transients and causes no direct damage. A non-circular toroidal bubble forms, particularly following the primary and secondary bubble collapses at SD = 1.0 and 3.0 mm, respectively. We observe three intensified bubble collapses with strong shock wave emissions: the intensified bubble collapse by shock wave, the ensuing reflected shock wave from the solid boundary, and self-intensified collapse of an inverted "triangle-shaped" or "horseshoe-shaped" bubble. Third, high-speed shadowgraph imaging and 3D-PCM confirm that the shock origins from the distinctive bubble collapse form either two discrete spots or a "smiling-face" shape. The spatial collapse pattern is consistent with the similar BegoStone surface damage, suggesting that the shockwave emissions during the intensified asymmetric collapse of the pear-shaped bubble are decisive for the solid damage.
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Affiliation(s)
- Gaoming Xiang
- Thomas Lord Department of Mechanical and Materials Science, Duke University, Durham, North Carolina 27708, USA
| | - Daiwei Li
- Department of Biomedical Engineering, Duke University, Durham, North Carolina 27708, USA
| | - Junqin Chen
- Thomas Lord Department of Mechanical and Materials Science, Duke University, Durham, North Carolina 27708, USA
| | - Arpit Mishra
- Thomas Lord Department of Mechanical and Materials Science, Duke University, Durham, North Carolina 27708, USA
| | - Georgy Sankin
- Thomas Lord Department of Mechanical and Materials Science, Duke University, Durham, North Carolina 27708, USA
| | - Xuning Zhao
- Department of Aerospace and Ocean Engineering, Virginia Polytechnic Institute and State University, Blacksburg, Virginia 24061, USA
| | - Yuqi Tang
- Department of Biomedical Engineering, Duke University, Durham, North Carolina 27708, USA
| | - Kevin Wang
- Department of Aerospace and Ocean Engineering, Virginia Polytechnic Institute and State University, Blacksburg, Virginia 24061, USA
| | - Junjie Yao
- Department of Biomedical Engineering, Duke University, Durham, North Carolina 27708, USA
| | - Pei Zhong
- Thomas Lord Department of Mechanical and Materials Science, Duke University, Durham, North Carolina 27708, USA
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Tokas T, Rice P, Seitz C, Gauhar V, Somani B. Temperature change during laser upper-tract endourological procedures: current evidence and future perspective. Curr Opin Urol 2023; 33:108-115. [PMID: 36226721 DOI: 10.1097/mou.0000000000001048] [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: 02/01/2023]
Abstract
PURPOSE OF REVIEW To examine the most recent data on temperatures produced during laser lithotripsy and to provide several strategies for maintaining lower values and reducing the risk of complications during endourological treatment. RECENT FINDINGS Endourologists have access to a wide range of alternatives with the help of the holmium: yttrium-aluminum-garnet (Ho:YAG), thulium: yttrium-aluminum-garnet (TM:YAG), and thulium fiber laser (TFL) that compose a robust and adaptable laser lithotripsy armamentarium. Nevertheless, the threat of thermal damage increases as the local temperature rises with high total power. Most endourologists are not familiar with normal and pathological temperature ranges, how elevated temperatures affect perioperative problems, or how to avoid them. SUMMARY Increased temperatures experienced during laser lithotripsy may affect the course of the healing process. All lasers display a safe temperature profile at energies below 40 W. At equal power settings, Ho:YAG, Tm:YAG, and TFL lasers change the temperature comparably. Shorter on/off laser activation intervals, chilled irrigation, open irrigation systems, and UASs all aid in maintaining acceptable temperatures.
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Affiliation(s)
- Theodoros Tokas
- Department of Urology and Andrology, General Hospital Hall in Tirol, Hall in Tirol
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Austria
| | - Patrick Rice
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Christian Seitz
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
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Tissue thermal effect during lithotripsy and tissue ablation in endourology: a systematic review of experimental studies comparing Holmium and Thulium lasers. World J Urol 2023; 41:1-12. [PMID: 36515722 DOI: 10.1007/s00345-022-04242-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 12/02/2022] [Indexed: 12/15/2022] Open
Abstract
PURPOSE We looked into the Thulium: yttrium-aluminum-garnet (TM:YAG), Thulium Fibre laser (TFL) and Holmium: yttrium-aluminum-garnet (Ho:YAG) thermal laser tissue effect during lithotripsy and tissue ablation. METHODS We performed a PubMed, Scopus, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) search. RESULTS During lithotripsy, the Ho:YAG generated temperatures from 24 to 68.7 °C at powers < 20 W, the Tm:YAG from 43.7 °C at 30 W to 68 °C at powers < 20 W, and the TFL from 33 to 40.46 °C. During ablation, the Ho:YAG and continuous wave (cw) Tm:YAG tissue incision depths ranged from 0.08 to 2.26 mm, and from 0.28 to 3.22 mm. The Ho:YAG and Tm:YAG vaporization areas ranged from 0.044 to 0.078 mm2 and from 0.050 to 0.078 mm3 and their coagulation zones were 0.075 mm2 and 0.125 mm3 respectively. Ho:YAG and Tm:YAG laser damage zones ranged from 0.093 to 2.6 mm3 and from 0.207 to 0.98 mm3 respectively. The TFL incision depth ranged from 0.04 to 5.7 mm. The cw and SuperPulsed (SP) vaporization volumes ranged from 8 to 28.2 mm3/s and from 4 to 11 mm3/s. TFL coagulation depth and coagulation zone ranged from zero to 1.1 mm, 2.2 to 5.1 mm3 in SP mode and from 7.7 to 18.1 mm3 in cw mode. CONCLUSION During lithotripsy all lasers caused similar temperature changes and had a safe temperature profile at < 40 W. During tissue ablation, Ho:YAG has a deeper incision depth, while cwTm:YAG and cwTFL have broader coagulation and total laser areas.
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14
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Thulium Fiber Laser Behavior on Tissue During Upper- and Lower-Tract Endourology. Curr Urol Rep 2022; 23:271-278. [PMID: 36178569 DOI: 10.1007/s11934-022-01117-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW To present the latest evidence on thulium fiber laser (TFL) effects on tissue, during lithotripsy and ablation, emphasizing on generated temperatures, thermal damage thresholds, incision depths, areas of coagulation, and laser damage. RECENT FINDINGS Lasers are frequently utilized during endoscopic treatment of different urological conditions. The holmium:yttrium-aluminum-garnet (Ho:YAG) is most frequently used for various types of stones and soft tissue. The TFL has been recently introduced, offering several advantages. However, its activity on tissue during upper and lower tract endourology is poorly understood. At equivalent power settings, TFL and Ho:YAG generate similar temperature changes during lithotripsy. TFL has a shallow incision depth during tissue ablation. Compared to SP TFL, (cw) TFL results in a broader coagulation zone, whereas SP TFL gives of Ho:YAG-similar incision, and (cw) TFL offers a quick, precise cut with more carbonization.
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Zhang B, Zhang G. A novel integrated angioscope-laser system for atherosclerotic carotid artery occlusion: Feasibility and techniques. Front Surg 2022; 9:937492. [PMID: 36299568 PMCID: PMC9589886 DOI: 10.3389/fsurg.2022.937492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Atherosclerotic extracranial carotid artery stenosis accounts for about 20%-30% of all strokes, which is one of the leading causes of adult morbidity and mortality. Although carotid endarterectomy (CEA) is still the mainly operational manner for atherosclerotic carotid artery stenosis/occlusion (ACAS/ACAO), and carotid angioplasty and stenting (CAS) have been used as an alternative, both CEA and CAS have limitations of their own, such as extensive invasiveness and in-stent restenosis. Methods In this study we established a novel interventional system in vitro to take advantage of both CEA and CAS. Twenty consecutive carotid atherosclerotic plaques were harvested from the patients who underwent CEA. The plaques were randomized into two groups and inserted into the pruned and sutured descending aortas of the swine in vitro. The ZebraScope™ was modified with a protective device on its flexible tip, so that the plaque could be dissected from the wall of parent carotid artery and ablated completely without damage to the carotid artery. The holmium:YAG (Ho:YAG) and thulium fiber laser (TFL) generators were alternately used when needed. Results All the carotid atherosclerotic plaques were completely ablated by Ho:YAG laser and/or TFL. The Ho:YAG laser was more effective for the atherosclerotic plaques with severe calcification, while the TFL was more suitable for those with moderate calcification. There were still some thermal injury spots on the inner wall of the parent carotid artery caused by the laser in the non-protected group B. In the protected group A, on the contrary, there was no even a thermal injury spot was found on the relevant location except for one sample. The difference of ablating duration was statistically significant between group A (36.5 ± 4.79 min) and group B (63.4 ± 6.55 min) (P < 0.01). Conclusion According to our knowledge, this is the first attempt to ablate carotid atherosclerotic plaques assisted by the ZebraScope™ in vitro. The protective and dissecting device on the tip of the angioscope makes it safe and visible when the ablation is performed to carotid atherosclerotic plaques. The Ho:YAG laser and TFL are effective and safe for ablating the plaque in vitro.
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Affiliation(s)
- Boqian Zhang
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guiyun Zhang
- Department of Neurovasclar Intervention and Neurosurgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China,Correspondence: Guiyun Zhang
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The Effects of Scanning Speed and Standoff Distance of the Fiber on Dusting Efficiency during Short Pulse Holmium: YAG Laser Lithotripsy. J Clin Med 2022; 11:jcm11175048. [PMID: 36078979 PMCID: PMC9457447 DOI: 10.3390/jcm11175048] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/21/2022] [Accepted: 08/25/2022] [Indexed: 11/16/2022] Open
Abstract
To investigate the effects of fiber lateral scanning speed across the stone surface (vfiber) and fiber standoff distance (SD) on dusting efficiency during short pulse holmium (Ho): YAG laser lithotripsy (LL), pre-soaked BegoStone samples were treated in water using 0.2 J/20 Hz at SD of 0.10~0.50 mm with vfiber in the range of 0~10 mm/s. Bubble dynamics, pressure transients, and stone damage were analyzed. To differentiate photothermal ablation vs. cavitation damage, experiments were repeated in air, or in water with the fiber tip at 0.25 mm proximity from the ureteroscope end to mitigate cavitation damage. At SD = 0.10 mm, the maximum dusting efficiency was produced at vfiber = 3.5 mm/s, resulting in long (17.5 mm), shallow (0.15 mm), and narrow (0.4 mm) troughs. In contrast, at SD = 0.50 mm, the maximum efficiency was produced at vfiber = 0.5 mm/s, with much shorter (2.5 mm), yet deeper (0.35 mm) and wider (1.4 mm), troughs. With the ureteroscope end near the fiber tip, stone damage was significantly reduced in water compared to those produced without the ureteroscope. Under clinically relevant vfiber (1~3 mm/s), dusting at SD = 0.5 mm that promotes cavitation damage may leverage the higher frequency of the laser (e.g., 40 to 120 Hz) and, thus, significantly reduces the procedure time, compared to at SD = 0.1 mm that promotes photothermal ablation. Dusting efficiency during short pulse Ho: YAG LL may be substantially improved by utilizing an optimal combination of vfiber, SD, and frequency.
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Lange B, Ozimek T, Wießmeyer JR, Kramer M, Merseburger A, Brinkmann R. Theoretical and experimental evaluation of the distance dependence of fiber-based fluorescence and reflection measurements for laser lithotripsy. Biomed Phys Eng Express 2022; 8. [PMID: 35858536 DOI: 10.1088/2057-1976/ac82c7] [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: 02/28/2022] [Accepted: 07/20/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES In laser lithotripsy, a green aiming beam overlying the infrared (IR) treatment radiation gives rise to reflection and fluorescence signals that can be measured via the treatment fiber. While stone autofluorescence is used for target detection, the condition of the fiber can be assessed based on its Fresnel reflection. For good applicability, fluorescence detection of stones should work even when the stone and fiber are not in direct contact. Fiber breakage detection, on the other hand, can be falsified if surfaces located in front of the fiber reflect light from the aiming laser back into it. For both applications, therefore, a fundamental investigation of the dependence of the signal amplitude on the distance between fiber and surface is important. METHODS Calculations of the signal drop of fluorescence or diffuse and specular reflection with increasing fiber distance were performed using ray tracing based on a simple geometric model for different fiber core diameters. Reflection signals from a mirror, diffuse reflector, human calculi, and porcine renal tissue placed in water were measured at varying distances (0 - 5 mm). For human calculi, fluorescence signals were recorded simultaneously. RESULTS The calculations showed a linear signal decrease down to ~60% of the maximum signal (fiber in contact). The distance z at which the signal drops to for example 50% depends linearly on the diameter of the fiber core. For fibers used in lithotripsy and positioned in water,z50%ranges from 0.55 mm (200 µm core diameter) to 2.73 mm (1 mm core diameter). The calculations were in good agreement with the experimental results. CONCLUSIONS The autofluorescence signals of stones can be measured in non-contact mode. Evaluating the Fresnel signal of the end face of the fiber to detect breakage is possible unless the fiber is situated less than some millimeters to reflecting surfaces.
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Affiliation(s)
- Birgit Lange
- Medizinisches Laserzentrum Lübeck GmbH, Peter-Monnik-Weg 4, Lubeck, 23562, GERMANY
| | - Tomasz Ozimek
- Department of Urology, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, Lübeck, 23568, GERMANY
| | - Judith Riccarda Wießmeyer
- Department of Urology, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, Lübeck, 23568, GERMANY
| | - Mario Kramer
- Department of Urology, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, Lübeck, 23568, GERMANY
| | - Axel Merseburger
- Department of Urology, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, Lübeck, 23568, GERMANY
| | - Ralf Brinkmann
- Medizinisches Laserzentrum Lübeck GmbH, Peter-Monnik-Weg 4, Lubeck, 23562, GERMANY
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18
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Doizi S. Lasers for benign prostatic hyperplasia (hybrid, blue diode, TFL, Moses). Which one to choose? Curr Opin Urol 2022; 32:438-442. [PMID: 35674689 DOI: 10.1097/mou.0000000000000998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To present the evidence of latest developments of lasers for the surgical treatment of benign prostatic hyperplasia (BPH). We focused on recent advancements in Ho:YAG laser such as Moses technology, the Thulium Fiber Laser (TFL), the blue diode laser, and hybrid laser. RECENT FINDINGS Laser enucleation of prostate techniques using either Ho:YAG laser with the Moses technology and Moses 2.0, or TFL seem efficient and safe compared with the standard enucleation using Ho:YAG laser. Only in vitro studies evaluated the blue diode laser and hybrid laser (combination of a continuous wave TFL and blue diode laser). Blue diode laser showed intermediate incision depth and minimal coagulation depth compared with Ho:YAG laser and Super Pulse TFL. Hybrid laser showed deep incision depth and small coagulation area compared with Ho:YAG laser and continuous wave TFL. SUMMARY Surgical treatment of BPH using Moses technology, Moses 2.0, and TFL shows encouraging results comparable to the standard enucleation using Ho:YAG laser. Only in vitro data are currently available for blue diode laser and hybrid laser. Future well-designed studies comparing these technologies and evaluating them on specific risk groups of patients as well as the long-term durability of outcomes are needed.
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Affiliation(s)
- Steeve Doizi
- Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire.,Sorbonne Université, Service d'Urologie, AP-HP, Hôpital Tenon, Paris, France
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Chen J, Ho DS, Xiang G, Sankin G, Preminger GM, Lipkin ME, Zhong P. Cavitation Plays a Vital Role in Stone Dusting During Short Pulse Holmium:YAG Laser Lithotripsy. J Endourol 2022; 36:674-683. [PMID: 34806899 PMCID: PMC9145256 DOI: 10.1089/end.2021.0526] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objective: To investigate the mechanism of stone dusting in Holmium (Ho): YAG laser lithotripsy (LL). Materials and Methods: Cylindrical BegoStone samples (6 × 6 mm, H × D) were treated in water using a clinical Ho:YAG laser lithotripter in dusting mode (0.2-0.4 J with 70-78 μs in pulse duration, 20 Hz) at various fiber tip to stone standoff distances (SD = 0, 0.5, and 1 mm). Stone damage craters were quantified by optical coherence tomography and bubble dynamics were captured by high-speed video imaging. To differentiate the contribution of cavitation vs thermal ablation to stone damage, three additional experiments were performed. First, presoaked wet stones were treated in air to assess stone damage without cavitation. Second, the laser fiber was advanced at various offset distances (OSD = 0.25, 1, 2, 3, and 10 mm) from the tip of a flexible ureteroscope to alter the dynamics of bubble collapse. Third, stones were treated with parallel fiber to minimize photothermal damage while isolating the contribution of cavitation to stone damage. Results: Treatment in water resulted in 2.5- to 90-fold increase in stone damage compared with those produced in air where thermal ablation dominates. With the fiber tip placed at OSD = 0.25 mm, the collapse of the bubble was distracted away from the stone surface by the ureteroscope tip, leading to significantly reduced stone damage compared with treatment without the scope or with scope at large OSD of 3-10 mm. The average crater volume produced by parallel fiber orientation at 0.2 J after 100 pulses, where cavitation is the dominant mechanism of stone damage, was comparable with those produced by using perpendicular fiber orientation within SD = 0.25-1 mm. Conclusion: Cavitation plays a dominant role over photothermal ablation in stone dusting during short pulse Ho:YAG LL when 10 or more pulses are delivered to the same location.
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Affiliation(s)
- Junqin Chen
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
| | - Derek S. Ho
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
| | - Gaoming Xiang
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
| | - Georgy Sankin
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
| | - Glenn M. Preminger
- Division of Urology, Duke University Medical Center, Durham, North Carolina, USA
| | - Michael E. Lipkin
- Division of Urology, Duke University Medical Center, Durham, North Carolina, USA
| | - Pei Zhong
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA.,Address correspondence to: Pei Zhong, PhD, Department of Mechanical Engineering and Materials Science, Duke University, Box 90300, Durham, NC 27708, USA
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Patil A, Reddy M NK, Shah D, Singh A, Ganpule A, Sabnis RB, Desai M. Holmium with MOSES technology or Thulium Fiber Laser in Miniperc with suction - A new curiosity. J Endourol 2022; 36:1348-1354. [PMID: 35331003 DOI: 10.1089/end.2021.0915] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To present initial clinical comparison between high-power Holmium with MOSES technology(HPH-M) and Thulium Fiber laser(TFL) during mini-PCNL for renal calculi with specific emphasis on fragmentation efficiency, fragment size distribution and stone-free rates(SFR). MATERIAL AND METHODS Between Aug2018-Dec2019, we performed mini-PCNL for renal calculi <3cm using HPH-M(Lumenis, Israel) or TFL(Urolase SP, IPG Photonics). Data was collected prospectively in our institutional stone registry. Propensity score matching(1:1) was performed using stone size and density as predictors resulting in matched cohort of 51 patients in each group. MiniPCNL with active suction sheath was standard across all patients. Primary end-point was SFR at immediate post-procedure and 1month using CT/Xray KUB. Stone fragments were retrieved and segregated to assess proportion of dust(<1mm), small(1-3mm) and large(>3mm) fragments. RESULT Both groups were comparable in terms of stone size(p=0.74), volume(p=0.17) and density(p=0.69). SFR at 48 hours was 78.43% in HPH-M group and 68.63 % in TFL group. Patients with residual fragments were completely clear at 1month. Lasing time(678.6v/s551.95 seconds;p=0.17), stone fragmentation rate(4.6v/s5.2 mm3/s;p=0.23) and total laser energy(21.9v/s16.3KJ;p=0.09) were comparable in both arms. Both groups produced similar dusting (46.8v/s46.41%;p=0.93). TFL produced a greater proportion of fragments >3mm(36%v/s22.68%, p=0.002). On sub-set analysis based on stone density, all outcome parameters were comparable except a shorter total operative time with TFL (p=<0.05). CONCLUSION HPH-M and TFL showed similar SFR. Within constraints of the laser fiber size and energy settings, both modalities were equivalent in terms of fragmentation efficiency and proportion of dusting across stone densities.
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Affiliation(s)
- Abhijit Patil
- Muljibhai Patel Urological Hospital, 29025, Urology, Muljibhai Patel Urological Hospital, V V Desai Road, Nadiad, India, 387001;
| | - Naveen Kumar Reddy M
- Muljibhai Patel Urological Hospital, 29025, Urology, Dr V V Desai Road, Nadiad, Gujarat, India, 387001;
| | - Darshit Shah
- Muljibhai Patel Urological Hospital Department of Urology, 537606, Nadiad, Gujarat, India;
| | - Abhishek Singh
- Muljibhai Patel Urological Hospital, 29025, Urology, Nadiad, Gujarat, India;
| | - Arvind Ganpule
- Muljibhai Patel Urological Hospital, 29025, Department of Urology, Nadiad, Gujarat, India;
| | - R B Sabnis
- Muljibhai Patel Urological Hospital, 29025, Urology, Nadiad, Gujarat, India;
| | - Mahesh Desai
- Muljibhai Patel Urological Hospital, 29025, Urology, Nadiad, Gujarat, India;
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21
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Belle JD, Chen R, Srikureja N, Amasyali A, Keheila M, Baldwin DD. Does the Novel Thulium Fiber Laser Have a Higher Risk of Urothelial Thermal Injury than the Conventional Holmium Laser in an In Vitro Study? J Endourol 2022; 36:1249-1254. [PMID: 35302382 DOI: 10.1089/end.2021.0842] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION AND OBJECTIVE The novel thulium fiber laser (TFL) has been shown to break stones more rapidly than the holmium:YAG laser (HL). However, some evidence suggests that the TFL generates more heat. The purpose of this study is to compare ureteral temperatures generated by these lasers during ureteroscopic laser lithotripsy in a benchtop model. METHODS A 1-cm BegoStone was manually impacted in the proximal ureter of a 3D printed kidney-ureter model and submerged in 35.5°C saline. Lithotripsy was performed using a 7.6 French flexible ureteroscope and a 200µm laser fiber without a ureteral access sheath. The Dornier 30W HL, Olympus 100W HL, and Olympus 60W TFL were compared. A needle thermocouple to measure temperature was inserted 2 mm from the laser tip. Irrigation was maintained at 35cc/min at room temperature using the Thermedx FluidSmart System. Intraluminal temperature was continuously recorded for 60 seconds of laser activation. 5 trials were performed for each of 4 different power settings: 3.6, 10, 20, and 30 Watts. ANOVA and Mann-Whitney U tests were performed with p<0.05 considered significant. RESULTS Intraureteral fluid temperature increased as laser power settings increased for all lasers (p<0.05). The TFL generated higher average ureteral fluid temperatures than the Dornier and Empower HL at all power settings tested (p<0.001). The maximum temperature for the TFL was higher than the Dornier and Empower HL at all power settings tested (p<0.001), except at 20W with the Empower HL. At 30W, the TFL exceeded 43°C, the threshold for tissue damage. CONCLUSIONS The TFL generated more heat at all settings tested. Supraphysiologic ureteral temperatures may be generated with extended use at high energy settings and low irrigation rates. Understanding the heat generation properties of both lasers could help improve the safety of ureteroscopic laser lithotripsy.
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Affiliation(s)
- Joshua D Belle
- Loma Linda University Medical Center, 23335, Urology, Loma Linda, California, United States;
| | - Ricky Chen
- Loma Linda University Medical Center, 23335, Urology, Loma Linda, California, United States;
| | - Nathaniel Srikureja
- Loma Linda University Medical Center, 23335, Urology, Loma Linda, California, United States;
| | - Akin Amasyali
- Loma Linda University Medical Center, 23335, Urology, Loma Linda, California, United States;
| | - Mohamed Keheila
- Loma Linda University Medical Center, Urology, 24920 Mound street, Loma Linda, California, United States, 92350;
| | - D Duane Baldwin
- Loma Linda University Medical Center, Urology, 11234 Anderson Street, Room A560, Loma Linda, California, United States, 92354;
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Taratkin M, Azilgareeva C, Cacciamani GE, Enikeev D. Thulium fiber laser in urology: physics made simple. Curr Opin Urol 2022; 32:166-172. [PMID: 34954703 DOI: 10.1097/mou.0000000000000967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW In this narrative review, we will focus on a novel thulium fiber laser's physical properties in terms of its clinical applicability. RECENT FINDINGS TFL has successfully moved forward from the preclinical trials into clinical practice and now is being widely used in clinics around the world. The available data suggest that the device effectively operates in soft tissues - benign prostate hyperplasia (BPH) and bladder tumors, as well as in lithotripsy. Also, the first promising results were obtained from laparoscopic surgery showing its possible applicability in the management of renal cell carcinoma. The constructional changes in fiber laser's design, lead to alteration of laser-tissue interactions, which resulted in clinical advantages of the device. Yet, the exact mechanism often is considered complex for understanding. With this work, we are aiming to build a bridge between biophysics and clinical practice and give a simple explanation of how the devices is working and why the knowledge of it is important for a clinician. SUMMARY The more effective wavelength (closer to the water absorption peak), favorable beam profile, different modes of action allowing to decrease carbonization on one hand and retropulsion on the other, all this makes TFL an evolution in urologic surgery. Further trials investigating on the possible pros and cons of the device are awaited.
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Affiliation(s)
- Mark Taratkin
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Camilla Azilgareeva
- International School 'Medicine of the Future', Sechenov University, Moscow, Russia
| | - Giovanni E Cacciamani
- USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, Keck School of Medicine
- Artificial Intelligence Center at USC Urology, USC Institute of Urology, University of Southern California, Los Angeles, California, USA
| | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
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Kaygısız O, Yeni S, Turan L, Cicek MC, Coskun B, Kilicarslan H. Ureterorenoscopic lithotripsy for pediatric kidney stones using Holmium: YAG laser devices: 15 W versus 30 W. J Endourol 2022; 36:916-920. [PMID: 35166132 DOI: 10.1089/end.2021.0922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction We aimed to compare the effectiveness of 15Watt (W) and 30 W Holmium: yttrium-aluminum-garnet (Ho: YAG) laser devices used in the treatment of pediatric kidney stones. Methods: Eighty-six consecutive pediatric patients who underwent retrograde intrarenal surgery between February 2010 and August 2020 were enrolled in the study. After exclusion criteria, the data of 79 children were evaluated retrospectively. Patients were divided into two groups according to the laser device power 15W (Group 15: N=30) and 30W (Group 30: N=49). The groups were compared according to demographic, stone feature, and clinical efficacy. Results The age, gender, height, weight, stone characteristics were similar between the groups. The mean operation time was shorter in Group 30. The stone-free rate after the first RIRS session (SF1) was 66.7% in Group 15 and 83.3% in Group 30. SF1 rate after the first RIRS procedure for 20 mm or larger kidney stones was found 0% in Group 15 and 62.5% in Group 30. However, there was no statistically significant difference between the two groups in terms of stone-free rate. Conclusion: In pediatric kidney stone treatment, 30 W Ho:YAG laser devices should be preferred as they shorten the operation time compared to 15 W devices and provide final stone-free with fewer procedures, especially in large kidney stones.
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Affiliation(s)
- Onur Kaygısız
- Bursa Uludağ University, Faculty of Medicine, Urology, Bursa, Turkey;
| | - Sezgin Yeni
- Bursa Uludag University, 37523, Bursa Uludag University Faculty of Medicine Hospital, Department of Urology, Bursa, Turkey, 16059;
| | - Levent Turan
- Bursa Uludağ University, Faculty of Medicine, Urology, Bursa, Turkey;
| | | | - Burhan Coskun
- Bursa Uludag University, Faculty of Medicine, urology, Bursa, Turkey;
| | - Hakan Kilicarslan
- Bursa Uludag University, Faculty of Medicine, Urology, Bursa, Turkey;
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24
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Mahajan AD, Mahajan SA. Thulium fiber laser versus holmium:yttrium aluminum garnet laser for stone lithotripsy during mini-percutaneous nephrolithotomy: A prospective randomized trial. Indian J Urol 2022; 38:42-47. [PMID: 35136294 PMCID: PMC8796767 DOI: 10.4103/iju.iju_331_21] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 10/31/2021] [Accepted: 12/06/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION We aimed to evaluate the effectiveness and safety of the newly launched thulium fiber laser (TFL) with holmium laser lithotripsy in the miniaturized percutaneous nephrolithotomy (Miniperc) procedure for renal stones. METHODS The prospective study included patients with renal stones of size >1 cm to ≤3 cm. The patients who opted for extracorporeal shock wave lithotripsy, retrograde intrarenal surgeries, and stones >3 cm were excluded from the study. Demographics such as patient's age, sex, stone volume, and hardness were evaluated. The patients were randomized into holmium and TFL group for stone lithotripsy. Both the procedures were evaluated for stone disintegration time, operative time, hospital stay, intra- and postoperative complications, and stone-free rate. RESULTS A total of 125 patients with renal stones who underwent Miniperc were included in this study. The average size of the stone was comparable in both the groups (P = 0.053). The median stone disintegration time with holmium laser was 20 min 45 s and with TFL, it was 11 min 19 s (P < 0.001). The most common complications were Clavien grade I and II complications (P = 0.128). Prolonged postoperative hematuria was observed in the Thulium fiber laser group, which was conservatively managed. The stone-free rate with TFL (94.9%) was better than Holmium lithotripsy (90.9%). CONCLUSIONS The TFL has significant less stone disintegration time which effectively reduced the operative time of Miniperc procedure. The stone-free rate is better, but the incidence of self-limiting hematuria is higher with TFL as compared to Holmium laser.
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Affiliation(s)
- Abhay Dinkar Mahajan
- Department of Urology, Sai Urology Hospital, Aurangabad, Maharashtra, India,E-mail:
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25
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Jiang P, Peta A, Brevik A, Arada RB, Ayad M, Afyouni AS, Limfueco L, Nguyen N, Palma A, Patel RM, Landman J, Clayman R. Ex-vivo Renal Stone Dusting: Impact of Laser Modality, Ureteral Access Sheath, and Suction on Total Stone Clearance. J Endourol 2021; 36:499-507. [PMID: 34693735 DOI: 10.1089/end.2021.0544] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Conventional renal stone dusting is challenging; the holmium laser (Ho:YAG) and holmium with MOSES Effect (Ho:YAG-MOSES) fail to uniformly produce fragments <100 microns (i.e. dust). The superpulse thulium fiber laser (sTFL) may more effectively render uroliths into "dust," and may thus improve stone free rates. Accordingly, we performed ex-vivo evaluations with all three laser modalities, assessing stone fragments and stone clearance. METHODS Seventy-two ex-vivo porcine kidney-ureter models were divided into 12 groups of six: laser type (Ho:YAG, Ho:YAG-MOSES, sTFL), ureteroscope (URS) with and without applied suction, and presence or absence of a 14Fr ureteral access sheath (UAS). Calcium oxalate stones were pre-weighed and implanted into each kidney via a pyelotomy. Stones were treated at 16 watts using dusting settings of 0.4Jx40Hz (Ho:YAG) 0.2Jx80Hz (Ho:YAG-MOSES), and 0.2Jx80Hz (sTFL) for up to 20 minutes. No stone basketing was performed. Kidneys were bi-valved and residual fragments were collected, dried, weighed, and sieved to determine fragment size and stone clearance. RESULTS Initial stone mass (mg), procedure time (sec), and laser energy expenditure (kJ) were similar in all 12 groups. The greatest stone clearance was seen with sTFL+suction+UAS (94%) compared to a conventional technique (Ho:YAG+no suction+no UAS) (65%, p<0.01). The use of sTFL provided greater stone clearance than Ho:YAG or Ho:YAG-MOSES. Aspiration improved stone clearance for sTFL (p=0.01) but not for Ho:YAG or Ho:YAG-MOSES, consistent with the creation of smaller fragments with sTFL. Presence of a 14F UAS improved stone clearance in all scenarios (p<0.01). CONCLUSIONS In this ex-vivo study, stone clearance was optimized under the following conditions: sTFL laser, 14F ureteral access sheath, and aspiration. This combination resulted in 94% of stone fragments cleared; the 6% remaining fragments were all <2 mm. In all scenarios, deployment of a 14Fr UAS improved stone clearance.
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Affiliation(s)
- Pengbo Jiang
- University of California Irvine, 8788, Urology, 333 The City Blvd West, Suite 2100, Irvine, California, United States, 92868;
| | - Akhil Peta
- University of California Irvine, 8788, Urology, Irvine, California, United States;
| | - Andrew Brevik
- University of California Irvine, 8788, Urology, Irvine, California, United States;
| | - Raphael B Arada
- University of California Irvine Department of Urology, 481083, 101 The City Dr S, Orange, California, United States, 92868-2987;
| | - Maged Ayad
- University of California Irvine, 8788, Urology, 101 The City Drive S, Orange, California, United States, 92868;
| | - Andrew S Afyouni
- University of California Irvine, 8788, Urology, Irvine, California, United States;
| | - Luke Limfueco
- University of California Irvine School of Medicine, 12219, Urology, 333 City Blvd W Suite 2100, Orange, California, United States, 92868;
| | - Nicholas Nguyen
- University of California Irvine, 8788, Urology, 333 City Boulevard, Orange, California, United States, 92868;
| | - Anton Palma
- University of California Irvine, 8788, Institute for Clinical and Translational Science, Irvine, California, United States;
| | - Roshan M Patel
- University of California Irvine, 8788, Urology, Orange, California, United States;
| | - Jaime Landman
- University of California Irvine, 8788, Urology, Irvine, California, United States;
| | - Ralph Clayman
- University of California Irvine, 8788, Urology, Orange, California, United States;
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Temperature rise during ureteral laser lithotripsy: comparison of super pulse thulium fiber laser (SPTF) vs high power 120 W holmium-YAG laser (Ho:YAG). World J Urol 2021; 39:3951-3956. [PMID: 33604733 DOI: 10.1007/s00345-021-03619-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 01/30/2021] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The holmium-YAG (Ho:YAG) Laser system is the current gold standard for laser lithotripsy (LL). Super Pulse Thulium Fiber Laser (SPTF) has emerged as an effective alternative. We compared the temperature profile of both the 120 W Ho:YAG and the 60 W SPTF systems during ureteral lithotripsy. METHODS Antegrade ureteroscopy with LL was performed in ex-vivo porcine kidneys with 3 mm Begostones. Intra-ureteral temperature was measured using one probe proximal and one distal to the site of lithotripsy. LL was performed using a 200 μm core fiber at dusting (SPTF-0.1 J, 200 Hz, SP; Ho:YAG-0.3 J, 70 Hz, LP) and fragmenting (0.8 J, 8 Hz, SP for both) settings for 5 s. Fifteen repetitions were recorded for each laser at each setting. Tissue samples of the ureter were collected for histological analysis. RESULTS There was a rise in temperature at the site of lithotripsy using both systems at every setting evaluated. The median temperatures were greater for the SPTF on the fragmenting setting (33.3 °C vs 30.0 °C, p = 0.004). On the dusting setting, the median temperature was not statistically greater for Ho:YAG (40.6 °C vs 35.8 °C, p = 0.064), (Graphic 1). Histological analysis did not show any signs of injury or necrosis in any of the tested settings. CONCLUSION Higher power settings used for dusting have a higher temperature rise in the ureter during lasering. Median ureteral intra-luminal temperature rise during LL was equivalent during dusting and higher in the SPTF during fragmentation, but neither reached the threshold for thermal injury based on the duration of exposure.
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Doizi S, Germain T, Panthier F, Comperat E, Traxer O, Berthe L. Comparison of Holmium:YAG and Thulium Fiber lasers on soft tissue : an ex vivo study. J Endourol 2021; 36:251-258. [PMID: 34409842 DOI: 10.1089/end.2021.0263] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To assess the fiber-tissue interaction through ablation, coagulation, and carbonization characteristics of the Ho:YAG laser and Super Pulsed Thulium Fiber Laser (TFL) in a non-perfused porcine kidney model. To assess the degradation of laser fibers during soft tissue treatment. METHODS A 50W TFL generator was compared to a 120W Ho:YAG laser. The laser settings that can be set identically between the two lasers (pulse energy and frequency), and clinically relevant for prostate laser enucleation, were identified and used for tissue incisions on fresh non-frozen porcine kidneys. For each parameter were also tested the short, medium and long pulse durations for the Ho:YAG generator, and the different peak powers 150W, 250W and 500W for the TFL. Laser incisions were performed with 550μm stripped laser fiber fixed on a robotic arm at a distance of 0.1mm with the tissue surface and at a constant speed of 10mm/s. Histological analysis was then performed, evaluating: incision shape, incision depth and width, axial coagulation depth, presence of carbonization. Degradation of the laser fiber was defined as reduction of laser fiber tip length after laser activation. RESULTS Incision depths and areas of coagulation were greater with the Ho:YAG laser compared to the TFL. While no carbonization zone was found with the Ho:YAG laser, this was constant with the TFL. While a fiber tip degradation was constantly observed with Ho:YAG laser, except in the case of a long pulse duration and low pulse energy (0.2J), this was not the case with TFL. CONCLUSION TFL appears to be an efficient alternative to Ho:YAG laser for soft tissue surgery. The histological analysis found greater tissue penetration with the Ho:YAG laser and different coagulation properties between the two lasers. These results need to be investigated in vivo to assess the clinical impact of these differences and find the optimal settings for laser prostate enucleation.
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Affiliation(s)
- Steeve Doizi
- Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, F-75020 Paris, France. Sorbonne Université, Service d'Urologie, AP-HP, Hôpital Tenon, F-75020 Paris, France., Paris, France.,PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, 151 bd de l'Hôpital, F-75013 Paris, France, Paris, France;
| | - Thibault Germain
- Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, F-75020 Paris, France. Sorbonne Université, Service d'Urologie, AP-HP, Hôpital Tenon, F-75020 Paris, France., Paris, France;
| | - Frédéric Panthier
- Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, F-75020 Paris, France. Sorbonne Université, Service d'Urologie, AP-HP, Hôpital Tenon, F-75020 Paris, France., Paris, France.,Department of Urology, hôpital européen Georges-Pompidou, Paris-Descartes University, 20, rue Leblanc, 75015 Paris, France., Paris, France;
| | - Eva Comperat
- Sorbonne Université, Service d'Anatomopathologie, AP-HP, Hôpital Tenon, F-75020 Paris, France, Paris, France;
| | - Olivier Traxer
- Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, F-75020 Paris, France. Sorbonne Université, Service d'Urologie, AP-HP, Hôpital Tenon, F-75020 Paris, France., Paris, France;
| | - Laurent Berthe
- PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, 151 bd de l'Hôpital, F-75013 Paris, France, Paris, France;
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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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Castellani D, Corrales M, Lim EJ, Cracco C, Scoffone C, Teoh JYC, Traxer O, Gauhar V. The impact of lasers in percutaneous nephrolithotomy outcomes: results from a systematic review and meta-analysis of randomized comparative trials. J Endourol 2021; 36:151-157. [PMID: 34314230 DOI: 10.1089/end.2021.0507] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background Percutaneous nephrolithotomy (PCNL) is the first choice treatment of renal stones larger than 2 cm. We aimed to evaluate if lasers perform as equal as non-laser devices in patients with kidney stones candidate to PCNL. Materials and methods A comprehensive literature search was performed in MEDLINE via PubMed, Scopus and Cochrane Central Register of Controlled Trials (CENTRAL) to assess the differences in the perioperative course, incidence of postoperative complications, and stone free-rate (SFR) in patients with kidney stones undergoing laser versus non-laser PCNL in randomized studies. The incidences of complications were pooled using the Cochran-Mantel-Haenszel Method with the random effect model and expressed as Risk Ratios (RR), 95% Confidence Intervals (CI), and p-values. Surgical time and length of stay were pooled using the inverse variance of the mean difference (MD) with a random effect, 95% CI, and p-values. Analyses were two-tailed, with a significance set at p ≤0.05. Results Six papers including 732 patients (311 patients undergoing holmium laser and 421 non-laser PCNL) were included in meta-analysis. Surgical time and postoperative stay were shorter in the non-laser group (MD:11.14, 95% CI:2.32-19.96, p=0.002; MD:-0.81, 95%CI:-2.18-0.57 p=0.25, respectively). SFR was significantly higher in the non-laser group (RR:1.08, 95% CI:1.01-1.15, p=0.03). Patients undergoing laser PCNL had a non-significant higher risk of postoperative fever >38°C (RR:0.64, 95%CI: .31-1.30, p=0.22). Transfusion rate did not differ between the two groups (RR:1.02, 95% CI:0.50-2.11 p=0.95). The need for stent positioning due to urine extravasation was higher risk in the laser group but the difference did not reach significance (RR:0.49, 95% CI:0.17-1.41 p=0.19). Conclusions Non-laser PCNL showed better perioperative outcomes and SFR as compared to holmium laser PCNL.
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Affiliation(s)
- Daniele Castellani
- AOU Ospedali Riuniti di Ancona, 18494, via conca 71, Ancona, Italy, 60126;
| | - Mariela Corrales
- Hospital Tenon, 55705, Urology, 4 Rue de la Chine, Paris, Île-de-France, France, 75020;
| | - Ee Jean Lim
- Singapore General Hospital, Department of Urology, Academia Level 5, 20 College Rd, Singapore 169856, Singapore, Singapore, 169856;
| | - Cecilia Cracco
- San Luigi Hospital, University of Turin, Department of Urology, regione gonzole 10, Orbassano (Torino), Italy, 10043.,Ospedale Cottolengo, 46961, Department of Urology, via Cottolengo 9, Torino, Italy, 10152;
| | - Cesare Scoffone
- Cottolengo Hospital, Division of Urology, via Cottolengo 9, Torino, Torino, Italy, 10152;
| | - Jeremy Y C Teoh
- Prince of Wales Hospital, Surgery, 30-32 Ngan Shing Street, Shatin, New Territories., Hong Kong, Hong Kong;
| | - Olivier Traxer
- Tenon Hospital, Assitance Publique-Hopitaux De Paris. Pierre Et Marie Curie University, Paris 6, Urology, 4 rue de la Chine, Paris, France, 75020;
| | - Vineet Gauhar
- Ng Teng Fong General Hospital, 242949, Urology, Singapore, Singapore;
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Rice P, Somani BK. A Systematic Review of Thulium Fiber Laser: Applications and Advantages of Laser Technology in the Field of Urology. Res Rep Urol 2021; 13:519-527. [PMID: 34327179 PMCID: PMC8314925 DOI: 10.2147/rru.s233979] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/02/2021] [Indexed: 12/11/2022] Open
Abstract
Laser technology is widely used in urological surgery, from lithotripsy, prostate surgery to en-bloc resection of tumours. While Holmium:YAG has been widely employed over the last two decades, in recent years, there has been a surge of interest in Thulium Fiber Laser (TFL), which offers theoretical advantages of better water absorption and lower stone ablation thresholds. A systematic review was conducted to assess the evidence from clinical research on TFL's application for lithotripsy and prostate surgery. It identified 357 articles and 8 (1506 patients) were selected, of which 4 clinical studies each investigated TFL enucleation of prostate (ThuFLEP) and TFL lithotripsy. For flexible ureteroscopic lithotripsy (FURSL), stone ablation settings ranged from 0.1-4 J, and 7-300 Hz, mean operative time ranged from 23.4-39.8 minutes and lasing time ranged from 1.2-10 minutes. For stone dusting in percutaneous nephrolithotomy (PCNL), settings of 0.2 J and 125-200 Hz were found to be optimal. For ThuFLEP, all studies showed a significant improvement in IPSS (International Prostate Symptom Score), urinary flow rate (Qmax), quality of life measures, and post-void residual volume, with mean operative time ranging from 67-104.5 minutes. Our review shows that there is limited evidence on the use and clinical outcomes of TFL. ThuFLEP might suggest equivalence to the widely used HoLEP in the available evidence so far. TFL lithotripsy shows promising results but further prospective, randomized trials are required to properly assess its usability, clinical effectiveness and standardisation of the settings for successful adoption of the technology.
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Affiliation(s)
- Patrick Rice
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
- Manipal Academy of Higher Education, Manipal, India
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31
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Carrera RV, Randall JH, Garcia-Gil M, Knudsen BE, Chew BH, Thompson JA, Humphreys MR, Molina WR. Ureteroscopic Performance of High Power Super Pulse Thulium Fiber Laser for the Treatment of Urolithiasis: Results of the First Case Series in North America. Urology 2021; 153:87-92. [PMID: 33621583 DOI: 10.1016/j.urology.2020.12.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/30/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To report the first case series of ureterorenoscopy in North America using the High Power Super Pulse Thulium Fiber Laser for the treatment of upper urinary tract stones. METHODS After Institutional Review Board approval, a multicentric retrospective chart review of patients treated with the High Power Super Pulse Thulium Fiber Laser from October 2019 to March 2020 was conducted. Basic demographic information, pre-operative, and peri-operative data were recorded. RESULTS Seventy-six patients were included with a mean age of 60.9 ± 13.3 years. 118 stones were treated including 32 within the ureter, 49 in the lower pole, 37 in mid or upper poles. Dusting technique was commonly used (67.1%) with pulse frequencies up to 2400 Hz. Mean operative time was 59.4 ± 31.5 minutes. Mean laser time and total laser energy were 10.8 ± 14.1 minutes and 12.5 ± 19.1 KJ, respectively. Intraoperative complications were limited to 7 grade 1, 3 grade 2, and 1 grade 3 ureteral injuries and one case of renal collecting system bleeding that was adequately managed with laser coagulation settings (1J-20Hz). CONCLUSION This initial case series in North America of the High Power Super Pulse Thulium Fiber Laser is promising for the treatment of urolithiasis. Sub-200 μm fibers and dusting settings up to 2400 Hz were utilized successfully. No specific complications related to use of the laser were seen.
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Affiliation(s)
- Raphael V Carrera
- University of Kansas Medical Center, Department of Urology, Kansas City, KS, United States
| | - J Hogan Randall
- University of Kansas Medical Center, Department of Urology, Kansas City, KS, United States
| | - Maurilio Garcia-Gil
- The Ohio State University Wexner Medical Center, Department of Urology, Columbus, OH, United States
| | - Bodo E Knudsen
- The Ohio State University Wexner Medical Center, Department of Urology, Columbus, OH, United States
| | - Ben H Chew
- University of British Columbia, Department of Urologic Sciences, Vancouver, BC, Canada
| | - Jeffrey A Thompson
- Department of Biostatistics & Data Science, Kansas City, KS, United States
| | | | - Wilson R Molina
- University of Kansas Medical Center, Department of Urology, Kansas City, KS, United States.
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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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Taratkin M, Laukhtina E, Singla N, Tarasov A, Alekseeva T, Enikeev M, Enikeev D. How Lasers Ablate Stones: In Vitro Study of Laser Lithotripsy (Ho:YAG and Tm-Fiber Lasers) in Different Environments. J Endourol 2021. [DOI: 10.1089/end.2019.0441 10.1089/end.2019.0441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mark Taratkin
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Ekaterina Laukhtina
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Nirmish Singla
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Alexander Tarasov
- Institute of Linguistics and Intercultural Communication, Sechenov University, Moscow, Russia
| | - Tatyana Alekseeva
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Mikhail Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
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Liu M, Peng Y, Wang Z, Li L, Ming S, Fang Z, Dong H, Li R, Gao X. Ablation Efficiency of a Novel Thulium Fiber Laser: An In Vitro Study on Laser Setting and Fiber Usage. J Endourol 2021; 35:1211-1216. [PMID: 33403925 DOI: 10.1089/end.2020.1116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction: To investigate the ablation efficiency of super-pulse thulium fiber laser (SPTFL) with different laser settings and fiber usage. Materials and Methods: SPTFL machine was attached with different fibers. Artificial stones were fixed in water, whereas laser fiber was driven on a platform for ablation. Pulse energy, frequency, fiber-moving speed, fiber-to-stone distance, and fiber size were adjusted in each trial. The cross-sectional area of craters on the lateral stone surface was measured for comparison of ablation rate, combined with fiber-moving speed. Results: There was a trend that the ablation rate increased as pulse energy or frequency increased. When pulse energy was set as 0.2 J and frequency was increased from 50 to 150 Hz, the cross-sectional area of the crater was enlarged from 0.21 to 0.37 mm2 (p < 0.05); when the frequency was set as 100 Hz and pulse energy was increased from 0.1 to 0.3 J, the crater was enlarged from 0.10 to 0.45 mm2 (p < 0.05). Furthermore, energy demonstrated greater impact on ablation rate and the crater was enlarged from 0.20 mm2 in the 0.1 J × 300 Hz group to 0.44 mm2 in the 0.3 J × 100 Hz group (p < 0.05). Then fiber was set at different moving speeds with the same laser setting; the ablation rate of 3 mm/second group was 3.64 times higher than 0.5 mm/second group (p < 0.05). Ablation diminished as fiber-to-stone distance grew. A 200 μm fiber produced thinner and deeper fissure than 272 and 550 μm fibers, and the ablation rate was the highest for the 200 μm fiber. Conclusion: Pulse energy is a more important factor in influencing ablation efficiency compared with frequency. Closer fiber-to-stone distance, faster fiber movement, and smaller fiber size increase ablation efficiency.
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Affiliation(s)
- Min Liu
- Department of Urology, Shanghai Changhai Hospital, Shanghai, China
| | - Yonghan Peng
- Department of Urology, Shanghai Changhai Hospital, Shanghai, China
| | - Zeyu Wang
- Department of Urology, Shanghai Changhai Hospital, Shanghai, China
| | - Ling Li
- Department of Urology, Shanghai Changhai Hospital, Shanghai, China
| | - Shaoxiong Ming
- Department of Urology, Shanghai Changhai Hospital, Shanghai, China
| | - Ziyu Fang
- Department of Urology, Shanghai Changhai Hospital, Shanghai, China
| | - Hao Dong
- Department of Urology, Shanghai Changhai Hospital, Shanghai, China
| | - Rui Li
- Department of Urology, Shanghai Changhai Hospital, Shanghai, China
| | - Xiaofeng Gao
- Department of Urology, Shanghai Changhai Hospital, Shanghai, China
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Kaygısız O, Aydın YM, Çiçek MÇ, Çelen S, Coşkun B, Kılıçarslan H. 15 and 30 W Holmium:YAG Laser Lithotriptor in Ureteroscopic Lithotripsy: Which One Is More Effective and Safe? J Laparoendosc Adv Surg Tech A 2021; 31:839-842. [PMID: 33956528 DOI: 10.1089/lap.2021.0090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background: Holmium:yttrium-aluminium-garnet (Ho:YAG) laser lithotripsy with ureteroscopy (URS) was a safe and successful treatment option for pediatric ureteral stones. We aimed to comparatively evaluate the outcomes of 15 and 30 W Ho:YAG laser lithotriptors in pediatric ureter stones. Materials and Methods: We retrospectively evaluated 55 children who underwent ureteroscopic laser lithotripsy to treat ureter stone size up to 15 mm between September 2009 and March 2020. Groups were formed according to the laser lithotriptor power 15 W (Group 15: n = 32), 30 W (Group 30: n = 23). The efficiency of laser lithotriptors was compared between the groups. Results: The age, gender, and stone characteristics (longest stone diameter, density, location and multiple stones) were similar between the groups. In the postop first month, stone-free status was achieved in all cases except one child in Group 15. The median operative time was significantly shorter in Group 30 (40 minutes) than in Group 15 (52.5 minutes) (P = .010). Clavien-Dindo class (CDC) 2 complications occurred in 2 children in both groups (P = .597). Although ureteric stenosis was observed in 1 patient in Group 15, no ureteric stenosis was seen in Group 30 during follow-up (median 16.1 months). Length of hospital stay (LoHS) and stone-free rates were similar between groups. Conclusion: URS with 15 and 30 W Ho:YAG laser lithotriptors is an effective treatment option for pediatric ureteral stones with a high success rate and low complication rates. In brief, 30 W Ho:YAG laser lithotriptors should be preferred over 15 W lithotriptors due to their shorter operative time with similar success rate.
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Affiliation(s)
- Onur Kaygısız
- Department of Urology, Bursa Uludag University, Bursa, Turkey
| | | | | | - Sinan Çelen
- Department of Urology, Pamukkale University, Denizli, Turkey
| | - Burhan Coşkun
- Department of Urology, Bursa Uludag University, Bursa, Turkey
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Okhunov Z, Jiang P, Afyouni AS, Ayad M, Arada RB, Brevik A, Akopian G, Patel RM, Landman J, Clayman RV. Caveat Emptor: The Heat Is "ON": An In Vivo Evaluation of the Thulium Fiber Laser and Temperature Changes in the Porcine Kidney during Dusting and Fragmentation Modes. J Endourol 2021; 35:1716-1722. [PMID: 33906433 DOI: 10.1089/end.2021.0206] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION We sought to examine the intrarenal fluid and tissue temperature during dusting and fragmentation with the Thulium fiber laser (TFL) in an in vivo porcine kidney. METHODS In two pigs, temperature was continuously measured within the upper, middle, and lower calyces and at the tip of the ureteroscope. Four experimental protocols were performed: dual lumen ureteroscope with both warmed (37°C) and room temperature (20-22ºC) irrigation and single lumen ureteroscope with warmed and room temperature irrigation. In each pig, one kidney had a 14F ureteral access sheath (UAS), other kidney had no UAS. A 200µm TFL was fired at three settings: dusting (0.5J, 80Hz, 40W) with continuous activation for 5 minutes or until a temperature reached 44⁰C; low power (1J, 10Hz, 10W) and high-power fragmentation (1.5J, 20Hz, 30W). For fragmentation, the laser was activated for 10 seconds with a 2 second intermission for 1 minute. RESULTS In the absence of an UAS, in all but one circumstance, temperatures exceeded 44ºC at all settings with the use of either warm or room temperature irrigation, regardless of the type of ureteroscope. Temperatures recorded at the ureteroscope tip were 4ºC - 22ºC less than the temperatures recorded in the renal calyces. In contrast, with a 14F UAS in place, 6 distinct groups had temperatures that did not exceed 44ºC, specifically at low and high-power fragmentation settings with room temperature irrigation for both sets of ureteroscopes and at dusting and low-power fragmentation settings with warm temperature irrigation solely for the single lumen ureteroscope. Temperatures at the ureteroscope tip with an UAS yielded temperature differences from 17ºC less to 19ºC more than the renal calyces. CONCLUSIONS Thulium fiber laser is a novel technology for lithotripsy. In the absence of a UAS, high-power TFL fragmentation settings, may create temperatures that could result in urothelial tissue injury.
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Affiliation(s)
- Zhamshid Okhunov
- University of California, Irvine, Urology, 333 City Boulevard, Suite 2100, 333 City Boulevard, Suite 2100, Orange, California, United States, 92868;
| | - Pengbo Jiang
- University of California Irvine, 8788, Urology, Irvine, California, United States;
| | - Andrew Shea Afyouni
- University of California Irvine, 8788, Department of Urology, 333 City Blvd W, Orange, California, United States, 92868;
| | - Maged Ayad
- University of California Irvine, 8788, Urology, 101 The City Drive S, Orange, California, United States, 92868;
| | - Raphael B Arada
- University of California Irvine Department of Urology, 481083, 101 The City Dr S, Orange, California, United States, 92868-2987;
| | - Andrew Brevik
- University of California Irvine, 8788, Urology, 333 City Blvd West, Orange, California, United States, 92868.,Kansas City University of Medicine and Biosciences, 32959, Kansas City, Missouri, United States, 64106-1453;
| | - Gagik Akopian
- I M Sechenov First Moscow State Medical University, 68477, Research Institute of Uronephrology and Reproductive Health, Moskva, Moskva, Russian Federation;
| | - Roshan M Patel
- University of California Irvine, 8788, Urology, Orange, California, United States;
| | - Jaime Landman
- University of California Irvine, Urology, 333 City Blvd West, Orange, California, United States, 92868;
| | - Ralph V Clayman
- Univ. of California, Irvine, Urology, 101 The City Drive South, Bldg. 55, Room 304, Route 81, Irvine, California, United States, 92868;
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Enikeev D, Traxer O, Taratkin M, Okhunov Z, Shariat S. A review of thulium-fiber laser in stone lithotripsy and soft tissue surgery. Curr Opin Urol 2021; 30:853-860. [PMID: 32925311 DOI: 10.1097/mou.0000000000000815] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW To evaluate emerging evidence and practical applications of thulium-fiber laser (TFL) for genitourinary soft tissue disease and urinary stone disease treatment. RECENT FINDINGS A systematic review was developed using the PubMed, ScienceDirect, Wiley, SpringerLink and Mary Ann Liebert Scopus databases between 2012 and 2020 years, using the PRISMA statement. We analyzed recent publications including in vitro and in humans outcomes of surgery using TFL. This new laser technology can be used in soft tissue diseases and stones present in the genitourinary system. Most of the comparisons are made with the Ho:YAG laser, using completely different settings. Nevertheless, TFL is safe, feasible and effective in the management of urologic diseases, showing superiority to Ho:YAG even in some studies. SUMMARY The introduction of pulsed TFL technology has enabled the ablation of stones at rates comparable to or better than currently existing lasers in vitro, while also potentially reducing stone retropulsion. TFL is effective in treating genitourinary soft tissue diseases, including benign prostatic hyperplasia, and early data indicate that it may be effective in the treatment of urinary stone disease. More clinical studies are needed to better understand the indications for this novel technology and clarify its position in the urologic endoscopy armamentarium.
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Affiliation(s)
- Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Olivier Traxer
- GRC #20 Lithiase Urinaire, Sorbonne University, Hôpital Tenon, Paris, France
| | - Mark Taratkin
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Zhamshid Okhunov
- Department of Urology, University of California, Irvine, California, USA
| | - Shahrokh Shariat
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.,Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Department of Urology, Weill Cornell Medical College, New York, New York.,Department of Urology, University of Texas Southwestern, Dallas, Texas, USA.,Department of Urology, Second Faculty of Medicine, Charles University, Prag, Czech Republic.,Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan
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Ho DS, Scialabba D, Terry RS, Ma X, Chen J, Sankin GN, Xiang G, Qi R, Preminger GM, Lipkin ME, Zhong P. The Role of Cavitation in Energy Delivery and Stone Damage During Laser Lithotripsy. J Endourol 2021; 35:860-870. [PMID: 33514285 DOI: 10.1089/end.2020.0349] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose: Although cavitation during laser lithotripsy (LL) contributes to the Moses effect, the impact of cavitation on stone damage is less clear. Using different laser settings, we investigate the role of cavitation bubbles in energy delivery and stone damage. Materials and Methods: The role of cavitation in laser energy delivery was characterized by using photodetector measurements synced with high-speed imaging for laser pulses of varying durations. BegoStone samples were treated with the laser fiber oriented perpendicularly in contact with the stone in water or in air to assess the impact of cavitation on crater formation. Crater volume and geometry were quantified by using optical coherence tomography. Further, the role of cavitation in stone damage was elucidated by treatment in water with the fiber oriented parallel to the stone surface and by photoelastic imaging. Results: Longer pulse durations resulted in higher energy delivery but smaller craters. Stones treated in water resulted in greater volume, wider yet shallower craters compared with those treated in air. Stones treated with the parallel fiber showed crater formation after 15 pulses, confirmed by high-speed imaging of the bubble collapse with the resultant stress field captured by photoelastic imaging. Conclusions: Despite improved energy delivery, the longer pulse mode produced smaller crater volume, suggesting additional processes secondary to photothermal ablation are involved in stone damage. Our critical observations of the difference in stone damage treated in water vs in air, combined with the crater formation by parallel fiber, suggest that cavitation is a contributor to stone damage during LL.
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Affiliation(s)
- Derek S Ho
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
| | - Dominick Scialabba
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
| | - Russell S Terry
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Xiaojian Ma
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA.,Department of Research and Development, China Academy of Launch Vehicle Technology, Beijing, China
| | - Junqin Chen
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
| | - Georgy N Sankin
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
| | - Gaoming Xiang
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
| | - Robert Qi
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Glenn M Preminger
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Michael E Lipkin
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Pei Zhong
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
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Theodosiou A, Aubrecht J, Kašík I, Dousek D, Komanec M, Kalli K. Femtosecond Laser Plane-by-Plane Inscribed Cavity Mirrors for Monolithic Fiber Lasers in Thulium-Doped Fiber. SENSORS (BASEL, SWITZERLAND) 2021; 21:1928. [PMID: 33801791 PMCID: PMC8000636 DOI: 10.3390/s21061928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 02/25/2021] [Accepted: 03/05/2021] [Indexed: 11/16/2022]
Abstract
A monolithic fiber laser operating in the short wavelength infrared that is suitable for CO2 gas sensing applications is proposed and presented. The current study reports a laser design based on the direct inscription of a monolithic Fabry-Perot (FP) cavity in a thulium-doped optical fiber using the femtosecond laser (FsL) plane-by-plane inscription method to produce the cavity mirrors. The FP cavity was inscribed directly into the active fiber using two wavelength-identical fiber Bragg gratings (FBGs), one with high and one with low reflectivity. Initially the effective length of the fiber was defined using a single high reflectivity FBG and subsequently a very weak FBG was inscribed at the other end of the fiber in order to demonstrate a fully monolithic fiber laser. All fiber lasers were designed for continuous wave operation at 1950 nm and characterized with respect to the power output, slope efficiency, stability, and effective resonator length. The performance of the presented monolithic laser cavities was evaluated using the same active fiber as a reference fiber spliced to FBGs inscribed in passive fiber; an improvement exceeding 12% slope efficiency is reported for the presented monolithic laser.
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Affiliation(s)
- Antreas Theodosiou
- Lumoscribe LTD, Margaritas Liasidou 12, Paphos 8310, Cyprus
- Photonics and Optical Sensors Research Laboratory (PhOSLab), Cyprus University of Technology, Saripolou 33, Limassol 3036, Cyprus;
| | - Jan Aubrecht
- Institute of Photonics and Electronics of the Czech Academy of Sciences, Chaberská 57, 182 51 Prague, Czech Republic; (J.A.); (I.K.)
| | - Ivan Kašík
- Institute of Photonics and Electronics of the Czech Academy of Sciences, Chaberská 57, 182 51 Prague, Czech Republic; (J.A.); (I.K.)
| | - Daniel Dousek
- Department of Electromagnetic Field, Czech Technical University in Prague, Technicka 1902/2, 166 27 Prague, Czech Republic; (D.D.); (M.K.)
| | - Matěj Komanec
- Department of Electromagnetic Field, Czech Technical University in Prague, Technicka 1902/2, 166 27 Prague, Czech Republic; (D.D.); (M.K.)
| | - Kyriacos Kalli
- Photonics and Optical Sensors Research Laboratory (PhOSLab), Cyprus University of Technology, Saripolou 33, Limassol 3036, Cyprus;
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Minimally invasive percutaneous nephrolithotomy with SuperPulsed Thulium-fiber laser. Urolithiasis 2021; 49:485-491. [PMID: 33655346 DOI: 10.1007/s00240-021-01258-2] [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: 12/21/2020] [Accepted: 02/18/2021] [Indexed: 12/19/2022]
Abstract
We aimed to assess the efficacy and safety of minimally invasive percutaneous nephrolithotomy (PCNL) with SuperPulsed Thulium-fiber laser (SP TFL) using different frequency settings. 125 patients with solitary kidney calculi of up to 55 mm in the maximum diameter underwent mini-PCNL with the SP TFL. Stone-free rate, laser-on time, ablation efficacy, energy consumption, ablation speed and complications were all analyzed. Negative low-dose computed tomography scan or asymptomatic patients with stone fragments < 2 mm were the criteria for assessing the stone-free status. In 36 patients (28.8%) low frequency regimens were used (LF: 3-19 Hz-0.5-6 J), in 75 patients (60%) high frequency regimens were chosen (HF: 20-49 Hz-0.2-2 J) and in 14 (11.2%) patients higher frequency (HRF: 50-200 Hz-0.1-0.5 J) regimens were preferred. The mean age was 52 ± 1.8 years. Median stone diameter and median stone volume were larger at low frequency regimens compared to high frequency regimens. Ablation efficacy (J/mm3) was lower at low rather than at high frequency regimens. Ablation speed (mm3/sec) was higher at low compared to high frequency regimens. Surgeons reported minimal and absent retropulsion at higher frequency regimens. The best visibility was observed at high frequency regimens. The overall stone free rate (SFR) at 3 months was 85%. The majority of the postoperative complications were classified between Clavien grades I-II. SP TFL is an effective and safe tool for performing mini-PCNL regardless of the laser settings.
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Kronenberg P, Hameed BMZ, Somani B. Outcomes of thulium fibre laser for treatment of urinary tract stones: results of a systematic review. Curr Opin Urol 2021; 31:80-86. [PMID: 33470684 PMCID: PMC7879830 DOI: 10.1097/mou.0000000000000853] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Lasers have become a fundamental aspect of stone treatment. Although Holmium:Yttrium-Aluminum-garnet (Ho:YAG) laser is the current gold-standard in endoscopic laser lithotripsy, there is a lot of buzz around the new thulium fibre laser (TFL). We decided to evaluate the latest data to help create an objective and evidence-based opinion about this new technology and associated clinical outcomes. RECENT FINDINGS Sixty full-text articles and peer-reviewed abstract presentations were included in the qualitative synthesis of this systematic review performed over the last 2 years. Current super pulsed TFL machines are capable of achieving peak powers of 500W and emit very small pulse energies of 0.025 Joules going up to 6 Joules, and capable of frequency over 2000 Hz. This makes the TFL ablate twice as fast for fragmentation, 4 times as fast for dusting, more stone dust of finer size and less retropulsion compared to the Ho:YAG laser. Because of the smaller laser fibres with the TFL, future miniaturization of instruments is also possible. SUMMARY Based on the review, the TFL is a potential game-changer for kidney stone disease and has a promising role in the future. However larger multicentric prospective clinical studies with long-term follow-up are needed to establish the safety and efficacy of the TFL in endourology.
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Affiliation(s)
| | - BM Zeeshan Hameed
- Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Bhaskar Somani
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Barh A, Heidrich J, Alaydin BO, Gaulke M, Golling M, Phillips CR, Keller U. Watt-level and sub-100-fs self-starting mode-locked 2.4-µm Cr:ZnS oscillator enabled by GaSb-SESAMs. OPTICS EXPRESS 2021; 29:5934-5946. [PMID: 33726125 DOI: 10.1364/oe.416894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 02/02/2021] [Indexed: 06/12/2023]
Abstract
Femtosecond lasers with high peak power at wavelengths above 2 µm are of high interest for generating mid-infrared (mid-IR) broadband coherent light for spectroscopic applications. Cr2+-doped ZnS/ZnSe solid-state lasers are uniquely suited since they provide an ultra-broad bandwidth in combination with watt-level average power. To date, the semiconductor saturable absorber mirror (SESAM) mode-locked Cr:ZnS(e) lasers have been severely limited in power due to the lack of suitable 2.4-µm SESAMs. For the first time, we develop novel high-performance 2.4-µm type-I and type-II SESAMs, and thereby obtain state-of-the-art mode-locking performance. The type-I InGaSb/GaSb SESAM demonstrates a low non-saturable loss (0.8%) and an ultrafast recovery time (1.9 ps). By incorporating this SESAM in a 250-MHz Cr:ZnS laser cavity, we demonstrate fundamental mode-locking at 2.37 µm with 0.8 W average power and 79-fs pulse duration. This corresponds to a peak power of 39 kW, which is the highest so far for any saturable absorber mode-locked Cr:ZnS(e) oscillator. In the same laser cavity, we could also generate 120-fs pulses at a record high average power of 1 W. A comparable laser performance is achieved using type-II InAs/GaSb SESAM as well. These results pave the way towards a new class of high-power femtosecond SESAM mode-locked oscillators operating directly above 2-µm wavelength.
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Corrales M, Traxer O. Initial clinical experience with the new thulium fiber laser: first 50 cases. World J Urol 2021; 39:3945-3950. [PMID: 33590280 DOI: 10.1007/s00345-021-03616-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/25/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy, safety, and laser settings of thulium fiber laser (TFL) in laser lithotripsy during retrograde intrarenal surgery (RIRS) for ureteral and renal stones. METHODS A prospective study of the first 50 patients with ureteral and renal stones who underwent RIRS using TFL (SOLTIVE Premium, Olympus, Japan) was performed. 200 and 150 µm laser fibers were used for ureteral and renal stones, respectively. Stone size, stone density, laser-on time (LOT), and laser settings were recorded. We also assessed the ablation speed (mm3/s), laser power (W), and Joules/mm3 values for each lithotripsy. RESULTS A total of 50 patients were included in the study with a median (IQR) age of 66 (55.5-74) years old for patients with ureteral stones and 55 (44-61.5) years old for patients with renal stones. Most of the patients had a Charlson comorbidity index score of 0. Median (IQR) stone volume for ureteral stones was 486 (332-1250) mm3 and for renal stones was 1800 (682.8-2760) mm3. Median (IQR) stone density for ureteral and renal stones was 998 (776-1300) HU and 1200 (750-1300) HU, respectively. Median (IQR) pulse energy for ureteral stones was 0.4 (0.2-0.4) J; and for renal stones, 0.3 (0.2-0.6) J. Median pulse frequency, laser power, and laser operative time were higher in the renal stones group. The overall complication rate was low in both groups. CONCLUSION TFL is a safe and effective modality for lithotripsy during RIRS with minimal complication rates.
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Affiliation(s)
- Mariela Corrales
- Sorbonne University GRC Urolithiasis No. 20 Tenon Hospital, 75020, Paris, France.,Department of Urology AP-HP, Tenon Hospital, Sorbonne University, 75020, Paris, France
| | - Olivier Traxer
- Sorbonne University GRC Urolithiasis No. 20 Tenon Hospital, 75020, Paris, France. .,Department of Urology AP-HP, Tenon Hospital, Sorbonne University, 75020, Paris, France.
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Giglio NC, Hutchens TC, South AA, Fried NM. Dynamic properties of surfactant-enhanced laser-induced vapor bubbles for lithotripsy applications. JOURNAL OF BIOMEDICAL OPTICS 2021; 26:JBO-200350R. [PMID: 33515219 PMCID: PMC7846116 DOI: 10.1117/1.jbo.26.1.018001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 01/15/2021] [Indexed: 06/12/2023]
Abstract
SIGNIFICANCE Water is a primary absorber of infrared (IR) laser energy, and urinary stones are immersed in fluid in the urinary tract and irrigated with saline during IR laser lithotripsy. Laser-induced vapor bubbles, formed during lithotripsy, contribute to the stone ablation mechanism and stone retropulsion effects. AIM Introduction of a surfactant may enable manipulation of vapor bubble dimensions and duration, potentially for more efficient laser lithotripsy. APPROACH A surfactant with concentrations of 0%, 5%, and 10% was tested. A single pulse from a thulium fiber laser with wavelength of 1940 nm was delivered to the surfactant through a 200-μm-core optical fiber, using a wide range of laser parameters, including energies of 0.05 to 0.5 J and pulse durations of 250 to 2500 μs. RESULTS Bubble length, width, and duration with surfactant increased on average by 29%, 17%, and 120%, compared with water only. CONCLUSIONS Our study demonstrated successful manipulation of laser-induced vapor bubble dimensions and duration using a biocompatible and commercially available surfactant. With further study, use of a surfactant may potentially improve the "popcorn" technique of laser lithotripsy within the confined space of the kidney, enable non-contact laser lithotripsy at longer working distances, and provide more efficient laser lithotripsy.
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Affiliation(s)
- Nicholas C. Giglio
- University of North Carolina at Charlotte, Department of Physics and Optical Science, Charlotte, North Carolina, United States
| | - Thomas C. Hutchens
- University of North Carolina at Charlotte, Department of Physics and Optical Science, Charlotte, North Carolina, United States
| | - Austin A. South
- University of North Carolina at Charlotte, Department of Mechanical Engineering, Charlotte, North Carolina, United States
| | - Nathaniel M. Fried
- University of North Carolina at Charlotte, Department of Physics and Optical Science, Charlotte, North Carolina, United States
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Petzold R, Suarez-Ibarrola R, Miernik A. Gas Bubble Anatomy During Laser Lithotripsy: An Experimental In Vitro Study of a Pulsed Solid-State Tm:YAG and Ho:YAG Device. J Endourol 2020; 35:1051-1057. [PMID: 33207950 DOI: 10.1089/end.2020.0526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: To examine gas bubbles generated by two laser lithotripsy devices, a pulsed thulium solid-state laser and a holmium:yttrium-aluminum-garnet (Ho:YAG) device, and their possible effects in lithotripsy. Materials and Methods: We investigated two Dornier laser devices, a Medilas H Solvo 35 and a pulsed solid-state thulium laser evaluation model (Dornier MedTech Laser GmbH, Wessling, Germany). Our setup consisted of a water-filled glass tank heated to 37/60/70°C. Different laser power/frequency settings and short/long pulses were examined for both laser devices. We analyzed the impact of degraded, cut, and broken fibers on gas bubble anatomy. Furthermore, high-speed recordings of BegoStone ablation were analyzed. For all recordings, we used a Photron Nova S12 camera. Results: These two devices produced differently shaped gas bubbles under different fiber conditions, temperatures, power settings, and short and long pulse settings, which explain the differing repulsive force and pressure values. Inside the gas bubble, a cone was visible whose angle correlates with the protruding jet. We observed turbulences and swirls moving back and forth the fiber tip. During fragmentation, sparks are generated that demonstrate the photothermal effect, and we recorded stone fragments being pulled toward the fiber. Both devices showed comparable results with differences mainly due to pulse lengths. Conclusion: The shapes of the vapor bubbles formed during laser lithotripsy depend on several factors. Excessive transoperative fiber cleavage seems to be unnecessary. Due to the large gas bubbles observed and because of the amount of potential pressure generated, only low energies should be applied in the ureter.
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Affiliation(s)
- Ralf Petzold
- Department of Urology, Faculty of Medicine, University of Freiburg - Medical Centre, Freiburg, Germany
| | - Rodrigo Suarez-Ibarrola
- Department of Urology, Faculty of Medicine, University of Freiburg - Medical Centre, Freiburg, Germany
| | - Arkadiusz Miernik
- Department of Urology, Faculty of Medicine, University of Freiburg - Medical Centre, Freiburg, Germany
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[Innovative laser technologies in the treatment of urolithiasis : A change to more gentle methods with increased patient safety]. Urologe A 2020; 60:19-26. [PMID: 33315134 DOI: 10.1007/s00120-020-01409-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2020] [Indexed: 10/22/2022]
Abstract
Management of urolithiasis has undergone fundamental changes with the introduction of extracorporeal shock wave lithotripsy (ESWL) and percutaneous and ureterorenoscopic techniques in the 1980s. Since then, these minimally invasive techniques have been continuously optimized and specific laser techniques for stone disintegration have emerged. Besides the established holmium laser, other types of lasers are also emerging. Especially the thulium fiber laser is the subject of promising research due to its variable adjustment options. In terms of patient safety, both holmium and thulium techniques seem to be similar . While serious direct physical lesions are rare, there is increasing evidence of clinically relevant secondary thermal injury due to increased temperatures in the upper urinary tract during treatment. Our research group has recently demonstrated in both in vitro and in vivo (porcine animal model) experiments that monitoring the fluorescence spectra of calculi allows precise target differentiation between stone, tissue, and endoscope components. Consequently, pulse emissions were only emitted when stone material was detected. We believe that target monitoring will minimize the risk of laser-induced urothelial damage and decrease energy release into the upper urinary tract allowing adequate temperature management.
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Taratkin M, Kovalenko A, Laukhtina E, Paramonova N, Spivak L, Wachtendorf LJ, Eminovic S, Afyouni AS, Okhunov Z, Karagezyan M, Mikhailov V, Strakhov Y, Herrmann TR, Enikeev D. Ex vivo study of Ho:YAG and thulium fiber lasers for soft tissue surgery: which laser for which case? Lasers Med Sci 2020; 37:149-154. [PMID: 33175250 DOI: 10.1007/s10103-020-03189-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 11/04/2020] [Indexed: 12/11/2022]
Abstract
The goal of this study was to assess the ablation, coagulation, and carbonization characteristics of the holmium:YAG (Ho:YAG) laser and thulium fiber lasers (TFL). The Ho:YAG laser (100 W av.power), the quasi-continuous (QCW) TFL (120 W av.power), and the SuperPulsed (SP) TFL (50 W av.power) were compared on a non-frozen porcine kidney. To control the cutting speed (2 or 5 mm/s), an XY translation stage was used. The Ho:YAG was tested using E = 1.5 J and Pav = 40 W or Pav = 70 W settings. The TFL was tested using E = 1.5 J and Pav = 30 W or Pav = 60 W settings. After ex vivo incision, histological analysis was performed in order to estimate thermal damage. At 40 W, the Ho:YAG displayed a shallower cutting at 2 and 5 mm/s (1.1 ± 0.2 mm and 0.5 ± 0.2 mm, respectively) with virtually zero coagulation. While at 70 W, the minimal coagulation depth measured 0.1 ± 0.1 mm. The incisions demonstrated zero carbonization. Both the QCW and SP TFL did show effective cutting at all speeds (2.1 ± 0.2 mm and 1.3 ± 0.2 mm, respectively, at 30 W) with prominent coagulation (0.6 ± 0.1 mm and 0.4 ± 0.1 mm, respectively, at 70 W) and carbonization. Our study introduced the TFL as a novel efficient alternative for soft tissue surgery to the Ho:YAG laser. The SP TFL offers a Ho:YAG-like incision, while QCW TFL allows for fast, deep, and precise cutting with increased carbonization.
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Affiliation(s)
- Mark Taratkin
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.
| | - Anastasia Kovalenko
- NTO "IRE-Polus", One Vvedenskogo Sq, Fryazino, Moscow Region, Russia, 141120
| | - Ekaterina Laukhtina
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Nina Paramonova
- Centralized Pathology Department, Sechenov University, Moscow, Russia
| | - Leonid Spivak
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | | | - Semil Eminovic
- Faculty of Medicine, Philipps University Marburg, Marburg, Germany
| | | | - Zhamshid Okhunov
- Department of Urology, University of California, Irvine, CA, USA
| | - Marina Karagezyan
- Institute of Linguistics and Intercultural Communication, Sechenov University, Moscow, Russia
| | - Vasily Mikhailov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Yuriy Strakhov
- Centralized Pathology Department, Sechenov University, Moscow, Russia
| | - Thomas Rw Herrmann
- Department of Urology, Spital Thurgau AG, Pfaffenholzstrasse 4, 8501, Frauenfeld, Switzerland
- Department of Urology, Hannover Medical School, Hannover, Germany
| | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
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Giglio NC, Hutchens TC, Wilson CR, Gonzalez DA, Fried NM. Surfactant Enhanced Laser-Induced Vapor Bubbles for Potential use in Thulium Fiber Laser Lithotripsy .. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:5045-5048. [PMID: 33019120 DOI: 10.1109/embc44109.2020.9176236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The Thulium fiber laser (TFL) is being explored as a potential alternative to the gold standard Holmium:YAG laser for infrared laser ablation of kidney stones. Laser-induced vapor bubbles contribute to both the ablation mechanism and stone retropulsion. In this preliminary study, a biocompatible surfactant with concentrations of 1-5% was used to enhance the vapor bubble dimensions during the laser pulse. Bubble dimensions using surfactant increased on average by 25% compared with water only (control). With further development, introduction of the surfactant into the saline irrigation flow typically delivered through the working channel of the ureteroscope during laser lithotripsy, may contribute to more efficient stone ablation.Clinical Relevance-This preliminary study demonstrates that the dimensions of laser-induced vapor bubbles created during infrared laser lithotripsy can be enhanced by up to 25%, for potential clinical translation into more efficient lithotripsy and use in the "popcorn" ablation method.
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Lildal SK, Andreassen KH, Baard J, Brehmer M, Bultitude M, Eriksson Y, Ghani KR, Jung H, Kamphuis G, Kronenberg P, Turney B, Traxer O, Ulvik Ø, Osther PJS. Consultation on kidney stones, Copenhagen 2019: aspects of intracorporeal lithotripsy in flexible ureterorenoscopy. World J Urol 2020; 39:1673-1682. [PMID: 33067728 PMCID: PMC8217045 DOI: 10.1007/s00345-020-03481-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 10/01/2020] [Indexed: 12/20/2022] Open
Abstract
Purpose To summarize current knowledge on intracorporeal laser lithotripsy in flexible ureterorenoscopy (fURS), regarding basics of laser lithotripsy, technical aspects, stone clearance, lithotripsy strategies, laser technologies, endoscopes, and safety. Methods A scoping review approach was applied to search literature in PubMed, EMBASE, and Web of Science. Consensus was reached through discussions at the Consultation on Kidney Stones held in September 2019 in Copenhagen, Denmark. Results and conclusions Lasers are widely used for lithotripsy during fURS. The Holmium laser is still the predominant technology, and specific settings for dusting and fragmenting have evolved, which has expanded the role of fURS in stone management. Pulse modulation can increase stone ablation efficacy, possibly by minimizing stone retropulsion. Thulium fibre laser was recently introduced, and this technology may improve laser lithotripsy efficiency. Small fibres give better irrigation, accessibility, and efficiency. To achieve optimal results, laser settings should be adjusted for the individual stone. There is no consensus whether the fragmentation and basketing strategy is preferable to the dusting strategy for increasing stone-free rate. On the contrary, different stone scenarios call for different lithotripsy approaches. Furthermore, for large stone burdens, all laser settings and lithotripsy strategies must be applied to achieve optimal results. Technology for removing dust from the kidney should be in focus in future research and development. Safety concerns about fURS laser lithotripsy include high intrarenal pressures and temperatures, and measures to reduce both those aspects must be taken to avoid complications. Technology to control these parameters should be targeted in further studies.
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Affiliation(s)
| | - Kim Hovgaard Andreassen
- Department of Urology, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Joyce Baard
- Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marianne Brehmer
- Department of Surgery and Urology, Danderyd University Hospital, Stockholm, Sweden
- Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Matthew Bultitude
- Urology Centre and Stone Unit, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Ylva Eriksson
- Department of Surgery and Urology, Danderyd University Hospital, Stockholm, Sweden
- Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Khurshid R Ghani
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Helene Jung
- Department of Urology, Urological Research Center, Lillebaelt Hospital, University of Southern Denmark, Vejle, Denmark
| | - Guido Kamphuis
- Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Peter Kronenberg
- Department of Urology, Hospital CUF Descobertas, Lisbon, Portugal
| | - Ben Turney
- Department of Urology, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | | | - Øyvind Ulvik
- Department of Urology, Haukeland University Hospital, Bergen, Norway
| | - Palle Jörn Sloth Osther
- Department of Urology, Urological Research Center, Lillebaelt Hospital, University of Southern Denmark, Vejle, Denmark.
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Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize recent developments in the array of devices which are commonly used by urologists in the surgical management of kidney stones. To accomplish this goal, an extensive review of recent endourology literature, conference abstracts, and publicly available documents from manufacturers and the United States Food and Drug Administration was collected and reviewed. RECENT FINDINGS Recent developments in the holmium:yttrium-aluminum-garnet (Ho:YAG) laser lithotripsy include the introduction of pulse modulation. This technique delivers the laser energy in an asymmetric manner such that an initial bubble is created (the 'Moses effect') through which the remainder of the energy can then travel through without being absorbed by surrounding water. Even more novel is the thulium fiber laser, which is produced in a fundamentally different way than traditional Ho:YAG lasers and is not yet available for clinical use. Finally, novel mechanical lithotrites which effectively combine ultrasonic energy, ballistic energy, and suction capability appear to be highly effective for stone clearance in recent benchtop and clinical studies. SUMMARY With the introduction of both new modifications of time-tested technologies as well as completely novel modalities, the practicing urologist's armamentarium of devices for the surgical management of kidney stones continues to grow. As the popularity of 'mini' procedures continues to grow, the adaptability of these technologies to these procedures will be critical to maintain maximum relevance.
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