Thulium fiber laser lithotripsy in anin vitroureter model
- 1 December 2014
- journal article
- Published by SPIE-Intl Soc Optical Eng in Journal of Biomedical Optics
- Vol. 19 (12), 128001
- https://doi.org/10.1117/1.jbo.19.12.128001
Abstract
Using a validated in vitro ureter model for laser lithotripsy, the performance of an experimental thulium fiber laser (TFL) was studied and compared to the clinical gold standard holmium:YAG laser. The holmium laser () was operated with standard parameters of 600 mJ, , 6 Hz, and -core optical fiber. The TFL () was operated with 35 mJ, , 150 to 500 Hz, and a -core fiber. Urinary stones (60% calcium oxalate monohydrate/40% calcium phosphate) of uniform mass and diameter (4 to 5 mm) were laser ablated with fibers through a flexible video-ureteroscope under saline irrigation with flow rates of 22.7 and for the TFL and holmium laser, respectively. The temperature 3 mm from the tube’s center and 1 mm above the mesh sieve was measured by a thermocouple and recorded throughout each experiment for both lasers. Total laser and operation times were recorded once all stone fragments passed through a 1.5-mm sieve. The holmium laser time measured (). TFL times measured , , and , for pulse rates of 150, 300, and 500 Hz, respectively ( each). Mean peak saline irrigation temperatures reached for holmium, and , , and , for TFL at pulse rates of 150, 300, and 500 Hz, respectively. To avoid thermal buildup and provide a sufficient safety margin, TFL lithotripsy should be performed with pulse rates below 500 Hz and/or increased saline irrigation rates. The TFL rapidly fragmented kidney stones due in part to its high pulse rate, high power density, high average power, and observation of reduced stone retropulsion and may provide a clinical alternative to the conventional holmium laser for lithotripsy.
Keywords
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