Advances in laser technology and fibre-optic delivery systems in lithotripsy

Abstract

The flashlamp-pumped, solid-state holmium:yttrium-aluminium-garnet (YAG) laser has been the laser of choice for use in ureteroscopic lithotripsy for the past 20 years. However, although the holmium laser works well on all stone compositions and is cost-effective, this technology still has several fundamental limitations. Newer laser technologies, including the frequency-doubled, double-pulse YAG (FREDDY), erbium:YAG, femtosecond, and thulium fibre lasers, have all been explored as potential alternatives to the holmium:YAG laser for lithotripsy. Each of these laser technologies is associated with technical advantages and disadvantages, and the search continues for the next generation of laser lithotripsy systems that can provide rapid, safe, and efficient stone ablation. New fibre-optic approaches for safer and more efficient delivery of the laser energy inside the urinary tract include the use of smaller-core fibres and fibres that are tapered, spherical, detachable or hollow steel, or have muzzle brake distal fibre-optic tips. These specialty fibres might provide advantages, including improved flexibility for maximal ureteroscope deflection, reduced cross section for increased saline irrigation rates through the working channel of the ureteroscope, reduced stone retropulsion for improved stone ablation efficiency, and reduced fibre degradation and burnback for longer fibre life.

High power holmium:YAG versus thulium fiber laser treatment of kidney stones in dusting mode: ablation rate and fragment size studies

“…The experimental Thulium fiber laser (TFL) is currently being studied as a potential alternative to the Holmium laser for treatment of kidney stones. Potential advantages of TFL technology have recently been reviewed in the literature [19,20]. While the majority of previous reports have been based on preliminary laboratory studies [21][22][23][24][25], the TFL has also shown promise in early clinical studies as well [26][27][28].…”

Study on the Energy Band Regulation of Bi2−xSbxTe3 and Its Application as Mode Locking Material in Low Gain Ultrafast Fiber Laser

“…Ultrafast pulsed fiber laser has been widely used in medical, spectral imaging, sensing, and processing fields in recent years by virtue of its high stability, good heat dissipation, and low cost . Passive operation of fiber laser via materials has recently been a hotspot which attracts enormous attention, especially in the field of communication .…”

“…Ultrafast pulsed fiber laser has been widely used in medical, spectral imaging, sensing, and processing fields in recent years by virtue of its high stability, good heat dissipation, and low cost. [1][2][3][4][5][6][7] Passive operation of fiber laser via materials has recently been a hotspot which attracts enormous attention, especially in the field of communication. [8][9][10][11] On the one hand, mode locking based on the artificially saturable absorbers (SA): nonlinear polarization rotation mode-locking, nonlinear optical (NLO) loop mirror mode-locking, nonlinear multimode interference mode-locking, and material-mode-locking based www.advopticalmat.de carbon nanotubes (SWCNTs) can realize the tuning of modulation depth.…”

The Evaluation of Laser Application in Surgery: A Review Article

“…Thuliumdoped fiber lasers, erbium-doped fiber lasers, and Mid-IR hybrid lasers are suitable for this operation method. 6 Multiple systems of lasers are studied in some fields of medicine such as cancer treatment and tumor ablation, brain surgeries, epilepsy, cardiology and atrial fibrillation, lithotripsy, dermatology, skin rejuvenation, and lipolysis (see Figure 1). The energy of laser is a safe and effective tool for treating various cancers and the ablation of abnormal conductive pathways, for many reconstructive procedures and cosmetics.…”