Adverse Events Resulting from Lasers Used in Urology

Althunayan, Abdulaziz; Elkoushy, Mohamed A.; Elhilali, Mostafa; Andonian, Sero

doi:10.1089/end.2013.0451

Cited by 63 publications

(52 citation statements)

References 25 publications

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“…However, in a study of 598 patients spanning from 1993 to 1999, the Holmium:YAG laser only produced a single perforation . Overall, the FDA has reported 41 adverse events associated with Holmium:YAG laser lithotripsy, including three deaths from ureteral perforation and retroperitoneal bleeding using the Holmium:YAG laser between 2003 and 2005 . Although more definitive clinical data will ultimately need to be gathered, we speculate that it is possible that the TFL, with its shorter optical penetration depth (as described in more detail in the next section below) and lower pulse energy, may result in even fewer accidental ureter perforations.…”

Section: Discussionmentioning

confidence: 96%

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Collateral damage to the ureter and Nitinol stone baskets during thulium fiber laser lithotripsy

et al. 2015

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Section: Discussionmentioning

confidence: 96%

“…Previous experimental and clinical studies have reported perforation of the ureter during Holmium:YAG laser lithotripsy . Recently, Holmium:YAG and TFL lithotripsy has been conducted in an artificial in vitro ureter model, where stone ablation times and saline temperature readings were compared .…”

Section: Introductionmentioning

confidence: 99%

Collateral damage to the ureter and Nitinol stone baskets during thulium fiber laser lithotripsy

et al. 2015

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“…For example, several previous studies have reported accidental ureter perforation from the nitinol wires on stone baskets during holmium laser lithotripsy, due in part to poor visibility. [13][14][15][16][17] Current optical illumination methods in ureteroscopy utilize single or double illumination points on the front face of the ureteroscope. This point source illumination method provides a measured 45 deg of high intensity and a 70-deg total field of light, causing harsh shadows across stone and tissue surfaces, making differentiation between stones and soft tissues difficult to resolve.…”

Section: Ureteroscope Designsmentioning

confidence: 99%

Miniature ureteroscope distal tip designs for potential use in thulium fiber laser lithotripsy

et al. 2018

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Thulium fiber laser lithotripsy using smaller optical fibers may enable development of miniature ureteroscopes. Two ureteroscope distal tip prototypes were built and characterized. The first design was 4.5-French (Fr) [1.5-mm outer diameter (OD)], five channel tip, housing 200-μm inner diameter (ID) dedicated central channel for insertion of 100-μm core fibers and four surrounding channels, each with 1.5 Fr (510-μm ID) for instrumentation, irrigation, imaging, and illumination, respectively. The second design was 6.0-Fr (2.0-mm OD), three-dimensional printed tip with larger, hemispherical common working channel and separate detection port integrated with ring lighting. Standard instruments, including optical fibers, guidewires, and stone baskets, were inserted through working channels to demonstrate feasibility. Gravitational and manual pump-assisted saline irrigation rates were measured. Luminous intensity distribution curves (LIDCs) were modeled for both ring and conventional lighting designs. Imaging was conducted using 3000, 6000, and 10,000 pixel, miniature, flexible endoscopes with 0.4-, 0.6-, and 0.9-mm OD, to differentiate between urinary stones and ureter wall, for potential clinical application. The multichannel ureteroscope tip with 1.5-Fr working channel yielded a gravitational saline flow rate of 3.9 ± 0.2 mL / min compared to 31.3 ± 0.6 mL / min for standard (3.6 Fr) ureteroscope channel. Manual, pump-assisted irrigation increased flow rate to 32.5 ± 3.0 mL / min. The 6000 pixel, 0.6-mm OD, flexible endoscope provided a balance of clear differentiation between stones and ureter wall and sufficiently small OD. A ring lighting configuration provided more uniform illumination than conventional cross-lighting geometry as demonstrated by LIDCs. With further development, these miniature ureteroscope tip designs may be integrated into a fully functional ureteroscope to permit ureteral access with minimal trauma and improved patient safety and comfort.

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“…Injuries have been reported involving eyes, skin, and respiratory systems. 1,2 Injuries to the skin and the respiratory system are usually burns, with the degree varying based on exposure time. The type of damage to eyes depends on the location receiving the beam and may include retinal burns, ocular burns, or macular holes.…”

Section: Mitigating Risk Of Injurymentioning

confidence: 99%

“…1 However, these valuable instruments have the potential to cause injury to patients or personnel if staff members do not follow proper safety precautions. 1,2 Prevention of injury is the responsibility of every member of the perioperative team, but the specific responsibilities differ based on the role the person performs in the OR. There are also personnel involved in prevention of laser injuries who may not be a part of the perioperative team, including the laser safety officer, the laser safety specialist, and the laser operator.…”

mentioning

confidence: 99%

Guideline Implementation: Energy‐Generating Devices, Part 2‐Lasers

Burlingame¹

2017

AORN Journal

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Lasers have been used in the OR for many years and are essential tools in many different types of procedures. However, laser beams that come into contact with unintended targets directly or via reflection can cause injury to patients or personnel or pose other hazards, such as fires. The new AORN "Guideline for safe use of energy-generating devices" provides guidance on the use of all energy-generating devices in the OR. This article focuses on key points of the guideline that address the safe use of lasers. These include the components of the laser safety program, the responsibilities of the personnel in roles specific to use of a laser, laser safety measures, and documentation of laser use. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.

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Adverse Events Resulting from Lasers Used in Urology

Abstract: Most of the AEs reported relate to equipment failure. There were no eye injuries reported with the use of Ho:YAG lasers. Caution must be exercised when using lasers in urology, including wearing appropriate eye protection when using Nd:YAG, KTP, and diode lasers.

Cited by 63 publications

References 25 publications

Collateral damage to the ureter and Nitinol stone baskets during thulium fiber laser lithotripsy

Collateral damage to the ureter and Nitinol stone baskets during thulium fiber laser lithotripsy

Miniature ureteroscope distal tip designs for potential use in thulium fiber laser lithotripsy

Guideline Implementation: Energy‐Generating Devices, Part 2‐Lasers

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