Evaluation of Efficacy of Novel Optically Activated Digital Endoscope Protection System Against Laser Energy Damage

Sung, Clifford; Singh, Harmanmeet; Schwartz, Marissa; Mirabile, Gabriella; Hruby, Gregory W.; Ryan, Caroline; Landman, Jaime

doi:10.1016/j.urology.2008.01.011

Cited by 14 publications

(4 citation statements)

References 8 publications

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“…8,9 Damage may occur from both fiber insertion through the working channel during ureteroscope deflection, as well as premature laser activation with the fiber still inside the ureteroscope. Several devices have been introduced to reduce the probability of ureteroscope damage in both situations, such as the endoscope protection system, 10 which employs an optical sensor that shuts off the laser if the distal fiber tip is still inside the ureteroscope working channel, and Flexguard, 11 a protective fiber sheath that insulates the ureteroscope working channel from the fiber. While both of these solutions address laser-induced damage, only the Flexguard sheath additionally prevents mechanical damage.…”

Section: Holmium: Yag Laser Lithotripsy Usingmentioning

confidence: 99%

Miniature ball-tip optical fibers for use in thulium fiber laser ablation of kidney stones

et al. 2016

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Optical fibers, consisting of 240-μm-core trunk fibers with rounded, 450-μm-diameter ball tips, are currently used during Holmium:YAG laser lithotripsy to reduce mechanical damage to the inner lining of the ureteroscope working channel during fiber insertion and prolong ureteroscope lifetime. Similarly, this study tests a smaller, 100-μm-core fiber with 300-μm-diameter ball tip during thulium fiber laser (TFL) lithotripsy. TFL was operated at a wavelength of 1908 nm, with 35-mJ pulse energy, 500-μs pulse duration, and 300-Hz pulse rate. Calcium oxalate/phosphate stone samples were weighed, laser procedure times were measured, and ablation rates were calculated for ball tip fibers, with comparison to bare tip fibers. Photographs of ball tips were taken before and after each procedure to track ball tip degradation and determine number of procedures completed before need for replacement. A high speed camera also recorded the cavitation bubble dynamics during TFL lithotripsy. Additionally, saline irrigation rates and ureteroscope deflection were measured with and without the presence of TFL fiber. There was no statistical difference (P > 0.05) between stone ablation rates for single-use ball tip fiber (1.3 AE 0.4 mg∕s) (n ¼ 10), multiple-use ball tip fiber (1.3 AE 0.5 mg∕s) (n ¼ 44), and conventional single-use bare tip fibers (1.3 AE 0.2 mg∕s) (n ¼ 10). Ball tip durability varied widely, but fibers averaged greater than four stone procedures before failure, defined by rapid decline in stone ablation rates. Mechanical damage at the front surface of the ball tip was the limiting factor in fiber lifetime. The small fiber diameter did not significantly impact ureteroscope deflection or saline flow rates. The miniature ball tip fiber may provide a cost-effective design for safe fiber insertion through the ureteroscope working channel and into the ureter without risk of instrument damage or tissue perforation, and without compromising stone ablation efficiency during TFL lithotripsy.

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Section: Holmium: Yag Laser Lithotripsy Usingmentioning

confidence: 99%

Miniature ball-tip optical fibers for use in thulium fiber laser ablation of kidney stones

et al. 2016

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“…Related to these degradation issues is laser fiber tip preparation. This old, but still current practice of laser fiber preparation can be done before and during the procedure (to “renew” the fiber tip) and consists of stripping off the terminal portion of the plastic fiber coating and then cleaving several millimeters off the end of the glassy fiber components using special instruments (e.g., laser fiber stripper, ceramic scissors) [ 60 – 62 , 63 ••]. One publication compared several cleaving methods, demonstrating that the “scribe pen” cleaving tool produced the highest average power output.…”

Section: Bibliographic Search Resultsmentioning

confidence: 99%

Advances in Lasers for the Treatment of Stones—a Systematic Review

2018

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Purpose of ReviewLaser lithotripsy is increasingly used worldwide and is a continuously evolving field with new and extensive research being published every year.Recent FindingsVariable pulse length Ho:YAG lithotripters allow new lithotripsy parameters to be manipulated, and there is an effort to integrate new technologies into lithotripters. Pulsed thulium lasers seem to be a viable alternative to holmium lasers. The performance of similar laser fibers varies from manufacturer to manufacturer. Special laser fibers and “cleaving only” fiber tip preparation can be beneficial for the lithotripsy procedure. Different laser settings and the surgical technique employed can have significant impact on the success of laser lithotripsy. When safely done, complications of laser lithotripsy are rare and concern the endoscopic nature of procedure, not the technology itself, making laser lithotripsy one of the safest tools in urology.SummaryLaser lithotripsy has had several new developments and more insight has been gained in recent years with many more advances expected in the future.

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“…Sung et al evaluated an artificial intelligence (AI) device based on the visualization of the colored protective jacket of laser fibers [56]. A digital ureteroscope was employed for live-image processing.…”

Section: Future Developmentsmentioning

confidence: 99%

Laser accessories: surgical fibers, strippers, cleavers, and protective glasses

Keller

Kronenberg

Tailly

et al. 2022

Current Opinion in Urology

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Purpose of reviewThis review provides most recent findings and developments relating to surgical laser fibers, strippers, cleavers, and protective glasses.Recent findingsThe smallest core diameter that can be used with Holmium:YAG lasers is 200 μm. Smaller core diameter fibers can be used with the Thulium fiber laser and offer better flexibility and lower risk of fracture, at the risk of greater burnback effect. Misleading discrepancies between the true diameter of laser fibers and their packaging labels must be considered. Fiber tip degradation from the burnback occurs within few minutes, thus questioning the need for time-consuming fiber tip reprocessing with fiber strippers and special cleaving tools. This shortcoming also applies to instrument-protecting ball-tip fibers. Cleavage of fiber tips through their protective jackets (‘coated tips’) is a cheaper alternative for instrument protection, additionally offering better visual control of the fiber tip. Third-generation side-firing greenlight laser fibers are still prone to rapid deterioration. Laser eyewear does not seem necessary for Holmium:YAG applications, whereas laser-specific protective glasses should be worn for greenlight laser applications.SummaryWith better understanding of laser accessories, practicing urologists may tailor their practice to reach optimal efficacy and safety for Holmium:YAG, Thulium fiber laser and Greenlight laser applications.

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Evaluation of Efficacy of Novel Optically Activated Digital Endoscope Protection System Against Laser Energy Damage

Abstract: In this evaluation, the novel EPS was highly effective and reliable. When using indigo carmine or high-density blood concentrations, the efficacy of the EPS was compromised. The EPS should be used to complement standard safe laser technique rather than to replace it.

Cited by 14 publications

References 8 publications

Miniature ball-tip optical fibers for use in thulium fiber laser ablation of kidney stones

Miniature ball-tip optical fibers for use in thulium fiber laser ablation of kidney stones

Advances in Lasers for the Treatment of Stones—a Systematic Review

Laser accessories: surgical fibers, strippers, cleavers, and protective glasses

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