How much energy do we need to ablate 1 mm3 of stone during Ho:YAG laser lithotripsy? An in vitro study

Panthier, F.; Ventimiglia, Eugenio; Berthe, Laurent; Miller, Catherine; Daudon, Michel; Doizi, Steeve; Traxer, Olivier

doi:10.1007/s00345-020-03091-5

Cited by 26 publications

(21 citation statements)

References 34 publications

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“… 6 While holmium laser is the gold standard of laser lithotripsy, controversy still exists on the optimal laser energy and settings, and uncertainty around the power needed to ablate a specific size and composition of stones. 7 Hence, there is a heated debate to determine whether a low- or high-power laser system is better.…”

Section: Introductionmentioning

confidence: 99%

Role of low- versus high-power laser in the treatment of lower pole stones: prospective non-randomized outcomes from a university teaching hospital

Pietropaolo

Mani

Hughes

et al. 2022

Therapeutic Advances in Urology

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Introduction: Ureteroscopy and laser stone fragmentation [flexible ureteroscopy and laser lithotripsy (FURSL)] has risen over the last two decades. Laser technology has also evolved over the time, shifting from low- to high-power lasers with the addition of MOSES technology that allows for ‘dusting and pop-dusting’ of stones. The aim of the study was to look at the outcomes of FURSL in lower pole stones (LPS) using low- and high-power lasers. Patient and Methods: In this study, we compared the outcomes of low-power holmium laser (group A, 20 W) and high-power holmium laser (group B, including both 60 W MOSES integrated system and 100 W lasers) for all patients with LPS treated with laser lithotripsy. Data were collected for patient demographics, stone location, size, pre- and postoperative stent, length of stay, complications and stone free rate (SFR). Results: A total of 284 patients who underwent FURSL procedure for LPS were analysed (168 group A, 116 group B). Outcomes showed that compared with group A, group B had a higher SFR (91.6% versus 96.5%, p = 0.13) and shorter operative time (52 versus 38 min, p < 0.001). The median length of stay was <24 h in all groups (day-case procedures). The complication rate was comparable between the two groups but with more infectious complications ( n = 7) noted in group A compared with group B ( n = 3) ( p = 0.53). Conclusion: Compared with low-power laser, the use of high-power laser for LPS significantly reduced the use of ureteral access sheath (UAS), postoperative stent and procedural time. Although non-statistically significant, the SFR was higher in the high-power group even for relatively larger stone sizes, which was also reflected in a reduction of sepsis-related complication rates with these lasers.

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Section: Introductionmentioning

confidence: 99%

Role of low- versus high-power laser in the treatment of lower pole stones: prospective non-randomized outcomes from a university teaching hospital

Pietropaolo

Mani

Hughes

et al. 2022

Therapeutic Advances in Urology

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“…Accumulated operative time, catheterization, hospital stay, stone-free rates, and complication rates of group A and Group B are mentioned in Table 2. The Ho: YAG laser fragment the stones in minute dusting constituent parts, trouble-free to pass lacking soreness or other undesirable results 12,13 . Our study outcomes demonstrated the elevated frequency of female patients with 60% and 63.3% in the laser versus pneumatic group.…”

Section: Resultsmentioning

confidence: 99%

Comparing Holmium (Ho): YAG Laser with Pneumatic Lithoclast for Treatment Efficacy of Ureteric Stones

2022

PJMD

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Background: Holmium YAG (yttrium-aluminum-garnet) laser, a comparatively new technique, can clear all types and sizes of stones and is only being used in two institutes of Karachi, Pakistan. The study aimed to compare pneumatic lithoclast and holmium YAG laser, to evaluate stone-free rate (SFR), postoperative complications, operative duration, and effectiveness. Methods: This cross-sectional research included 60 patients with age 16-65 years having ureteric stones, reporting to kidney center, Urology Department, Karachi, Pakistan. CT Scan of Kidneys, Ureter, and Bladder (KUB) were used to record stone size, laterality, and location within the ureter. Patients were divided into two clusters of 30 each, group A (Ho: YAG laser) and group B (pneumatic Lithoclast) having 0.5 to 02 cm of size ureteric stones. An Independent two-sample “t” test was used to assess the difference for the continuous variables. A p-value of ≤0.05 was considered statistically significant. Results: Stone sizes distribution was 1.3±0.3cms and 1.4±0.3cms for A and B groups respectively (p=0.8). The insignificance of the p-value demonstrated no substantial divergence between both groups and stone sizes. Clearance from the proximal ureter was noted 26(84.6%) in group A and 41.7% in group B with (p<0.05). A reduced lithotripsy activation period of 30.8±3.7mins was associated with stone size (p<0.05). Conclusion: Holmium: YAG Laser had better stone-free rate (SFR), with 84% clearance than pneumatic. Improved and effective clearance reduces the risk of residual stones within a lesser time, required for getting back to normal life routines. Keywords: Lasers; Ureteric Stones; Ho: YAG Laser; Pneumatic Lithoclast; Kidney Stones.

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“…We could have also used the characteristics of the ablated crater: deepness, width, length and produced fragments’ size. Consequently, even if our method has been validated by previous in vitro and in vivo studies, we could have analyzed the stone samples using a profilometric method [ 4 , 7 , 9 , 15 , 24 ]. A further dedicated experiment should directly compare both profilometric and three-dimensional segmentation methods.…”

Section: Discussionmentioning

confidence: 99%

“…To assess the ablation volumes, a three-dimensional scanning (micro-CT Quantum FX, Perkin Elmer © , Waltham, MA, USA) of the artificial stones and subsequent 3D segmentation using 3DSlicer software (NIH © ) was used ( Figure 2 ) [ 4 , 14 , 15 ].…”

Section: Methodsmentioning

confidence: 99%

Laser Fiber Displacement Velocity during Tm-Fiber and Ho:YAG Laser Lithotripsy: Introducing the Concept of Optimal Displacement Velocity

Panthier

Germain

Gorny

et al. 2021

JCM

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Background: Endocorporeal laser lithotripsy (EL) during flexible ureteroscopy (URS-f) often uses “dusting” settings with “painting” technique. The displacement velocity of the laser fiber (LF) at the stone surface remains unknown and could improve EL’s ablation rates. This in vitro study aimed to define the optimal displacement velocity (ODV) for both holmium:yttrium-aluminium-garnet (Ho:YAG) and thulium fiber laser (Tm-Fiber). Methods: A 50W-TFL (IRE Polus®, Russia) and a 30W-MH1-Ho:YAG laser (Rocamed®), were used with 272µm-Core-Diameter LF (Sureflex, Boston Scientific©), comparing three TFL modes, “fine dusting” (FD:0.05–0.15 J/100–600 Hz); “dusting” (D:0.5 J/30–60 Hz); “fragmentation” (Fr:1 J/15–30 Hz) and two Ho:YAG modes (D:0.5 J/20 Hz, Fr:1 J/15 Hz). An experimental setup consisting of immerged cubes of calcium oxalate monohydrate (COM) stone phantoms (Begostone Plus, Begoã) was used with a 2 seconds’ laser operation time. LF were in contact with the stones, static or with a displacement of 5, 10 or 20 mm. Experiments were repeated four times. Stones were dried and µ-scanned. Ablation volumes (mm3) were measured by 3D-segmentation. Results: ODV was higher in dusting compared to fragmentation mode during Ho:YAG lithotripsy (10 mm/sec vs. 5 mm/sec, respectively). With Tm-Fiber, dusting and fragmentation OVDs were similar (5 mm/sec). Tm-Fiber ODV was lower than Ho:YAGs in dusting settings (5 mm/s vs. 10 mm/sec, respectively). Without LF displacement, ablation volumes were at least two-fold higher with Tm-Fiber compared to Ho:YAG. Despite the LF-DV, we report a 1.5 to 5-fold higher ablation volume with Tm-Fiber compared to Ho:YAG. Conclusions: In dusting mode, the ODVTm-Fiber is lower compared to ODVHo:YAG, translating to a potential easier Tm-Fiber utilization for “painting” dusting technique. The ODV determinants remain unknown. Dynamic ablation volumes are higher to static ones, regardless of the laser source, settings or LF displacement velocity.

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How much energy do we need to ablate 1 mm3 of stone during Ho:YAG laser lithotripsy? An in vitro study

Cited by 26 publications

References 34 publications

Role of low- versus high-power laser in the treatment of lower pole stones: prospective non-randomized outcomes from a university teaching hospital

Role of low- versus high-power laser in the treatment of lower pole stones: prospective non-randomized outcomes from a university teaching hospital

Comparing Holmium (Ho): YAG Laser with Pneumatic Lithoclast for Treatment Efficacy of Ureteric Stones

Laser Fiber Displacement Velocity during Tm-Fiber and Ho:YAG Laser Lithotripsy: Introducing the Concept of Optimal Displacement Velocity

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