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

Abstract

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.

Innovations in Kidney Stone Removal

“… 8 This enhanced stone disintegration, however, is accompanied by stone retropulsion, most likely due to collapse of the vapor bubble 6 and also damage of the laser fiber tip (“burn back” effect), which leads to longer operative times. 9 Additionally, impairment of the endoscopic view during utilization of high-power settings is commonly encountered (“snowstorm” effect) and can necessitate compensation with an increased irrigation inflow. The latter may lead to an increased risk of elevated intrarenal pressures and increase the risk of infective complications.…”

“… 17 In vitro experiments suggest that long pulse settings benefit from less retropulsion and fiber damage, although real life clinical outcomes are not yet demonstrated. 6 , 9 , 18 Ho:YAG machines functioning both at short and long pulse settings deliver energy over one pulse, with the majority of energy being consumed during the creation of the vapor bubble. 7 A new characteristic of high-power machines is Moses technology, where the energy is applied with two pulses: the first creates the bubble, whilst the second transfers the energy through the already formed vapor channel to maximize the effect on the stone.…”

Ureteroscopy during pregnancy: Outcomes and lessons learned over 4 decades at a tertiary center in Norway

“…This was supported by the advent of next-generation ureteroscopes and newer laser technologies and accessories. [12,13] To this end, it has become our standard approach for URS during pregnancy.…”

“…This was supported by the advent of next-generation ureteroscopes and newer laser technologies and accessories. [12,13] To this end, it has become our standard approach for URS during pregnancy. It is important to note that URS is only performed by designated endourologists, and their involvement is now sought for all cases.…”

Advances in Ureteroscopy: New technologies and current innovations in the era of Tailored Endourological Stone Treatment (TEST)

“…Using high PE also results in increased degradation of fibre tip (so-called ‘burnback’ effect), which in turn may reduce laser ablation efficiency, but most importantly causes regular interruption of the operation cycle due to the need for laser fibre manipulation to compensate the length loss. 15,17…”