Optimal Settings for the Noncontact Holmium:YAG Stone Fragmentation Popcorn Technique

Emiliani, Esteban; Talso, Michele; Cho, Sung Yong; Baghdadi, Mohammed; Mahmoud, Saad; Pinheiro, Hugo; Traxer, Olivier

doi:10.1016/j.juro.2017.02.3371

Cited by 43 publications

(25 citation statements)

References 14 publications

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“…To our knowledge, the added value of laser lithotripsy in non-contact mode on ablation volume is reported for the first time. The only previous studies that are considered as non-contact lithotripsy were concerning the popcorn technique [14,15]. In comparison to our results, these authors found the highest efficiency with high energy and long pulse durations.…”

Section: Discussionsupporting

confidence: 51%

Ho:YAG laser lithotripsy in non-contact mode: optimization of fiber to stone working distance to improve ablation efficiency

Coninck

Keller

Chiron³

et al. 2018

World J Urol

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Purpose To evaluate how variable working distances between the laser fiber and the stone influence ablation volume. Methods A laser fiber was fixed on a robotic arm perpendicular to an artificial stone. A single laser pulse was triggered at different working distances (0-2.0 mm in 0.2 mm increments) between the distal fiber tip and the stone. To achieve a measurable impact, pulse energy was set to 2 and 3 J, with either short or long pulse duration. Ablation volume was calculated with an optical microscope. Experiments were repeated five times for each setting. Results Highest ablation volume was observed with a long pulse of 3 J at a working distance of 0.4 mm between the laser fiber and the stone surface (p value < 0.05). At 2 J, the highest ablation volume was noticed with a short pulse in contact mode. However, ablation volume of the latter was not significantly greater than with a long pulse of 2 J at a working distance of 0.4 mm (p value > 0.05). Compared to lithotripsy in contact mode, triggering a single long pulse at 0.4 mm increased ablation volume by 81% (p value = 0.016) at 2 J and by 89% (p value = 0.034) at 3 J. Conclusions For Ho:YAG laser lithotripsy, ablation volume may be higher in non-contact mode using long pulses, rather than in direct contact to the stone. Findings of the current study support the need of further studies of lithotripsy in noncontact mode.

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Section: Discussionsupporting

confidence: 51%

Ho:YAG laser lithotripsy in non-contact mode: optimization of fiber to stone working distance to improve ablation efficiency

Coninck

Keller

Chiron³

et al. 2018

World J Urol

Self Cite

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“…Two different techniques can be employed. One is the “pop-corn” technique, whose optimal settings have been confirmed by using a higher pulse energy (≈ 1.5 J), usually associated with a high-frequency (20–40 Hz), long-pulse mode, as well as a small-diameter laser fiber, and taking as much time as possible to produce clinically insignificant fragments [ 84 •]. The other one is the “pop-dusting” technique, quite similar to the pop-corn technique but using a lower pulse energy (0.5 J), resulting in finer fragments without compromising fiber tip burn-back [ 82 ].…”

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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“…Recently, Emiliani and colleagues found that high PE (1.5 J) and high pulse Fr (40 Hz) resulted in more efficient popcorning. They also found longer lithotripsy time (4 vs 2 min) and smaller laser fiber (273 vs 365 µm) led to higher fragmentation success, which was defined as 50% reduction of stone volume ( 25 ). So far, the optimal settings that result in fine fragments, as well as the effects on fluid dynamics and temperature changes to the surrounding tissue are not fully understood.…”

Section: Non-contact Laser Lithotripsymentioning

confidence: 99%

Holmium Laser Lithotripsy in the New Stone Age: Dust or Bust?

et al. 2017

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Modern day holmium laser systems for ureteroscopy (URS) provide users with a range of settings, namely pulse energy (PE), pulse frequency (Fr), and pulse width (PW). These variables allow the surgeon to choose different combinations that have specific effects on stone fragmentation during URS lithotripsy. Contact laser lithotripsy can be performed using fragmentation or dusting settings. Fragmentation employs settings of low Fr and high PE to break stones that are then extracted with retrieval devices. Dusting is the utilization of high Fr and low PE settings to break stones into submillimeter fragments for spontaneous passage without the need for basket retrieval. Use of the long PW mode during lithotripsy can reduce stone retropulsion and is increasingly available in new generation lasers. During non-contact laser lithotripsy, stone fragments are rapidly pulverized in a calyx in laser bursts that result in stones breaking into fine fragments. In this review, we discuss the effect of different holmium laser settings on stone fragmentation, and the clinical implications in a very much evolving field.

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Optimal Settings for the Noncontact Holmium:YAG Stone Fragmentation Popcorn Technique

Abstract: Higher energy, a longer pulse, frequencies higher than 10 Hz, a longer duration and a smaller laser fiber predict a popcorn technique that is more efficient at reducing stone volume.

Cited by 43 publications

References 14 publications

Ho:YAG laser lithotripsy in non-contact mode: optimization of fiber to stone working distance to improve ablation efficiency

Ho:YAG laser lithotripsy in non-contact mode: optimization of fiber to stone working distance to improve ablation efficiency

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

Holmium Laser Lithotripsy in the New Stone Age: Dust or Bust?

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