The Effect of Laser Fiber Cleave Technique and Lithotripsy Time on Power Output

Peplinski, Brandon; Faaborg, Daniel; Miao, Edna; Alsyouf, Muhannad; Myklak, Kristene; Kelln, Wayne; Baldwin, D. Duane

doi:10.1089/end.2015.0835

Cited by 14 publications

(8 citation statements)

References 22 publications

(38 reference statements)

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“…Haddad et al evaluated the effects of different laser cleaving techniques on lithotripsy and found no significant clinical difference between techniques after 1 minute of lithotripsy. In a similar study, Peplinski et al noted variable initial power output with different cleave techniques; however, this difference disappeared after 3 minutes of use. In that study, larger fibers were noted to have more durable power output with time.…”

Section: Discussionmentioning

confidence: 84%

“…The effectiveness of several fiber‐cleaving devices has been evaluated in the urology literature relative to holmium:yttrium aluminum garnet lasers. Vassantachart et al compared different cleaving tools, and found the pen cleaving tool and scalpel resulted in better power output as compared to metallic scissors and a cleaving wheel.…”

Section: Discussionmentioning

confidence: 99%

“…Even with optimized laser settings, a common surgical observation is that performance is degraded by carbon debris that has accumulated on the fiber tip, resulting in increased vessel rupture instead of coagulation and increased time to ablate epithelial disease. To correct this, the fiber can be freshly cleaved to restore a clean and relatively flat tip surface that is perpendicular to the fiber axis; however, improper cleaving of the laser fiber tip can produce an irregular surface that negatively affects its optical properties and power output . The purpose of this study was to better quantify and understand the effects of carbon debris, optimal cleaving, and suboptimal cleaving on power output and beam characteristics and how these effects impact coagulation efficacy in a chorioallantoic membrane (CAM) model.…”

Section: Introductionmentioning

confidence: 99%

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Carbon debris and fiber cleaving: Effects on potassium‐titanyl‐phosphate laser energy and chorioallantoic membrane model vessel coagulation

et al. 2019

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Objectives/Hypothesis Photoangiolytic precision afforded by the 532‐nm potassium‐titanyl‐phosphate (KTP) laser relies on predictable energy delivery. Inadequate energy output can cause vessel rupture, and excessive energy can cause thermal damage. The quality of the cleaved surface and carbon deposits from ablated tissue are two factors that could negatively impact fiber performance. The effects of these on energy output and blood vessel coagulation were assessed using a chorioallantoic membrane (CAM) model. Study Design Comparative analysis. Methods Laser fibers with carbon debris, optimal fiber cleaving, and suboptimal cleaving were inspected at three times magnification, and the light dispersion pattern of each fiber was rated. The average energy output from consecutive pulses through each fiber configuration was recorded. The effect of these fiber conditions on clinical efficacy was estimated by measuring vessel coagulation versus rupture in the CAM model. Repeated measures analysis of variance compared results. Results Carbon debris and suboptimal cleaving resulted in decreased energy output in comparison to optimal cleaving ([−Δ244 mJ, d = 4.31, P < .001] and [−Δ195 mJ, d = 6.04, P < .001]). Optimal cleaving resulted in immediate coagulation of vessels. Fibers with suboptimal cleaving and carbon debris had unpredictable outcomes, requiring multiple pulses for coagulation or causing vessel rupture. Conclusions KTP laser fiber function is significantly affected by fiber tip condition. Carbon debris and suboptimal cleaving create significant attenuation of energy, which results in an unpredictable angiolytic effect, as demonstrated by increased vessel rupture in the CAM model. Optimal recleaving of KTP laser fibers restores prior energy output and predictable coagulation. Care should be taken to avoid carbon debris on laser‐fiber tips and to cleave fibers properly. Level of Evidence NA Laryngoscope, 129:2244–2248, 2019

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Carbon debris and fiber cleaving: Effects on potassium‐titanyl‐phosphate laser energy and chorioallantoic membrane model vessel coagulation

et al. 2019

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“…Another advantage of keeping the fibers coated is that most of these fibers are able to pass through all angles of deflections in most scopes, while stripped fibers cannot without being harmful to the scopes’ working channel [ 66 ]. However, there is also evidence that initial advantages of certain cleaving methods over another level themselves out and the fibers become quite similar in performance in the first minutes of lithotripsy, because of equal, short-term fiber degradation [ 65 , 67 , 68 •]. However, even over this topic, there is controversy among researchers, with some advocating against routine cleaving [ 67 ], others endorsing fiber tip preparation and renewal after 15 min or 10,000 J of laser emission, which is also important for reusable fibers [ 63 ••, 68 •, 69 ], while still others claim that stripped fibers achieve greater stone ablation [ 65 ].…”

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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“…Five kinds of fiber tips were compared: a new intact fiber, cleaved with ceramic scissors, cleaved with metallic scissors, first cleaved then stripped and first stripped then cleaved. The fibers were surgical scissors, scalpel, ceramic scissors and/or strippers have been used [5,6]. The aim of this study was to compare different methods of cleavage in order to improve the efficiency of the laser fibers in endourology.…”

Section: Introductionmentioning

confidence: 99%