The effect of laser fiber on the damage of the working channel of a flexible ureteroscope

Abstract

Introduction Flexible ureteroscopy involves expensive equipment that is expensive to repair. This study aimed to investigate the effects of cleavage by various tools on the laser fiber tip and to determine the extent of damage incurred to the laser passing through the working channel and firing at different degrees of deflection. Materials and methods We investigated the effect of cleavage on Lumenis Slimline reusable fibers (272 and 365 μm) as performed by four cleavage tools: a scribe pen, a surgical blade, suture scissors, and ceramic scissors. Following cleavage, we recorded the pattern of light dispersion and power output. The laser fibers passed through the working channel at various. Results The ceramic scissors provided the best pattern of light dispersion and the highest power output. The suture scissors provided unacceptable levels of light dispersion. The 272 μm fiber was able to pass through the working channel at 30 and 45 degrees of deflection. The 365 μm laser fiber was only able to pass through the working channel at 30 degrees of deflection. There was no breakage of the laser fiber at any of the degrees of deflection evaluated. Conclusions Analysis showed that the ceramic scissors were the best tool for cleaving Lumenis Slimline reusable fibers and that suture scissors were unacceptable. We also found that the deflection angle that causes damage to the working channel by laser insertion is dependent on both the size of the laser fiber and the degree of bending. Firing the laser during scope deflection could be performed safely at any degree of deflection, even with a high laser power of 40 W for a duration of 30 s

In vitro Comparison of the Mechanical and Optical Characteristics of 5 Disposable Flexible Ureteroscopes

“…The irrigation flow losses of the disposable devices were comparable. The working channel of the reusable device may have some effects on its surface after several procedures that caused the irrigation flow rates lower than the disposable device [ 18 ].…”

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

“…The latter is easily observable and well known by urologists and prompts possible additional manipulations to the laser fiber to compensate for the loss of fiber tip length [25]. These changes can be measured either by microscopic analysis of the laser fiber tip, by power output measurement, or by changes in the laser aiming beam quality [26 ▪ ]. The extent of energy transmission loss as well as fiber degradation length is highly variable and has been reported as difficult to predict in multiple studies [25,27,28].…”