The effect of prolonged laser activation on irrigation fluid temperature: an in vitro experimental study

Tsaturyan, Arman; Peteinaris, Angelis; Pantazis, Lampros; Farsari, E.; Pagonis, Konstantinos; Adamou, Constantinos; Vagionis, Athanasios; Natsos, Anastasios; Liatsikos, Evangelos; Kallidonis, Panagiotis

doi:10.1007/s00345-022-04000-8

Cited by 10 publications

(5 citation statements)

References 22 publications

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“…Consistently, Teng, J et al [23] found that a ow of 15 mL/min can prevent temperature rise above 43ºC in human fURS with laser settings up to 20W. In an vitro model, we also found that a ow of 20 mL/min can prevent dangerous temperature rise with laser settings up to 60W [24]. Furthermore, our group has also shown that high-power lithotripsy with 60W can be safely performed in a porcine model without reaching dangerous temperatures using a manual pumping irrigation system and a UAS [10].…”

Section: Discussionsupporting

confidence: 87%

Determinants of outflow rate during flexible ureteroscopy: an experimental in vivo study in an anesthetized porcine model

Faria-Costa

Tsaturyan

Peteinaris

et al. 2022

Preprint

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Purpose: To evaluate the effect of different ureteroscope positions, saline pumping frequency, laser fiber diameter and ureteral access sheath (UAS) on outflow rate during flexible ureteroscopy (fURS). Material and Methods: This study was performed in an anesthetized porcine model. The fURS setup included a manual pumping system, a 9.5Fr single used-digital flexible ureteroscope and a ureteral access sheath (UAS). Outflow was collected and measured from the UAS during 1 minute in all experimental settings. The evaluated variables were the position of the ureteroscope, the pumping frequency (2s, 3s or 5s), the diameter of the used UAS (12/14Fr or 14/16Fr) and laser fiber (200 μm or a 272 μm). Results: Ureteroscope position in the lower calyx was associated with significantly lower outflow rate (p<0.05). The use of the 14/16Fr UAS resulted in improved flow in the renal pelvis and upper calyx (p<0.05) but not in the lower calyx. The use of a 200 μm laser fiber only improved flow in the upper calyx and when a 14/16Fr UAS was being used.Pumping frequency did not show a significant correlation with outflow rate.Conclusions: The ureteroscope positioning and UAS size were important determinants of outflow rate during fURS, while laser fiber diameter had a limited effect. In the lower calyx the outflow was minimal and was not improved by using a larger UAS.

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Section: Discussionsupporting

confidence: 87%

Determinants of outflow rate during flexible ureteroscopy: an experimental in vivo study in an anesthetized porcine model

Faria-Costa

Tsaturyan

Peteinaris

et al. 2022

Preprint

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“…Their work sought to adapt their previous findings to an in vivo porcine model and found that temperatures capable of tissue damage were easily achieved but can be negated by increasing irrigation flow rate 15 . Other labs have also evaluated irrigation rates and have determined that increased irrigation rates can mitigate temperature increases during active lasing, as too can the use of a UAS [16][17][18] .…”

Section: Discussionmentioning

confidence: 99%

Turning up the HEAT: Surgical simulation of the Moses 2.0 laser in an anatomic model

Wanderling,

Saxton,

Phan

et al. 2024

CUAJ

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Introduction: With advancements in laser technology, urologists have been able to treat urinary calculi more efficiently by increasing the energy delivered to the stone. With increases in power used, there is an increase in temperatures generated during laser lithotripsy. The aim of this study was to evaluate the thermal dose and temperatures generated with four laser settings at a standardized power in a high-fidelity, anatomic model. Methods: Using high-fidelity, 3D printed hydrogel models of a pelvicalyceal collecting system with a synthetic BegoStone implanted in the renal pelvis, surgical simulation of ureteroscopic laser lithotripsy was performed with the Moses 2.0 holmium laser. At a standard power (40 W) and irrigation pressure (100 cm H2O), we evaluated operator duty cycle (ODC) variations with different time-on intervals at four different laser settings. Temperature was measured at two separate locations: at the stone and ureteropelvic junction. Results: Greater cumulative thermal doses and maximal temperatures were achieved with greater ODCs and longer laser activation periods. There were statistically significant differences between the thermal doses and temperature profiles of the laser settings evaluated. Temperatures were greater closer to the tip of the laser fiber. Conclusions: Laser energy and frequency play an important role in the thermal loads delivered during laser lithotripsy. Urologists must perform laser lithotripsy cautiously when aggressively treating large renal pelvis stones, as dangerous temperatures can be reached. To reduce the risk of causing thermal tissue injury, urologists should consider reducing their ODC and laser-on time.

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“…In the same scenario, but with an irrigation of 8 mL/s, the peak temperature was 37.4°C [ 18 ]. Another in vitro assessment showed that fluid outflow rates of 20 and 30 mL/min were sufficient to maintain the temperature below the threshold (43°C) when using 40 W and 60 W in an intermittent activation fashion [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Temperature effect of Moses (TM) 2.0 during flexible ureteroscopy: an in vitro assessment

2023

Cent European J Urol

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Introduction One of the main issues related to the use of high-power lasers is the associated rise in temperature. The aim of this study was to characterize temperature variations with activation of the Moses™ 2.0 laser. Material and methods An in vitro experimental study was designed using a high-fidelity uretero-nephroscope simulation model to assess changes in temperature during intracorporeal laser lithotripsy. Renal and ureteral temperature records were obtained from the treatment of BegoStones positioned in the renal pelvis. Different laser settings over three time periods and two possible irrigation flow speeds were evaluated. We considered 43°C as the threshold since it is associated with denaturation of proteins. The Wilcoxon–Mann–Whitney test was used to assess quantitative variables and the Kruskal–Wallis test for categorical variables. Results The highest increase in intrarenal temperature was reached with 30 seconds of laser activation at a laser setting of 0.5 J/100 Hz (50 W) and a flow of 10 mL/min. Only 15 seconds of activation was sufficient for most settings to exceed 43°C. The ureteral temperature did not increase significantly, regardless of the combination of laser setting, time, or irrigation flow, except when 30 W was used for a 30 second period. Multivariate analysis showed that an irrigation flow of 20 mL/min produced an intrarenal temperature decrease of 4.7–9.2°C (p <0.001). Conclusions Use of high-power lasers, both for the ureter and kidney, should involve consideration of temperature increases evidenced in this study, due to the potential biological risk entailed.

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The effect of prolonged laser activation on irrigation fluid temperature: an in vitro experimental study

Cited by 10 publications

References 22 publications

Determinants of outflow rate during flexible ureteroscopy: an experimental in vivo study in an anesthetized porcine model

Determinants of outflow rate during flexible ureteroscopy: an experimental in vivo study in an anesthetized porcine model

Turning up the HEAT: Surgical simulation of the Moses 2.0 laser in an anatomic model

Temperature effect of Moses (TM) 2.0 during flexible ureteroscopy: an in vitro assessment

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