Thermal Injury and Laser Efficiency with Holmium YAG and Thulium Fiber Laser—An <i>In Vitro</i> Study

Sierra, Alba; Corrales, Mariela; Kolvatzis, Merkourios; Panthier, F.; Piñero, A.; Traxer, Olivier

doi:10.1089/end.2022.0216

Cited by 26 publications

(19 citation statements)

References 28 publications

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“…Similarly, it has been shown that a decrease in the irrigation flow and the absence of a ureteral access sheath during TFL activation can increase the temperature to levels that possibly cause renal thermal damage [ 3 , 16 ]. Higher frequency settings are related to ureteral thermal damage, especially when used by inexperienced surgeons [ 17 ]. Despite numerous studies conducted in this field, further investigation is needed to clarify the safety of these continuously developing laser devices.…”

Section: Discussionmentioning

confidence: 99%

High-power laser lithotripsy – do we treat or harm? Histological evaluation of temperature effects in an in vivo study with thulium fibre laser

2023

Cent european J Urol

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Introduction The aim of this study was to evaluate the possible histopathological alterations that occur in the kidneys due to a continuous temperature increase above 43°C for one hour of lithotripsy using a newly introduced thulium fiber laser (TFL). Material and methods Two female pigs were used. After the insertion of a 9.5/11.5 ureteral access sheath, flexible ureteroscopy and laser lithotripsy for one hour were conducted. A TFL laser with a 200-μm fiber was used. The power setting used was 8 W (0.5 J × 16 Hz). A K-type thermocouple was inserted and fixed in the upper calyx of the right porcine kidney to record the temperature in the pelvicalyceal system during the laser activation. Second-look flexible nephroscopy followed by nephrectomy and pathohistological evaluation of the operated kidney was performed one week after the procedure in the first pig and 2 weeks after the surgery in the second pig. Results Flexible nephroscopy did not reveal significant differences between the 2 porcine kidneys. Nevertheless, the histopathological report demonstrated severe alterations in the kidney of the first pig. Mild changes were reported in the kidney of the second pig. A significant improvement in inflammation and haemorrhagic lesions was demonstrated when comparing the 2 kidneys. Conclusions The difference demonstrated between the 2 kidneys based on the histopathological report shows that the healing process is capable of improving severe to mild alterations within a one-week time frame. Two weeks after the surgery, only minor changes were observed, suggesting that even temperature increases above the threshold can be tolerated regarding renal damage.

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Section: Discussionmentioning

confidence: 99%

High-power laser lithotripsy – do we treat or harm? Histological evaluation of temperature effects in an in vivo study with thulium fibre laser

2023

Cent european J Urol

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“…Burst laser lithotripsy with high frequencies (>30 Hz) with ODC >50% are suggested to increase IRT and thermal dose whereas low power-low frequencies and continuous activation do not expose to thermal damage [56]. Moreover, maintaining low power settings in narrow volumes (minor calyxes or ureter) helps to avoid direct thermal damage and to reduce the irrigation flow, lowering IRP as a consequence [34,58].…”

Section: Discussionmentioning

confidence: 99%

“…This could lead to direct (mucosae laser injuries) and indirect (thermal) damages [33 & ]. Regarding the direct thermal injuries, Sierra et al reported in an in vitro ureter model a higher risk ureteral lesion using high frequencies or energies, and for a young practitioner [34]. Considering the indirect thermal damage of the tissues, two aspects are mandatory: the IRT level and the thermal dose (IRT elevation duration) [33 & ].…”

Section: Temperaturementioning

confidence: 99%

Retrograde intra renal surgery and safety: pressure and temperature. A systematic review

Panthier

Pauchard

Traxer

2023

Current Opinion in Urology

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Purpose of reviewRetrograde intra renal surgery (RIRS) with laser lithotripsy represents the gold-standard to treat renal stones up to 20 mm. Controlling intraoperative parameters such as intrarenal pressure (IRP) and temperature (IRT) is mandatory to avoid complications. This article reviews advances in IRP and IRT over the last 2 years. Recent findingsWe conducted a PubMed/Embase search and reviewed publications that include temperature and pressure during RIRS. Thirty-four articles have been published which met the inclusion criteria. Regarding IRP, a consensus has emerged to control IRP during RIRS, in order to avoid (barotraumatic and septic) complications. Several monitoring devices are under evaluation but none of them are clinically approved for RIRS. Ureteral access sheath, low irrigation pressure and occupied working channel help to maintain a low IRP. Robotic systems and suction devices would improve IRP intraoperative management and monitoring. IRT determinants are the irrigation flow and laser settings. Low power settings(<20 W) with minimal irrigation flow (5--10 ml/min) are sufficient to maintain low IRT and allows continuous laser activation. SummaryRecent evidence suggests that IRP and IRT are closely related. IRP depends on inflow and outflow rates. Continuous monitoring would help to avoid surgical and infectious complications. IRT depends on the laser settings and the irrigation flow.

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“…Finally, a recent study also showed that any kind of glasses can protect the surgeon from eye lesions [66,67]. Although the use of prescription glasses has also reported only partial eye protection [68]…”

Section: Thulium Laser Fibermentioning

confidence: 99%

“…Concerns regarding intrarenal temperature with the use of HP have raised [35][36][37] and more studies are needed to find the limits to avoid the potential damage [38][39] especially when treating ureteral stones [40][41][42]. For this issue, temperature sensors have been proposed [43].…”

Section: Disadvantagesmentioning

confidence: 99%

Lasers for stone lithotripsy: advantages/disadvantages of each laser source

Emiliani

Kanashiro

Angerri

2023

Current Opinion in Urology

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The purpose of this article was to make a narrative review of the literature in search of all articles regarding thulium:yttrium-aluminium-garnet (YAG), thulium laser fiber (TFL) and holmium:YAG (Ho:YAG) for lithotripsy from 2020 to 2023. A selection of articles of special interest and best evidence was made in order to give a better perspective on their advantages and disadvantages. Recent findingsNew Ho:YAG technologies of as high power, high frequency and pulsed modulations have shown promising results for lithotripsy by reducing retropulsion with good ablation efficiency. High peak power makes it particularly good for percutaneous nephrolithotomy. High intrarenal temperatures and correct setting are still concerning points. TFL has arrived to be one of the main players in flexible ureteroscopy. Being highly efficient and quick, and by producing micro-dusting the laser is quickly heading to become a gold standard. The new pulsed Thulium YAG is the newest laser. For now, only in-vitro studies show promising results with efficient lithotripsy. As the peak power lies between Ho:YAG and TFL it may be able to adequately perform when needing and low power lithotripsy. SummarySeveral new technologies have been developed in the last years for stone lithotripsy. All being efficient and safe if well used. Different advantages and disadvantages of each laser must be taken into consideration to give each laser the proper indication.

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Thermal Injury and Laser Efficiency with Holmium YAG and Thulium Fiber Laser—An In Vitro Study

Cited by 26 publications

References 28 publications

High-power laser lithotripsy – do we treat or harm? Histological evaluation of temperature effects in an in vivo study with thulium fibre laser

High-power laser lithotripsy – do we treat or harm? Histological evaluation of temperature effects in an in vivo study with thulium fibre laser

Retrograde intra renal surgery and safety: pressure and temperature. A systematic review

Lasers for stone lithotripsy: advantages/disadvantages of each laser source

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