Thulium fiber laser ablation of kidney stones using a 50-μm-core silica optical fiber

Blackmon, Richard L.; Hutchens, Thomas C.; Hardy, Luke A.; Wilson, Christopher R.; Irby, Pierce B.; Fried, Nathaniel M.

doi:10.1117/1.oe.54.1.011004

Cited by 40 publications

(33 citation statements)

References 23 publications

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“…12 The TFL infrared wavelength of 1908 nm is also four times more strongly absorbed by the water component in tissue than the conventional holmium laser wavelength of 2120 nm, corresponding to an optical penetration depth four times less than for the holmium laser. Thulium fiber lasers (TFL) are capable of delivering sufficient power (>10 W) through small (50-and 100-μm core) optical fibers for tissue ablation.…”

Section: Thulium Fiber Lasermentioning

confidence: 98%

Thulium fiber laser recanalization of occluded ventricular catheters in an ex vivo tissue model

et al. 2017

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Hydrocephalus is a chronic medical condition that occurs in individuals who are unable to reabsorb cerebrospinal fluid (CSF) created within the ventricles of the brain. Treatment requires excess CSF to be diverted from the ventricles to another part of the body, where it can be returned to the vascular system via a shunt system beginning with a catheter within the ventricle. Catheter failures due to occlusion by brain tissues commonly occur and require surgical replacement of the catheter. In this preliminary study, minimally invasive clearance of occlusions is explored using an experimental thulium fiber laser (TFL), with comparison to a conventional holmium: yttrium aluminium garnet (YAG) laser. The TFL utilizes smaller optical fibers ( < 200 - ? m OD) compared with holmium laser ( > 450 - ? m OD), providing critical extra cross-sectional space within the 1.2-mm-inner-diameter ventricular catheter for simultaneous application of an endoscope for image guidance and a saline irrigation tube for visibility and safety. TFL ablation rates using 100 - ? m core fiber, 33-mJ pulse energy, 500 - ? s pulse duration, and 20- to 200-Hz pulse rates were compared to holmium laser using a 270 - ? m core fiber, 325-mJ, 300 - ? s , and 10 Hz. A tissue occluded catheter model was prepared using coagulated egg white within clear silicone tubing. An optimal TFL pulse rate of 50 Hz was determined, with an ablation rate of 150 ?? ? m / s and temperature rise outside the catheter of ? 10 ° C . High-speed camera images were used to explore the

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Section: Thulium Fiber Lasermentioning

confidence: 98%

Thulium fiber laser recanalization of occluded ventricular catheters in an ex vivo tissue model

et al. 2017

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“…OCT characterization of stone ablation crater dimensions is a common technique in the field. 19,[22][23][24] The OCT system operated at a center wavelength of 930 nm, with spectral bandwidth of 100 nm, and axial and lateral resolutions in air of 7 and 8 μm, respectively. Stone ablation crater volume, surface area, and depth were calculated from OCT data, as well as major and minor axis ratio, to determine ablation characteristics and analyze whether automated vibration produces a dusting-like ablation technique.…”

Section: System Characterizationmentioning

confidence: 99%

“…15,16 One TFL advantage is that the light originates within a small (18-to 25-μm core) thuliumdoped silica fiber, so the emitted light can be coupled into smaller (50-, 100-, or 150-μm-core surgical fibers) than used with the standard holmium laser (≥200-μm core). [17][18][19] These smaller fibers are more flexible and consume less cross-sectional space within the single working channel of the ureteroscope, thus yielding improved ureteroscope flexion and higher saline irrigation rates. These fiber characteristics (e.g., smaller diameter and less rigidity) are attractive for integration into a vibrating fiber system for potential use in laser lithotripsy in dusting mode.…”

Section: Introductionmentioning

confidence: 99%

Thulium fiber laser ablation of kidney stones using an automated, vibrating fiber

2019

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Our preliminary study investigates an automated, vibrating fiber optic tip for dusting of kidney stones during thulium fiber laser (TFL) lithotripsy. A (0.75-mm diameter and 5-mm length) magnetic bead was attached to the fiber jacket, centered 2 cm from distal fiber tip. A solenoid was placed parallel to the fiber with a 0.5-mm gap between solenoid and magnetic bead on fiber. The solenoid was used to create a magnetic force on the bead, inducing fiber vibration. Calibration tests for fiber motion in both air and water were performed. The ablation crater characteristics (surface area, volume, depth, and major/minor axis) of uric acid stones were measured using optical coherence tomography, after delivery of 1500 TFL pulses at 1908 nm, 33 mJ, 500 μs, and up to 300 Hz, through 50-, 100-, and 150-μm-core fibers. The resonant frequency was dependent on fiber diameter and rigidity, with a cutoff pivot point for optimum vibration amplitude at 4 cm. Maximum fiber displacement is about 1 mm in water and 4 mm in air. For 50-, 100-, and 150-μm-core fibers, ablated surface area averaged 1.7, 1.7, and 2.8 times greater with vibrating fiber than fixed fiber, respectively. For these fibers, ablation volume averaged 1.1, 1.5, and 1.1 times greater with vibrating fiber than fixed fiber, given a fixed energy per pulse, respectively. Our preliminary study demonstrates the functionality of an automated, vibrating fiber system for stone "dusting," with significantly larger surface area but similar ablation volumes as a fixed fiber. Future studies will focus on optimization of fiber parameters (especially displacement) and miniaturization of system components to facilitate integration into ureteroscopes.

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“…TFL kidney stone ablation rates have recently been shown to scale linearly with pulse rate, and when operated at pulse rates up to 500 Hz, the TFL is capable of rapid stone ablation . The excellent, near‐single mode TFL beam profile also provides transmission of higher laser power through smaller (e.g., 50 and 100‐μm‐core), more flexible fibers than currently used in the clinic, thus enabling maximal ureteroscope deflection, and freeing up valuable space for increased saline irrigation or simultaneous use of endoscopic tools within the single dedicated working channel of the flexible ureteroscope .…”

Section: Introductionmentioning

confidence: 99%

Collateral damage to the ureter and Nitinol stone baskets during thulium fiber laser lithotripsy

et al. 2015

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Thulium fiber laser ablation of kidney stones using a 50-μm-core silica optical fiber

Cited by 40 publications

References 23 publications

Thulium fiber laser recanalization of occluded ventricular catheters in an ex vivo tissue model

Thulium fiber laser recanalization of occluded ventricular catheters in an ex vivo tissue model

Thulium fiber laser ablation of kidney stones using an automated, vibrating fiber

Collateral damage to the ureter and Nitinol stone baskets during thulium fiber laser lithotripsy

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