Thulium Laser in the Upper Urinary Tract: Does the Heat Generation in the Irrigation Fluid Pose a Risk? Evidence from an <i>In Vivo</i> Experimental Study

Kallidonis, Panagiotis; Kamal, Wissam; Panagopoulos, Vasilis; Vasilas, Marinos; Amanatides, E.; Kyriazis, Iason; Vrettos, Theofanis; Fligou, Fotini; Liatsikos, Evangelos

doi:10.1089/end.2015.0768

Cited by 27 publications

(13 citation statements)

References 17 publications

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“…There is mounting evidence concerning the potentially harming thermal side effects of Ho:YAG and Tm:YAG lasers in in vitro investigations, which leads to the question whether there might be a relevant temperature increase of the irrigation fluid during Tm:YAG laser-based procedures [11][12][13][14]. The present work´s objective was to investigate the thermal effect of a 120 W Tm:YAG laser in a standardized in vitro prostate simulation setting on the surrounding irrigation fluid (urethra), the prostate parenchyma and deeper anatomical structures like the neurovascular bundles.…”

Section: Discussionmentioning

confidence: 99%

“…The pathological mechanisms of atypical postoperative complications after transurethral LUTS treatment and transient urge incontinence-independently from the source of energy-are not entirely understood. In several recent in vitro and animal studies, significant temperature increases of the irrigation fluid were confirmed in both Ho:YAG-and Tm:YAG models [11][12][13][14][15][16]. A theoretically available laser power up to 200 W in ThuVA(R)P, besides a high tissue ablation efficiency, might bear a high risk for the development of significant temperature increases of the surrounding irrigation fluid and tissue.…”

Section: Introductionmentioning

confidence: 90%

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Thermal effects of thulium: YAG laser treatment of the prostate—an in vitro study

et al. 2021

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Purpose To objectively determine whether there is potential thermal tissue damage during Tm:YAG laser-based LUTS treatment. Methods Our experimental model was comprised of a prostatic resection trainer placed in a 37 °C water bath. In a hollowed-out central area simulating the urethral lumen, we placed a RigiFib 800 fibre, irrigation inflow regulated with a digital pump, and a type K thermocouple. A second thermocouple was inserted 0.5/1 cm adjacently and protected with an aluminum barrier to prevent it from urethral fluid. We investigated continuous and intermittent 120 W and 80 W laser application with various irrigation rates in eight measurement sessions lasting up to 14 min. Thermal measurements were recorded continuously and in real-time using MatLab. All experiments were repeated five times to balance out variations. Results Continuous laser application at 120 W and 125 ml/min caused a urethral ∆T of ~ 15 K and a parenchymal temperature increase of up to 7 K. With 50 ml/min irrigation, a urethral and parenchymal ∆T of 30 K and 15 K were reached, respectively. Subsequently and in absence of laser application, prostatic parenchyma needed over 16 min to reach baseline body temperature. At 80 W lower temperature increases were reached compared to similar irrigation but higher power. Conclusions We showed that potentially harming temperatures can be reached, especially during high laser power and low irrigation. The heat generation can also be conveyed to the prostate parenchyma and deeper structures, potentially affecting the neurovascular bundles. Further clinical studies with intracorporal temperature measurement are necessary to further investigate this potentially harming surgical adverse effect.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 90%

Thermal effects of thulium: YAG laser treatment of the prostate—an in vitro study

et al. 2021

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“…Specifically, thulium laser characteristics allow to obtain an optimal coagulative effect with a shallow penetration in the tissues. [21][22][23][24] Conclusion: Thulium laser can effectively coagulate endometriotic bleeding spots in residual ureteral tissue and could be used to control ureteral endometriosis with an endoscopic approach. However, a longer follow-up is needed.…”

Section: Thulium Laser Coagulation Of Residual Ureteral Endometriosismentioning

confidence: 99%

Videourology Abstracts

2019

Journal of Endourology

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Introduction: Holmium laser enucleation of the prostate (HoLEP) is a size-independent treatment for benign prostatic hyperplasia (BPH) with durable and excellent long-term outcomes. However, HoLEP is characterized by its steep learning curve. In this video, we introduce the challenges we faced during HoLEP, and describe the steps we took to overcome them. Methods: We obtained the Institutional Review Board approval before conducting our study. From October 2017 to October 2018, we prospectively video-recorded all HoLEP procedures, after obtaining patient's consent, performed at our institution. The cases were managed by a single surgeon (H.E). We used a 100 W Holmium:YAG laser (Lumenis, Yokneam, Israel) with a 550 çm laser fiber. A 28F continuous sheath resectoscope (Karl Storz, Germany) was also utilized. Video clips of the challenges we faced during HoLEP were extracted from the original recordings. The steps we took to address and overcome these difficulties were included in the video. Results: These challenges identified from the recordings include difficulty with positioning the patient, multinodular adenomas, HoLEP after previous BPH surgery, difficult tissue planes, and patients receiving anticoagulant therapy and blood thinners. We also present the obstacles of morcellation in the prostatic fossa, subtrigonal nodules, and the need for perineal urethrostomy. Addressed in this video are patients with urethral strictures before HoLEP, as well as precautions to avoid ureteral injuries. Conclusion: A concern surgeons have about performing HoLEP is the purported steep learning curve. This video attempts to bridge the gap for those performing HoLEP from novice to expert. In this video, we discussed structured techniques to overcome these difficulties, and ways to prevent serious mistakes.

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“…3 Thulium laser lithotripsy has recently undergone further improvements, especially Thulium fiber lasers (TFL), and has been extensively investigated in terms of dusting/ fragmenting efficiency, stone ablation threshold/rates, gas bubble formation, and collateral damage assessment. [4][5][6][7][8][9][10][11][12][13][14][15] Taratkin and colleagues showed that TFL and Ho:YAG have a similar temperature behavior at identical power settings. 15 Dornier MedTech Laser GmbH (Wessling, Germany) provided an evaluation model of a novel Thulium pulsed solid-state laser that should not be confused with a TFL.…”

Section: Introductionmentioning

confidence: 99%

Temperature Assessment of a Novel Pulsed Thulium Solid-State Laser Compared with a Holmium:Yttrium-Aluminum-Garnet Laser

Petzold

Suarez-Ibarrola

Miernik

2021

Journal of Endourology

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Purpose: To compare a novel Thulium laser device with the commonly used Holmium:Yttrium-Aluminum-Garnet (Ho:YAG) laser in terms of the in vitro temperatures generated. Methods: Our study investigated and compared an evaluation model of a solid-state Thulium laser with a Medilas H Solvo 35 Holmium laser device, both by Dornier (Dornier MedTech Laser GmbH, Wessling, Germany). Our in vitro model consisted of a 20 mL test tube placed in a 37°C water bath. Constant irrigation was set at 50 mL/minute with a Reglo Z Digital pump (Cole Parmer, Chicago, IL). Four hundred micrometers of Dornier laser fibers were used. The temperature was measured with a type K thermocouple and a real-time data logger from Pico (PICO Technology, Cambridgeshire, United Kingdom). Power settings between 2 and 30 W were investigated. Each measurement lasted 120 seconds and was repeated five times. The data were evaluated by MATLAB Ò (The Mathworks, Inc., Natick, MA). Results: The resulting temperatures were directly proportional to the power supplied. When comparing Holmium with Thulium, we observed maximum deviations of £0.82 K in temperatures at 120 seconds. The highest investigated laser power of 30 W yielded maximum temperatures differing by 6.7 K from the initial value. Out of the five comparisons, Thulium showed marginally yet significantly lower end temperatures in four cases and slightly lower cumulative equivalent minutes at 43°C (CEM 43) values in three cases. Conclusion: The Thulium laser resembles the Holmium device in the temperatures generated during in vitro application. An increase in laser power, thus, leads to equivalent increases in temperature that are largely independent of frequency, pulse duration, and single pulse energy. Pulsed Thulium:Yttrium-Aluminum-Garnet (Tm:YAG), Ho:YAG, and Thulium fiber laser seem to share a similar risk profile for patients in terms of temperature development. Intrarenal power outputs exceeding 10 W during clinical application should be compensated by ensuring sufficient irrigation.

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Thulium Laser in the Upper Urinary Tract: Does the Heat Generation in the Irrigation Fluid Pose a Risk? Evidence from an In Vivo Experimental Study

Abstract: The use of Tm:YAG in continuous mode with power settings up to 40 W and flow rates similar to those used in the clinical practice seemed to result in temperature increases in the irrigation fluid, which do not represent a risk for the renal tissue during the UT endoscopic surgery.

Cited by 27 publications

References 17 publications

Thermal effects of thulium: YAG laser treatment of the prostate—an in vitro study

Thermal effects of thulium: YAG laser treatment of the prostate—an in vitro study

Videourology Abstracts

Temperature Assessment of a Novel Pulsed Thulium Solid-State Laser Compared with a Holmium:Yttrium-Aluminum-Garnet Laser

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