What is the impact of pulse modulation technology, laser settings and intraoperative irrigation conditions on the irrigation fluid temperature during flexible ureteroscopy? An in vivo experiment using artificial stones

Peteinaris, Angelis; Pagonis, Konstantinos; Vagionis, Athanasios; Adamou, Constantinos; Tsaturyan, Arman; Martínez, Begoña Ballesta; Karpetas, Georgios; Farsari, E.; Liatsikos, Evangelos; Kallidonis, Panagiotis

doi:10.1007/s00345-022-04002-6

Cited by 16 publications

(11 citation statements)

References 16 publications

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“…The most efficient and safest combination of laser settings and parameters for laser activation inside the pelvicalyceal system has been investigated in many in vitro and in vivo studies [ 13 , 14 ]. Regarding the Ho:YAG laser, recent studies have demonstrated that high-power laser lithotripsy can be conducted safely if the irrigation flow is sufficient [ 6 , 15 ]. 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 ].…”

Section: Discussionmentioning

confidence: 99%

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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%

“…Female pigs were selected because endoscopic access to the pelvicalyceal system is easier to perform. The ureteral catheterization was conducted as described in a previous study of our experimental team [ 6 ]. After the insertion of the ureteral catheter, each pig was moved into the prone position.…”

Section: Methodsmentioning

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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“…It has demonstrated that using a UAS and arti cial perfusion is the safest method to prevent heat damage to the kidney during surgery. 14 However, NoureldinY A, et al found in their study that arti cial perfusion signi cantly increased the maximum intrarenal pressure during retrograde intrarenal surgery (RIRS), which can be hazardous for the patient. Additionally, the size of the UAS was found to be a factor, with larger sheaths being associated with lower maximum pressure in the renal pelvis.…”

Section: Discussionmentioning

confidence: 99%

“…In the study conducted by Peteinaris A, Pagonis K, and Vagionis, it was observed that the use of a high-power Ho: YAG laser under gravity perfusion can lead to destructive thermal damage to the kidney, even with enough uid irrigation. 14 Additionally, the use of a higher laser power results in increased heat production, which necessitates increased uid perfusion. Consequently, increasing the height of the saline bag to enhance perfusion ow or utilizing a larger ureteral access sheath (UAS) with a smaller scope to increase perfusion out ow may be considered.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the safety and efficiency of flexible ureteroscopy with the different hanged water heights in a kidney model

Jiang¹,

Bai²,

Zhang³

et al. 2023

Preprint

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Objective To develop an in vitro model of the renal pelvis to compare intrarenal pressure(IRP) and irrigation flow at various suspended water heights during flexible ureteroscopy (fURS).Methods A 100 mL saline bag was used to simulate the renal pelvis. The fURS sheath was connected to the bag and the ureteric access sheath (UAS) was positioned at the junction of the ureteropelvic region. Central venous pressure tubing was connected to monitor the pressure in the renal pelvis under different conditions. Two different sheath sizes (12Fr and 14Fr) were tested with fURS sizes of 7.5, 8.5, and 9.5Fr, respectively. The perfusion method was gravity based, and the hanging water heights were set at 60, 90, 120, 150, and 180 cm. A separate manual pumping group was also measured.Results In the group using a 12Fr sheath, the use of a 9.5Fr flexible ureteroscope without accessories resulted in a minimum gravity perfusion pressure of 8.4 cmH2O and a maximum pressure of 17.5cmH2O. However, manually administering perfusion in the pelvis produced pressures exceeding 60cmH2O. When the fURS was employed with a 200um laser fiber within the same sheath size, the minimum pressure of gravity perfusion decreased to 6.4cmH2O, and the maximum pressure was 10.5cmH2O. The IRP reached 48cmH2O while hand pumping. In the 14Fr sheath group, while using a 9.5Fr fURS, minimum and maximum gravity perfusion pressures were 2.5cmH2O and 6.0cmH2O, respectively. In contrast, manual perfusion resulted in a pressure of 17cmH2O. For the 12Fr sheath group using a 7.5Fr fURS, the minimum pressure of gravity perfusion was 5.4cmH2O, the maximum was 8.2H2O, and renal pelvic pressure during manual perfusion was 25.5cmH2O.Conclusion It is safe and efficient to hang the water at different heights during the operation of the disposable ureteroscopy to maintain low and safe IRP when using a UAS.

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“…Increasing the inflow also help the operator to maintain reasonable IRT, but, as said before, with a risk of high IRP and specific complications. Over the past two years, several preclinical studies reported safe IRT level, using 8 W and 20 W maximum power without and with gravity-based irrigation on ex vivo porcine model [45,46]. An in vitro pediatric simulation demonstrated possible risk of thermally-induced tissue damage when using >20 W with irrigation at 5 ml/min, while in an ureter model, setting power at 10 W and irrigation at 10 ml/min maintained stable temperature irrespective of firing duration with Ho:YAG [47,48].…”

Section: Laser Settingsmentioning

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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What is the impact of pulse modulation technology, laser settings and intraoperative irrigation conditions on the irrigation fluid temperature during flexible ureteroscopy? An in vivo experiment using artificial stones

Cited by 16 publications

References 16 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

Comparison of the safety and efficiency of flexible ureteroscopy with the different hanged water heights in a kidney model

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

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