Advanced Laser Mode for Ureteroscopic Lithotripsy Applications

Abstract

The higher annual growth rate of kidney stone disease occurrence and the lower annual growth rate of practicing urologists require more efficient treatment tools. This chapter’s research explores ways to increase laser lithotripsy stone ablation efficiency while reducing the stone retropulsion so that the stone procedure time can be effectively shortened. It covers the investigation of laser stone ablation threshold, ablation efficiency, retropulsion control, and the optimal dusting mode of a concept Holmium-doped yttrium aluminum garnet (Ho:YAG) laser with advanced tailored pulse technology to produce a high ablation rate and low retropulsion. Ho:YAG laser stone damage and recoil movement were investigated in vitro utilizing a tabletop model in a highly reproducible manner while evaluating the effects of several laser mode pulses. A thorough evaluation of the pseudo-optimal dusting mode’s behavior (dusting rate and recoil movement) against a standard laser dusting mode was performed. The optimal dusting mode in this benchtop test model maintained a modest level of retropulsion while having a somewhat quick ablation rate. The transient pressure field measurement results of the standard and custom laser modes of a concept Ho: YAG laser are also included.