Assessing critical temperature dose areas in the kidney by magnetic resonance imaging thermometry in an ex vivo Holmium:YAG laser lithotripsy model

Wriedt, Robert; Yılmaz, Mehmet Emin; Lottner, Thomas; Reichert, Andreas; Wilhelm, Konrad; Pohlmann, Philippe-Fabian; Gratzke, Christian; Bock, Michael; Miernik, Arkadiusz

doi:10.1007/s00345-022-04255-1

Cited by 3 publications

(3 citation statements)

References 31 publications

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“…Their work sought to adapt their previous findings to an in vivo porcine model and found that temperatures capable of tissue damage were easily achieved but can be negated by increasing irrigation flow rate 15 . Other labs have also evaluated irrigation rates and have determined that increased irrigation rates can mitigate temperature increases during active lasing, as too can the use of a UAS [16][17][18] .…”

Section: Discussionmentioning

confidence: 99%

Turning up the HEAT: Surgical simulation of the Moses 2.0 laser in an anatomic model

Wanderling,

Saxton,

Phan

et al. 2024

CUAJ

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Introduction: With advancements in laser technology, urologists have been able to treat urinary calculi more efficiently by increasing the energy delivered to the stone. With increases in power used, there is an increase in temperatures generated during laser lithotripsy. The aim of this study was to evaluate the thermal dose and temperatures generated with four laser settings at a standardized power in a high-fidelity, anatomic model. Methods: Using high-fidelity, 3D printed hydrogel models of a pelvicalyceal collecting system with a synthetic BegoStone implanted in the renal pelvis, surgical simulation of ureteroscopic laser lithotripsy was performed with the Moses 2.0 holmium laser. At a standard power (40 W) and irrigation pressure (100 cm H2O), we evaluated operator duty cycle (ODC) variations with different time-on intervals at four different laser settings. Temperature was measured at two separate locations: at the stone and ureteropelvic junction. Results: Greater cumulative thermal doses and maximal temperatures were achieved with greater ODCs and longer laser activation periods. There were statistically significant differences between the thermal doses and temperature profiles of the laser settings evaluated. Temperatures were greater closer to the tip of the laser fiber. Conclusions: Laser energy and frequency play an important role in the thermal loads delivered during laser lithotripsy. Urologists must perform laser lithotripsy cautiously when aggressively treating large renal pelvis stones, as dangerous temperatures can be reached. To reduce the risk of causing thermal tissue injury, urologists should consider reducing their ODC and laser-on time.

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Section: Discussionmentioning

confidence: 99%

Turning up the HEAT: Surgical simulation of the Moses 2.0 laser in an anatomic model

Wanderling,

Saxton,

Phan

et al. 2024

CUAJ

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“…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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“…Wriedt et al [ 20 ] evaluated tissue heating with magnetic resonance imaging in an ex vivo porcine kidney model using different lithotripsy parameters. The authors reported that an irrigation rate of at least 70 ml/min is necessary to avoid exceeding 120 min CEM 43 when using a laser application of 30 W for 10 s. Additionally, they observed a focal temperature rise on the calyx wall in experiments with human stones, which they attributed to non-elimination of heated fragmented stone pieces from the surgical area in the kidney.…”

Section: Literature Reviewmentioning

confidence: 99%

The heat is on: the impact of excessive temperature increments on complications of laser treatment for ureteral and renal stones

Tonyali,

von Bargen,

Ozkan

et al. 2023

World J Urol

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Objective Technological advancements in the field of urology have led to a paradigm shift in the management of urolithiasis towards minimally invasive endourological interventions, namely ureteroscopy and percutaneous nephrolithotomy. However, concerns regarding the potential for thermal injury during laser lithotripsy have arisen, as studies have indicated that the threshold for cellular thermal injury (43 °C) can be exceeded, even with conventional low-power laser settings. This review aims to identify the factors that contribute to temperature increments during laser treatment using current laser systems and evaluate their impact on patient outcomes. Materials and methods To select studies for inclusion, a search was performed on online databases including PubMed and Google Scholar. Keywords such as 'temperature' or 'heat' were combined with 'lithotripsy', 'nephrolithotomy', 'ureteroscopy', or 'retrograde intrarenal surgery', both individually and in various combinations. Results Various strategies have been proposed to mitigate temperature rise, such as reducing laser energy or frequency, shortening the duration of laser activation, increasing the irrigation fluid flow rate, and using room temperature or chilled water for irrigation. It is important to note that higher irrigation fluid flow rates should be approached cautiously due to potential increases in intrarenal pressure and associated infectious complications. The utilization of a ureteral access sheath (UAS) may offer benefits by facilitating irrigation fluid outflow, thereby reducing intrapelvic pressure and intrarenal fluid temperature. Conclusion Achieving a balance between laser power, duration of laser activation, and irrigation fluid rate and temperature appears to be crucial for urologists to minimize excessive temperature rise.

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Assessing critical temperature dose areas in the kidney by magnetic resonance imaging thermometry in an ex vivo Holmium:YAG laser lithotripsy model

Cited by 3 publications

References 31 publications

Turning up the HEAT: Surgical simulation of the Moses 2.0 laser in an anatomic model

Turning up the HEAT: Surgical simulation of the Moses 2.0 laser in an anatomic model

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

The heat is on: the impact of excessive temperature increments on complications of laser treatment for ureteral and renal stones

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