Chilled Irrigation for Control of Temperature Elevation During Ureteroscopic Laser Lithotripsy:<i>In Vivo</i>Porcine Model

Dau, Julie J; Khajeh, Nikta Rezakahn; Hall, Timothy L.; Roberts, William W.

doi:10.1089/end.2021.0537

Cited by 10 publications

(3 citation statements)

References 28 publications

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“…An alternative to increasing the irrigation rate in order to maintain safe temperatures in the renal pelvis is to avoid prewarmed irrigation fluids. Instead, one should consider keeping irrigation fluid at room temperature, or even cooled, when laser lithotripsy is performed [31].…”

Section: Discussionmentioning

confidence: 99%

Temperature profiles during ureteroscopy with thulium fiber laser and holmium:YAG laser: Findings from a pre-clinical study

Æsøy

Juliebø‐Jones

Beisland

et al. 2022

Scandinavian Journal of Urology

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Objective: The aim of this study was to investigate temperature profiles in both the renal pelvis and parenchyma during Thulium Fiber Laser (TFL) and Holmium:yttrium-aluminium-garnet (Ho:YAG) laser activation in an ex-vivo porcine model. Methods: Three porcine kidneys with intact renal pelvis and proximal ureters were used in the study. A temperature sensor was inserted through a nephrostomy tube into the renal pelvis and a second sensor was inserted directly into the renal parenchyma. Temperatures were recorded during continuous laser activation for 180 s, and for an additional 60 s after deactivation. TFL (150 lm and 200 lm) and Ho:YAG (270 lm) laser delivered power at settings of 2.4 W, 8 W, 20 W and 30 W. Results: Intrapelvic temperatures correlated directly to power settings. Higher power produced higher temperatures. For example, using a 150 lm fiber at 2.4 W resulted in a 2.6 C rise from baseline (p ¼ 0.008), whereas using the same fiber at 20 W produced a rise in temperature of 19.9 C (p ¼ 0.02). Larger laser fibers caused significantly higher temperatures compared to smaller fibers using equivalent power settings, e.g. mean temperature at 20 W using 150 lm was 39.6 C compared to 44.9 C using 200 lm, p < 0.001. There was a significant increase in parenchymal temperatures when applying 20 W and 30 W of laser power with the two larger fibers. Conclusion:In this ex-vivo study, renal temperatures correlated directly to power settings. Higher power produced higher temperatures. Furthermore, larger laser fibers caused higher temperatures. These findings could help guide selection of safe power settings for ureteroscopic lithotripsy, but future clinical studies are needed for confirmation.

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Section: Discussionmentioning

confidence: 99%

Temperature profiles during ureteroscopy with thulium fiber laser and holmium:YAG laser: Findings from a pre-clinical study

Æsøy

Juliebø‐Jones

Beisland

et al. 2022

Scandinavian Journal of Urology

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“…In this sense, intra-renal temperature and pressure are twinned, and the user has to balance the equilibrium between the two. The use of chilled irrigation has been trialled in live pig setting and was found to delay the impact of thermal injury without affecting core body temperature, but no human studies exist to date [ 17 ]. If a reusable laser fibre is used, the tip (distal 2–5 cm) may need to be cut, to remove the most fragile part of the laser from the current procedure, to prepare it for the next procedure, thereby minimising the risk of laser fibre break or fracture.…”

Section: Methodsmentioning

confidence: 99%

Holmium and Thulium Fiber Laser Safety in Endourological Practice: What Does the Clinician Need to Know?

et al. 2023

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Purpose of Review To summarise the literature on laser safety during endourological practice. Recent Findings Holmium and Thulium Fiber laser are the two main energy sources in the current clinical practice. The latter may have superior properties, but more clinical studies are needed to formally establish this. Laser injury to urothelium is more dependent on user experience rather than laser type. Smaller laser fibres allow for lower intra-renal temperature profiles. Operators should pay close attention to laser technique including maintaining the safety distance concept and only firing the laser when tip is clearly in view. When adjusting laser settings, pay close attention to resultant power given the associated heat changes. Prolonged periods of laser activation are to be avoided for the same reason. Outflow can be manipulated such as with access sheath to mitigate temperature and pressure changes. There is still limited evidence to support the mandate for compulsory use of eye protection wear during laser lithotripsy. Summary Lasers are the gold standard energy source for stone lithotripsy. However, the safe clinical application of this technology requires an understanding of core principles as well as awareness of the safety and technical aspects that can help in protecting patient, surgeon and operating staff.

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“…Finally, the proportion of pulses that effectively reached the stone is lower when using high frequencies (20 Hz: 52%; 50 Hz: 23%; 80 Hz: 4%) [10,51]. A last in vivo porcine experiment showed that chilled irrigation fluid (18C) is associated with safe temperature profile up to 30 W at 12 ml/min irrigation flow rate [52]. In a clinical trial, low power settings (<20 W) and at least 15 ml/min irrigation maintained safe temperatures during laser activation [53].…”

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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Chilled Irrigation for Control of Temperature Elevation During Ureteroscopic Laser Lithotripsy:In VivoPorcine Model

Cited by 10 publications

References 28 publications

Temperature profiles during ureteroscopy with thulium fiber laser and holmium:YAG laser: Findings from a pre-clinical study

Temperature profiles during ureteroscopy with thulium fiber laser and holmium:YAG laser: Findings from a pre-clinical study

Holmium and Thulium Fiber Laser Safety in Endourological Practice: What Does the Clinician Need to Know?

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

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