Development of a smart Holmium:YAG laser lithotriptor

Goldey, Charles L.; Rosen, David I.; Hayes, Gary B.; Willscher, Max K.; Roth, Robert A.

doi:10.1002/(sici)1096-9101(1997)21:1<20::aid-lsm4>3.3.co;2-d

Cited by 4 publications

(5 citation statements)

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“…Goldey et al . in 1997 reported the development of a smart Holmium:YAG laser lithotripter which discriminated stone and tissue by monitoring laser‐induced visible/NIR photoemission . Contrary to those results, we could not measure a strong luminescence signal in vitro at the beginning of a laser pulse regularly, but quite irregularly on stone as well as on tissue.…”

Section: Introductioncontrasting

confidence: 62%

Stone/tissue differentiation during intracorporeal lithotripsy using diffuse white light reflectance spectroscopy: In vitro and clinical measurements

et al. 2014

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Section: Introductioncontrasting

confidence: 62%

Stone/tissue differentiation during intracorporeal lithotripsy using diffuse white light reflectance spectroscopy: In vitro and clinical measurements

et al. 2014

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“…For Ho:YAG laser‐induced incandescence, according to Goldey at al. the signal emitted by calculi is thermally induced radiation emitted from the calculus surface . They used this signal for stone/tissue discrimination.…”

Section: Discussionmentioning

confidence: 99%

“…In 1997, Goldey et al reported the development of a “smart” Ho:YAG laser lithotriptor . They were able to discriminate soft and hard biological tissue by monitoring prompt laser‐induced visible/NIR photoemissions via retrograde transmission over the laser delivery fiber in in vitro studies and an animal experiment.…”

Section: Introductionmentioning

confidence: 99%

Stone/tissue differentiation for holmium laser lithotripsy using autofluorescence

2015

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“…This automatic feedback prevented the laser being triggered when the fiber was incorrectly positioned on tissue. Goldey et al reported a similar development for the Ho:YAG laser lithotripter, but no clinical data have been published to the best of our knowledge.…”

Section: Introductionmentioning

confidence: 97%

Exploiting the aiming beam to increase the safety of laser lithotripsy: Experimental evaluation of light reflection and fluorescence

2019

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Background and Objectives In Holmium laser lithotripsy, usually, the surgeon is guided by a visible beam superimposing the infrared (IR) treatment radiation. It has been shown that a green aiming beam excites stone autofluorescence. This fluorescence signal can be used for calculi detection to check the correct fiber position before triggering the IR laser, thus preventing damage to soft tissue and application devices. However, also the directly reflected green light from the fiber tip gives valuable information on fiber position and its surface condition. Materials and Methods An external fiber‐fiber‐coupling‐box (fiber core diameter 365 µm) for pulsed holmium laser radiation (2.1 µm) was set up containing a green diode laser module (520 nm, average power on the sample <0.5 mW) and optics and detectors for measuring the reflected light of this aiming beam as well as the fluorescence excited with it. Measurements were done via a lock‐in technique with more than 20 human calculi samples and porcine calix in vitro. After the implementation of automatic data storage signals during ongoing in vitro lithotripsy procedures were recorded with the fiber positioned on tissue, stone, or in/on medical equipment (working channel of an endoscope, stone retrieval basket). Results Stone fluorescence signals measured were a factor of 7 to >100 higher than those of tissue. Stone fluorescence was detectable in “non‐contact mode” with a linear signal decrease over a distance up to ~1 mm in front of the fiber tip (core diameter 365 µm) and with severely damaged fibers (max. decrease: 75% with pinched off fiber). Reflection signals of the fiber tip surface in air and water surrounding decreased significantly when the fiber was damaged; measured ratios of intact to damaged fiber found in the air were (5–17):1 and in water (1.6–3.7):1. Surfaces in front of the fiber aggravated the evaluation of fiber condition due to reflections but enabled to detect, for example, the working channel of a flexible endoscope in combination with the (missing) fluorescence signal. Conclusions Autofluorescence induced by a green aiming beam can be exploited for stone detection in laser lithotripsy. A reflection measurement can give further information on fiber condition and position. Implementing this kind of safety features for an automatic block of IR laser emission in case of weak or missing fluorescence and un‐normal reflections can assist the surgeon by avoiding tissue perforation, and damage to medical devices such as endoscopes. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

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Development of a smart Holmium:YAG laser lithotriptor

Cited by 4 publications

References 0 publications

Stone/tissue differentiation during intracorporeal lithotripsy using diffuse white light reflectance spectroscopy: In vitro and clinical measurements

Stone/tissue differentiation during intracorporeal lithotripsy using diffuse white light reflectance spectroscopy: In vitro and clinical measurements

Stone/tissue differentiation for holmium laser lithotripsy using autofluorescence

Exploiting the aiming beam to increase the safety of laser lithotripsy: Experimental evaluation of light reflection and fluorescence

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