Evaluation of a Protective Laser Sheath for Application in Flexible Ureteroscopy

Durak, Evren; Hruby, Greg; Mitchell, R. E.; Marruffo, Franzo; Abundez, Jorge O.; Landman, Jaime

doi:10.1089/end.2006.0394

Cited by 16 publications

(8 citation statements)

References 9 publications

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“…Similar findings were reported by Durak and coworkers, 10 who showed a reduced insertion force for a sheathed laser fiber in a deflected ureteroscope. We recognize that it is commonly suggested that the urologist not push a laser fiber through a deflected ureteroscope.…”

Section: Discussionsupporting

confidence: 90%

In Vitro Evaluation of ScopeSafe Fibers and the Scope Guardian Sheath in Prevention of Ureteroscope Endolumenal Working Damage

Lusch

Abdelshehid

Liss

et al. 2013

Journal of Endourology

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Background and Purpose: Ureteroscope breakage is commonly related to laser fiber damage. Often, the damage is mechanical and not energy related. As such, we evaluated a novel laser fiber and sheath system in preventing mechanical ureteroscope damage during fiber insertion. Materials and Methods:We assessed 200-lm/272/3-lm laser fibers with the laser sheath in a flexible ureteroscope. Diminishment of active deflection and irrigation flow rates were compared with a standard laser fiber alone. Eight nonassembled working channel components were tested in a 0-degree/90-degree/210-degree deflection model. After insertion cycles, external and endolumenal damage to the working channel were classified. We also tested the sheath system in a 0-degree/90-degree/210-degree deflection model for fiber failure and laser damage. Results: In all test trials with the sheath and for standard laser fibers in the 0-degree model, there were no channel perforations or damage. With standard laser fibers, in the 210-degree model, superficial scratches and demarcated abrasions were visible after 10 and 60 to 70 insertions for the 273-lm laser fiber and after 30 insertions (superficial scratches) for the 200-lm laser fiber. In the 90-degree model, superficial scratches occurred after 20 insertions for the 273-lm fibers and after 40 insertions for the 200-lm laser fibers. No demarcated abrasions were seen after 100 insertions. In the 210-degree model, there was one perforation with the 272-lm fiber, but none with 200-lm fiber. There were no fiber failures with sheath use; however, the sheath did not prevent laser energy damage. The laser sheath resulted in a 4.7-degree/3.8-degree (1.2%/1.5%) diminishment in deflection (up/down) for the 200 lm and a 3.5-degree/4.3-degree (1.8%/1.5%) diminishment for 272-lm laser fiber compared with standard 200/272-lm laser fiber. Irrigation flow was diminished with the sheath on both the 200-lm and 272-lm laser fiber by 28.7% and 32.6%, respectively. Conclusion: The Scope Guardian Sheath prevented mechanical working channel damage with minimal diminishment of deflection and irrigation flow.

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Section: Discussionsupporting

confidence: 90%

In Vitro Evaluation of ScopeSafe Fibers and the Scope Guardian Sheath in Prevention of Ureteroscope Endolumenal Working Damage

Lusch

Abdelshehid

Liss

et al. 2013

Journal of Endourology

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“…8,9 Damage may occur from both fiber insertion through the working channel during ureteroscope deflection, as well as premature laser activation with the fiber still inside the ureteroscope. Several devices have been introduced to reduce the probability of ureteroscope damage in both situations, such as the endoscope protection system, 10 which employs an optical sensor that shuts off the laser if the distal fiber tip is still inside the ureteroscope working channel, and Flexguard, 11 a protective fiber sheath that insulates the ureteroscope working channel from the fiber. While both of these solutions address laser-induced damage, only the Flexguard sheath additionally prevents mechanical damage.…”

Section: Holmium: Yag Laser Lithotripsy Usingmentioning

confidence: 99%

Miniature ball-tip optical fibers for use in thulium fiber laser ablation of kidney stones

et al. 2016

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Optical fibers, consisting of 240-μm-core trunk fibers with rounded, 450-μm-diameter ball tips, are currently used during Holmium:YAG laser lithotripsy to reduce mechanical damage to the inner lining of the ureteroscope working channel during fiber insertion and prolong ureteroscope lifetime. Similarly, this study tests a smaller, 100-μm-core fiber with 300-μm-diameter ball tip during thulium fiber laser (TFL) lithotripsy. TFL was operated at a wavelength of 1908 nm, with 35-mJ pulse energy, 500-μs pulse duration, and 300-Hz pulse rate. Calcium oxalate/phosphate stone samples were weighed, laser procedure times were measured, and ablation rates were calculated for ball tip fibers, with comparison to bare tip fibers. Photographs of ball tips were taken before and after each procedure to track ball tip degradation and determine number of procedures completed before need for replacement. A high speed camera also recorded the cavitation bubble dynamics during TFL lithotripsy. Additionally, saline irrigation rates and ureteroscope deflection were measured with and without the presence of TFL fiber. There was no statistical difference (P > 0.05) between stone ablation rates for single-use ball tip fiber (1.3 AE 0.4 mg∕s) (n ¼ 10), multiple-use ball tip fiber (1.3 AE 0.5 mg∕s) (n ¼ 44), and conventional single-use bare tip fibers (1.3 AE 0.2 mg∕s) (n ¼ 10). Ball tip durability varied widely, but fibers averaged greater than four stone procedures before failure, defined by rapid decline in stone ablation rates. Mechanical damage at the front surface of the ball tip was the limiting factor in fiber lifetime. The small fiber diameter did not significantly impact ureteroscope deflection or saline flow rates. The miniature ball tip fiber may provide a cost-effective design for safe fiber insertion through the ureteroscope working channel and into the ureter without risk of instrument damage or tissue perforation, and without compromising stone ablation efficiency during TFL lithotripsy.

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“…The clinical use of the protective FlexGuard sheath (LISA Laser Products, Germany) has been studied [39] . It significantly reduced the amount of force required to insert the laser fibre through the working channel.…”

Section: Safety Issuesmentioning

confidence: 99%

Intracorporeal laser lithotripsy

Papatsoris

Skolarikos

Buchholz

2012

Arab Journal of Urology

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ObjectivesTo review the current literature on intracorporeal laser lithotripsy.MethodsWe searched PubMed for relevant reports up to January 2012, using the keywords ‘laser’, ‘lithotripsy’ and ‘intracorporeal’.ResultsWe studied 125 relevant reports of studies with various levels of evidence. Efficient lithotripsy depends on the laser variables (wavelength, pulse duration and pulse energy) and the physical properties of the stones (optical, mechanical and chemical). The most efficient laser for stones in all locations and of all mineral compositions is the holmium yttrium–aluminium–garnet laser (Ho:YAG). The frequency-doubled double-pulse Nd:YAG laser functions through the generation of a plasma bubble. New laser systems, such as the erbium:YAG and the thulium laser, are under evaluation. Laser protection systems have also been developed for the novel digital flexible ureteroscopes. Although complications are rare, a high relevant clinical suspicion is necessary.ConclusionsLaser lithotripsy technology is continuously developing, while the Ho:YAG laser remains the reference standard for intracorporeal lithotripsy.

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Evaluation of a Protective Laser Sheath for Application in Flexible Ureteroscopy

Cited by 16 publications

References 9 publications

In Vitro Evaluation of ScopeSafe Fibers and the Scope Guardian Sheath in Prevention of Ureteroscope Endolumenal Working Damage

In Vitro Evaluation of ScopeSafe Fibers and the Scope Guardian Sheath in Prevention of Ureteroscope Endolumenal Working Damage

Miniature ball-tip optical fibers for use in thulium fiber laser ablation of kidney stones

Intracorporeal laser lithotripsy

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