Jackets Off: The Impact of Laser Fiber Stripping on Power Output and Stone Degradation

Ritchie, Cayde; Yang, Patrick; Peplinski, Brandon; Keheila, Mohamed; Cheriyan, Salim; Abourbih, Samuel; Kelln, Wayne; Baldwin, D. Duane

doi:10.1089/end.2017.0160

Cited by 12 publications

(7 citation statements)

References 24 publications

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“…This was done to ensure optimal power delivery from the fiber to the stone. 9,10 Outcomes were crater depth, area at the stone surface, and ablation volume, all measured using a 3D laser confocal microscope (LEXT OLS 4000; Olympus, Tokyo, Japan). In addition, high-speed videos were recorded to demonstrate ablation during the 1st, 5th, 10th, 20th, 30th, and 40th pulse at the same stone location when delivering a total of 40 pulses using LP mode.…”

Section: Pulse Frequency Threshold: Fixed Laser Fiber Experimentsmentioning

confidence: 99%

Frequency Threshold for Ablation During Holmium Laser Lithotripsy: How High Can You Go?

Aldoukhi

Black

Hall

et al. 2020

Journal of Endourology

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Purpose: We performed in vitro studies to assess the relationship of pulse frequency on stone ablation during contact laser lithotripsy and determine if there is a threshold after which its effect on lithotripsy is limited. Methods: BegoStones were fragmented using a Ho:YAG laser (P120 Moses) and a 230 lm fiber at 0.5 J on long pulse (LP) and Moses distance (MD) modes in contact with the stone. The relationship between the number of pulses (1-40 Hz) on stone crater volume was assessed using three-dimensional confocal microscopy and nonlinear-segmented regression. To simulate a painting technique, we assessed fragmentation (mg/second) at 20, 40, and 60 Hz, with the fiber moving at a speed of 1 and 3 mm/second, respectively. High-speed imaging was used to record ablation. Results: When the laser fiber was fixed, after 13.0 (LP) and 15.4 (MD) pulses, greater pulse frequency did not lead to a significant increase in stone crater volume. Fragmentation was greatest at higher frequencies and faster fiber speed. Increasing the frequency from 20 to 60 Hz at 3 mm/second increased fragmentation by 82% and 61% for LP and MD modes, respectively. Using high-speed data, if the laser fiber is moving at 1 mm/second, a hypothetical frequency threshold for ablation was calculated to be 52 and 61.6 Hz for LP and MD modes, respectively. Conclusion: Increasing the fiber speed increases stone ablation when using high frequency settings. When the fiber is fixed there is a threshold after which increasing the pulse frequency leads to minimal gain in ablation. The exact value for threshold when the fiber is moving needs further study. Our study serves to provide insight for parameter selection and safety of laser lithotripsy for dusting technique.

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Section: Pulse Frequency Threshold: Fixed Laser Fiber Experimentsmentioning

confidence: 99%

Frequency Threshold for Ablation During Holmium Laser Lithotripsy: How High Can You Go?

Aldoukhi

Black

Hall

et al. 2020

Journal of Endourology

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“…They also concluded that simple cleaving methods such as using a metallic surgical scissor were as good as more costly methods, as long as the fibers remain coated [ 63 ••]. Some of these results favoring coated fibers have been confirmed by other researchers [ 65 ]. Another advantage of keeping the fibers coated is that most of these fibers are able to pass through all angles of deflections in most scopes, while stripped fibers cannot without being harmful to the scopes’ working channel [ 66 ].…”

Section: Bibliographic Search Resultsmentioning

confidence: 92%

“…Another advantage of keeping the fibers coated is that most of these fibers are able to pass through all angles of deflections in most scopes, while stripped fibers cannot without being harmful to the scopes’ working channel [ 66 ]. However, there is also evidence that initial advantages of certain cleaving methods over another level themselves out and the fibers become quite similar in performance in the first minutes of lithotripsy, because of equal, short-term fiber degradation [ 65 , 67 , 68 •]. However, even over this topic, there is controversy among researchers, with some advocating against routine cleaving [ 67 ], others endorsing fiber tip preparation and renewal after 15 min or 10,000 J of laser emission, which is also important for reusable fibers [ 63 ••, 68 •, 69 ], while still others claim that stripped fibers achieve greater stone ablation [ 65 ].…”

Section: Bibliographic Search Resultsmentioning

confidence: 99%

Advances in Lasers for the Treatment of Stones—a Systematic Review

2018

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Purpose of ReviewLaser lithotripsy is increasingly used worldwide and is a continuously evolving field with new and extensive research being published every year.Recent FindingsVariable pulse length Ho:YAG lithotripters allow new lithotripsy parameters to be manipulated, and there is an effort to integrate new technologies into lithotripters. Pulsed thulium lasers seem to be a viable alternative to holmium lasers. The performance of similar laser fibers varies from manufacturer to manufacturer. Special laser fibers and “cleaving only” fiber tip preparation can be beneficial for the lithotripsy procedure. Different laser settings and the surgical technique employed can have significant impact on the success of laser lithotripsy. When safely done, complications of laser lithotripsy are rare and concern the endoscopic nature of procedure, not the technology itself, making laser lithotripsy one of the safest tools in urology.SummaryLaser lithotripsy has had several new developments and more insight has been gained in recent years with many more advances expected in the future.

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“…Kronenberg and Traxer found that using unstripped, coated fibers provide better fragmentation than stripped fibers ( 30 ). In contrast, Ritchie and coworkers found that stripped fibers resulted in more efficient fragmentation compared to unstripped fibers due to better contact between the fiber tip and stone surface ( 31 ).…”

Section: Laser Fibersmentioning

confidence: 99%

Holmium Laser Lithotripsy in the New Stone Age: Dust or Bust?

et al. 2017

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Modern day holmium laser systems for ureteroscopy (URS) provide users with a range of settings, namely pulse energy (PE), pulse frequency (Fr), and pulse width (PW). These variables allow the surgeon to choose different combinations that have specific effects on stone fragmentation during URS lithotripsy. Contact laser lithotripsy can be performed using fragmentation or dusting settings. Fragmentation employs settings of low Fr and high PE to break stones that are then extracted with retrieval devices. Dusting is the utilization of high Fr and low PE settings to break stones into submillimeter fragments for spontaneous passage without the need for basket retrieval. Use of the long PW mode during lithotripsy can reduce stone retropulsion and is increasingly available in new generation lasers. During non-contact laser lithotripsy, stone fragments are rapidly pulverized in a calyx in laser bursts that result in stones breaking into fine fragments. In this review, we discuss the effect of different holmium laser settings on stone fragmentation, and the clinical implications in a very much evolving field.

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Jackets Off: The Impact of Laser Fiber Stripping on Power Output and Stone Degradation

Cited by 12 publications

References 24 publications

Frequency Threshold for Ablation During Holmium Laser Lithotripsy: How High Can You Go?

Frequency Threshold for Ablation During Holmium Laser Lithotripsy: How High Can You Go?

Advances in Lasers for the Treatment of Stones—a Systematic Review

Holmium Laser Lithotripsy in the New Stone Age: Dust or Bust?

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