Thermography-Based Comparison of Irrigation Temperatures Between Moses Mode and Virtual Basket Mode: An <i>In Vitro</i> Phantom Study

Yamashita, Shimpei; Inoue, Takaaki; Imai, Satoshi; Iwahashi, Yuya; Deguchi, Ryusuke; Muraoka, Satoshi; Kikkawa, Kazuro; Kohjimoto, Yasuo; Fujisawa, Masato; Hara, Isao

doi:10.1089/end.2022.0327

Cited by 3 publications

(6 citation statements)

References 20 publications

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“…The ratios of the high-temperature areas in the LPM and MM tended to be higher than those in the SPM and VBM. These results are understandable considering that the time to reach a threshold in the LPM and MM is significantly shorter than that in the SPM and VBM [ 5 ]. However, the exact etiology of the differences in heat production between different laser pulse modes remains unclear.…”

Section: Discussionmentioning

confidence: 97%

“…Winship et al reported that the MM produces significantly lower temperatures compared with the LPM [ 4 ]. In addition, the irrigation temperature in the MM could rise more rapidly than that in the VBM [ 5 ]. However, the influence of these laser pulse modes on dynamic changes in the area or the spread of high temperatures remains unclear.…”

Section: Discussionmentioning

confidence: 99%

“…A pulse modulation mode based on Moses technology, known as the Moses mode (MM), may reduce the risk of temperature elevation in irrigation fluids compared with the LPM. Moreover, our thermography-based in vitro phantom study suggested that although the virtual basket mode (VBM) is also a pulse modulation mode that uses Moses technology, there might be a more rapid rise in temperature in the MM than in the VBM [ 5 ]. However, the difference in impact on the irrigation temperatures between these two modes has not been sufficiently compared.…”

Section: Introductionmentioning

confidence: 99%

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Dynamic Changes in Fluid Temperatures during Laser Irradiation Using Various Laser Modes: A Thermography-Based In Vitro Phantom Study

Yamashita

Inoue

Imai³

et al. 2023

JCM

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The differences in dynamic thermal changes during laser lithotripsy between various laser pulse modes are unclear. We used thermography to evaluate the temporal changes in high-temperature areas during laser activation in order to compare different laser pulse modes. An unroofed artificial kidney model was used for the experiments. The laser fired for 60 s with a laser setting of 0.4 J/60 Hz in the following four different laser pulse modes without saline irrigation: short pulse mode (SPM), long pulse mode (LPM), virtual basket mode (VBM) and Moses mode (MM). Using the first 30 s of moving images, we compared the ratio of a high-temperature area of >43 °C to the total area every 5 seconds. The dynamic changes in fluid temperatures were shown to be different between the laser pulse modes. The extent of the high-temperature areas during the laser activation was large in the LPM and MM compared with the SPM and VBM. While the high-temperature areas expanded in an anterior direction in the early laser irradiation period using the LPM, they spread in a posterior direction in the early laser activation period using the MM. Although only the temperature profile in one specific plane was investigated, these results are considered useful for preventing thermal injuries during retrograde intrarenal surgeries.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Dynamic Changes in Fluid Temperatures during Laser Irradiation Using Various Laser Modes: A Thermography-Based In Vitro Phantom Study

Yamashita

Inoue

Imai³

et al. 2023

JCM

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“…An artificial kidney model was created by using Urovac evacuator™ (Boston Scientific, Marlborough, MA, USA; capacity: 340 ml, length: 14 cm, maximum diameter: 7.3 cm, thickness: 3.2 mm) as a renal pelvis calyx based on previous studies [ 12 , 13 ]. The nephrostomy sheath was connected to the Urovac evacuator™ so that it was 70° above the horizontal plane, which was designed to represent puncture of the lower calyx in a prone position in a human body.…”

Section: Methodsmentioning

confidence: 99%

Effect of nephrostomy sheath size on renal pelvic pressure during endoscopic combined intrarenal surgery: artificial kidney model study

Iguchi,

Yamashita,

Kohjimoto

et al. 2024

BMC Urol

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Background This study aimed to evaluate the intrarenal pelvic pressure in endoscopic combined intrarenal surgery using an artificial kidney model. Methods An artificial kidney model was created using the Urovac evacuator™. Four sizes of nephrostomy sheaths (MIP-L: 25/26 Fr, MIP-M: 16.5/17.5 Fr, MIP-S: 11/12 Fr, MIP-XS: 8.5/9.5 Fr) and two sizes of ureteral access sheaths (12/14 Fr and 10/12 Fr) were installed into the model. For each combination of nephrostomy and ureteral access sheath, renal pelvic pressure was measured with and without insertion of the retrograde flexible ureteroscope. Irrigation from the nephroscope was adjusted to 40–160 mmHg using an automatic irrigation device, and the irrigation of the ureteroscope was by spontaneous dripping at 80 cmH2O. Conditions were measured six times, and the renal pelvic pressure was compared in different conditions. Results Without ureteroscope insertion through the ureteral access sheath, the renal pelvic pressure never exceeded 30 mmHg. Meanwhile, when the ureteroscope was inserted, the renal pelvic pressure increased as the nephrostomy sheath and ureteral access sheath became narrower and as the irrigation pressure increased. Intrarenal pelvic pressure exceeded 30 mmHg when the irrigation pressure was increased in 12/14 Fr ureteral access sheath when MIP-XS was used, and in 10/12 Fr ureteral access sheath when MIP-XS and MIP-S were used. Conclusions The use of a thin nephrostomy sheath in endoscopic combined intrarenal surgery can lead to increased intrarenal pelvic pressure. Although our results are from an artificial kidney model, special care is suggested to be required when using a retrograde flexible ureteroscope simultaneously in treatment of patients.

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“…For this reason, several factors might be used by the operators to keep the temperature in a safe profile [39]. With irrigation, cooler water circulates through the system, dissipating heat [40,41]. The use of a larger calibre ureteral access sheath (UAS) (12/14 F or 14/16 Fr) results in temperatures around 43 • C, and in improved irrigation and lower intrarenal pressures [39,40].…”

Section: Role Of Temperature With Laser Usementioning

confidence: 99%

Evolving Role of Lasers in Endourology: Past, Present and Future of Lasers

et al. 2023

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The use of lasers in endourology has grown exponentially, leading to technological advancement and to miniaturization of the procedures. We aim to provide an overview of the lasers used in endourology and the associated future perspectives. Using MEDLINE, a non-systematic review was performed including articles between 2006 and 2023. English language original articles, reviews and editorials were selected based on their clinical relevance. Guidelines recommend ureteroscopy in case of stones <2 cm and a percutaneous approach for renal stones ≥2 cm. High-power holmium (Ho:YAG) lasers and the new thulium fibre laser (TFL) may change the future, offering shorter procedures for complex stones, with good outcomes. Increased intrarenal temperature associated with these new technologies may be overcome with adaptive strategies and optimal settings. For upper-tract urothelial carcinoma (UTUC), the combination of laser techniques and these new lasers may reduce the risk of stenosis and allow for a more accurate tumour ablation, potentially reducing the recurrence rates. Laser enucleation procedures are gaining a major role in benign prostate enlargement (BPE), especially in patients with larger prostates or under anticoagulant therapy. However, the superiority of one laser over the other has not been established yet, and the choice of technique is mainly deferred to the surgeon’s expertise. In conclusion, lasers will further expand their horizon in endourology, allowing for instrument adaptation to challenging anatomy. Prospective, randomized clinical trials are however needed to confirm available results and to provide the optimal settings for each pathology.

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Thermography-Based Comparison of Irrigation Temperatures Between Moses Mode and Virtual Basket Mode: An In Vitro Phantom Study

Cited by 3 publications

References 20 publications

Dynamic Changes in Fluid Temperatures during Laser Irradiation Using Various Laser Modes: A Thermography-Based In Vitro Phantom Study

Dynamic Changes in Fluid Temperatures during Laser Irradiation Using Various Laser Modes: A Thermography-Based In Vitro Phantom Study

Effect of nephrostomy sheath size on renal pelvic pressure during endoscopic combined intrarenal surgery: artificial kidney model study

Evolving Role of Lasers in Endourology: Past, Present and Future of Lasers

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