Use of the holmium:YAG laser in urology

Abstract

The tissue effects of a holmium:YAG (Ho:YAG) laser operating at a wavelength of 2.1 mu with a maximum power of 15 watts (W) and 10 different energy-pulse settings was systematically evaluated on kidney, bladder, prostate, ureteral, and vasal tissue in the dog. In addition, various urologic surgical procedures (partial nephrectomy, transurethral laser incision of the prostate, and laser-assisted vasovasostomy) were performed in the dog, and a laparoscopic pelvic lymph node dissection was carried out in a pig. Although the Ho:YAG laser has a strong affinity for water, precise tissue ablation was achieved in both the contact and non-contact mode when used endoscopically in a fluid medium to ablate prostatic and vesical tissue. Using the usual parameters for tissue destruction (blanching without charring), the depth of thermal injury in the bladder and ureter was kept superficial. In performing partial nephrectomies, a 2-fold reduction in the zone of coagulative necrosis was demonstrated compared to the use of the continuous wave Neodymium:YAG laser (Nd:YAG). When used through the laparoscope, the Ho:YAG laser provided precise cutting and, combined with electrocautery, allowed the dissection to proceed quickly and smoothly. Hemostatic control was adequate in all surgical procedures. Although the results of these investigations are preliminary, our initial experience with the Ho:YAG laser has been favorable and warrants further investigations.

Success of Laser Endoureterotomy of Ureteral Strictures Associated with Ureteral Stones Is Related to Stone Impaction

“…11 These characteristics, along with the ability to deliver it through a 200-micrometer fiber which fits easily into a 6.9 French flexible ureteroscope, make it ideal for endoureterotomy of ureteral strictures. The Ho:YAG laser can be found in most urology departments owing to it position as the flexible lithotrite of choice.…”

Laparoscopic partial upper pole nephrectomy in infants and children

“…For more substantial parenchyma, numerous other means are available, e.g. bipolar electrocautery, argon beam coagulator (ABC), Nd:YAG laser, holmium:YAG laser, electrosurgical snare electrode, microwave coagulator, and Gill renal tourniquet [6,[10][11][12][13][14][15]. A review of the literature shows that most surgeons prefer bipolar electrocautery with or without ABC [6,14,16].…”

URS Konusunda Teknolojik Gelişmeler

“…Ancak bu fleksibl URS'lerde tam bir defleksiyon sistemi ve çalışma kanalları mevcut değildi (6). Yeni fleksibl URS'lerin ve holmiyum lazerin kullanıma girdiği 1990'lara kadar fleksibl URS'ler yaygın olarak kullanılmamıştır (7,8). Fleksibl URS'ler basit olarak fiberoptik görüntüleme sistemi, defleksiyon mekanizması, çalışma ve kanalından oluşur.…”