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Comparison of holmium:YAG and thulium fiber laser lithotripsy: ablation thresholds, ablation rates, and retropulsion effects.
J Biomed Opt 2011; 16(7):071403JB

Abstract

The holmium:YAG (Ho:YAG) laser lithotriptor is capable of operating at high pulse energies, but efficient operation is limited to low pulse rates (∼10 Hz) during lithotripsy. On the contrary, the thulium fiber laser (TFL) is limited to low pulse energies, but can operate efficiently at high pulse rates (up to 1000 Hz). This study compares stone ablation threshold, ablation rate, and retropulsion for the two different Ho:YAG and TFL operation modes. The TFL (λ = 1908 nm) was operated with pulse energies of 5 to 35 mJ, 500-μs pulse duration, and pulse rates of 10 to 400 Hz. The Ho:YAG laser (λ = 2120 nm) was operated with pulse energies of 30 to 550 mJ, 350-μs pulse duration, and a pulse rate of 10 Hz. Laser energy was delivered through 200- and 270-μm-core optical fibers in contact mode with human calcium oxalate monohydrate (COM) stones for ablation studies and plaster-of-Paris stone phantoms for retropulsion studies. The COM stone ablation threshold for Ho:YAG and TFL measured 82.6 and 20.8 J∕cm(2), respectively. Stone retropulsion with the Ho:YAG laser linearly increased with pulse energy. Retropulsion with TFL was minimal at pulse rates less than 150 Hz, then rapidly increased at higher pulse rates. For minimal stone retropulsion, Ho:YAG operation at pulse energies less than 175 mJ at 10 Hz and TFL operation at 35 mJ at 100 Hz is recommended, with both lasers producing comparable ablation rates. Further development of a TFL operating with both high pulse energies of 100 to 200 mJ and high pulse rates of 100 to 150 Hz may also provide an alternative to the Ho:YAG laser for higher ablation rates, when retropulsion is not a primary concern.

Authors+Show Affiliations

University of North Carolina at Charlotte, Department of Physics and Optical Science, 9201 University City Avenue, Charlotte, North Carolina 28223-0001, USA.No affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

21806249

Citation

Blackmon, Richard L., et al. "Comparison of holmium:YAG and Thulium Fiber Laser Lithotripsy: Ablation Thresholds, Ablation Rates, and Retropulsion Effects." Journal of Biomedical Optics, vol. 16, no. 7, 2011, p. 071403.
Blackmon RL, Irby PB, Fried NM. Comparison of holmium:YAG and thulium fiber laser lithotripsy: ablation thresholds, ablation rates, and retropulsion effects. J Biomed Opt. 2011;16(7):071403.
Blackmon, R. L., Irby, P. B., & Fried, N. M. (2011). Comparison of holmium:YAG and thulium fiber laser lithotripsy: ablation thresholds, ablation rates, and retropulsion effects. Journal of Biomedical Optics, 16(7), p. 071403. doi:10.1117/1.3564884.
Blackmon RL, Irby PB, Fried NM. Comparison of holmium:YAG and Thulium Fiber Laser Lithotripsy: Ablation Thresholds, Ablation Rates, and Retropulsion Effects. J Biomed Opt. 2011;16(7):071403. PubMed PMID: 21806249.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of holmium:YAG and thulium fiber laser lithotripsy: ablation thresholds, ablation rates, and retropulsion effects. AU - Blackmon,Richard L, AU - Irby,Pierce B, AU - Fried,Nathaniel M, PY - 2011/8/3/entrez PY - 2011/8/3/pubmed PY - 2012/1/6/medline SP - 071403 EP - 071403 JF - Journal of biomedical optics JO - J Biomed Opt VL - 16 IS - 7 N2 - The holmium:YAG (Ho:YAG) laser lithotriptor is capable of operating at high pulse energies, but efficient operation is limited to low pulse rates (∼10 Hz) during lithotripsy. On the contrary, the thulium fiber laser (TFL) is limited to low pulse energies, but can operate efficiently at high pulse rates (up to 1000 Hz). This study compares stone ablation threshold, ablation rate, and retropulsion for the two different Ho:YAG and TFL operation modes. The TFL (λ = 1908 nm) was operated with pulse energies of 5 to 35 mJ, 500-μs pulse duration, and pulse rates of 10 to 400 Hz. The Ho:YAG laser (λ = 2120 nm) was operated with pulse energies of 30 to 550 mJ, 350-μs pulse duration, and a pulse rate of 10 Hz. Laser energy was delivered through 200- and 270-μm-core optical fibers in contact mode with human calcium oxalate monohydrate (COM) stones for ablation studies and plaster-of-Paris stone phantoms for retropulsion studies. The COM stone ablation threshold for Ho:YAG and TFL measured 82.6 and 20.8 J∕cm(2), respectively. Stone retropulsion with the Ho:YAG laser linearly increased with pulse energy. Retropulsion with TFL was minimal at pulse rates less than 150 Hz, then rapidly increased at higher pulse rates. For minimal stone retropulsion, Ho:YAG operation at pulse energies less than 175 mJ at 10 Hz and TFL operation at 35 mJ at 100 Hz is recommended, with both lasers producing comparable ablation rates. Further development of a TFL operating with both high pulse energies of 100 to 200 mJ and high pulse rates of 100 to 150 Hz may also provide an alternative to the Ho:YAG laser for higher ablation rates, when retropulsion is not a primary concern. SN - 1560-2281 UR - https://www.unboundmedicine.com/medline/citation/21806249/Comparison_of_holmium:YAG_and_thulium_fiber_laser_lithotripsy:_ablation_thresholds_ablation_rates_and_retropulsion_effects_ L2 - https://doi.org/10.1117/1.3564884 DB - PRIME DP - Unbound Medicine ER -