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In vitro fragmentation efficiency of holmium: yttrium-aluminum-garnet (YAG) laser lithotripsy--a comprehensive study encompassing different frequencies, pulse energies, total power levels and laser fibre diameters.
BJU Int. 2014 Aug; 114(2):261-7.BI

Abstract

OBJECTIVE

To assess the fragmentation (ablation) efficiency of laser lithotripsy along a wide range of pulse energies, frequencies, power settings and different laser fibres, in particular to compare high- with low-frequency lithotripsy using a dynamic and innovative testing procedure free from any human interaction bias.

MATERIALS AND METHODS

An automated laser fragmentation testing system was developed. The unmoving laser fibres fired at the surface of an artificial stone while the stone was moved past at a constant velocity, thus creating a fissure. The lithotripter settings were 0.2-1.2 J pulse energies, 5-40 Hz frequencies, 4-20 W power levels, and 200 and 550 μm core laser fibres. Fissure width, depth, and volume were analysed and comparisons between laser settings, fibres and ablation rates were made.

RESULTS

Low frequency-high pulse energy (LoFr-HiPE) settings were (up to six times) more ablative than high frequency-low pulse energy (HiFr-LoPE) at the same power levels (P < 0.001), as they produced deeper (P < 0.01) and wider (P < 0.001) fissures. There were linear correlations between pulse energy and fragmentation volume, fissure width, and fissure depth (all P < 0.001). Total power did not correlate with fragmentation measurements. Laser fibre diameter did not affect fragmentation volume (P = 0.81), except at very low pulse energies (0.2 J), where the large fibre was less efficient (P = 0.015).

CONCLUSIONS

At the same total power level, LoFr-HiPE lithotripsy was most efficient. Pulse energy was the key variable that drove fragmentation efficiency. Attention must be paid to prevent the formation of time-consuming bulky debris and adapt the lithotripter settings to one's needs. As fibre diameter did not affect fragmentation efficiency, small fibres are preferable due to better scope irrigation and manoeuvrability.

Authors+Show Affiliations

Departments of Urology, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24219145

Citation

Kronenberg, Peter, and Olivier Traxer. "In Vitro Fragmentation Efficiency of Holmium: Yttrium-aluminum-garnet (YAG) Laser Lithotripsy--a Comprehensive Study Encompassing Different Frequencies, Pulse Energies, Total Power Levels and Laser Fibre Diameters." BJU International, vol. 114, no. 2, 2014, pp. 261-7.
Kronenberg P, Traxer O. In vitro fragmentation efficiency of holmium: yttrium-aluminum-garnet (YAG) laser lithotripsy--a comprehensive study encompassing different frequencies, pulse energies, total power levels and laser fibre diameters. BJU Int. 2014;114(2):261-7.
Kronenberg, P., & Traxer, O. (2014). In vitro fragmentation efficiency of holmium: yttrium-aluminum-garnet (YAG) laser lithotripsy--a comprehensive study encompassing different frequencies, pulse energies, total power levels and laser fibre diameters. BJU International, 114(2), 261-7. https://doi.org/10.1111/bju.12567
Kronenberg P, Traxer O. In Vitro Fragmentation Efficiency of Holmium: Yttrium-aluminum-garnet (YAG) Laser Lithotripsy--a Comprehensive Study Encompassing Different Frequencies, Pulse Energies, Total Power Levels and Laser Fibre Diameters. BJU Int. 2014;114(2):261-7. PubMed PMID: 24219145.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - In vitro fragmentation efficiency of holmium: yttrium-aluminum-garnet (YAG) laser lithotripsy--a comprehensive study encompassing different frequencies, pulse energies, total power levels and laser fibre diameters. AU - Kronenberg,Peter, AU - Traxer,Olivier, Y1 - 2014/04/16/ PY - 2013/11/14/entrez PY - 2013/11/14/pubmed PY - 2014/9/23/medline KW - automated laser fragmentation testing system KW - high frequency lithotripsy KW - holmium:YAG laser lithotripsy KW - lithotripter settings KW - urinary calculi SP - 261 EP - 7 JF - BJU international JO - BJU Int VL - 114 IS - 2 N2 - OBJECTIVE: To assess the fragmentation (ablation) efficiency of laser lithotripsy along a wide range of pulse energies, frequencies, power settings and different laser fibres, in particular to compare high- with low-frequency lithotripsy using a dynamic and innovative testing procedure free from any human interaction bias. MATERIALS AND METHODS: An automated laser fragmentation testing system was developed. The unmoving laser fibres fired at the surface of an artificial stone while the stone was moved past at a constant velocity, thus creating a fissure. The lithotripter settings were 0.2-1.2 J pulse energies, 5-40 Hz frequencies, 4-20 W power levels, and 200 and 550 μm core laser fibres. Fissure width, depth, and volume were analysed and comparisons between laser settings, fibres and ablation rates were made. RESULTS: Low frequency-high pulse energy (LoFr-HiPE) settings were (up to six times) more ablative than high frequency-low pulse energy (HiFr-LoPE) at the same power levels (P < 0.001), as they produced deeper (P < 0.01) and wider (P < 0.001) fissures. There were linear correlations between pulse energy and fragmentation volume, fissure width, and fissure depth (all P < 0.001). Total power did not correlate with fragmentation measurements. Laser fibre diameter did not affect fragmentation volume (P = 0.81), except at very low pulse energies (0.2 J), where the large fibre was less efficient (P = 0.015). CONCLUSIONS: At the same total power level, LoFr-HiPE lithotripsy was most efficient. Pulse energy was the key variable that drove fragmentation efficiency. Attention must be paid to prevent the formation of time-consuming bulky debris and adapt the lithotripter settings to one's needs. As fibre diameter did not affect fragmentation efficiency, small fibres are preferable due to better scope irrigation and manoeuvrability. SN - 1464-410X UR - https://www.unboundmedicine.com/medline/citation/24219145/In_vitro_fragmentation_efficiency_of_holmium:_yttrium_aluminum_garnet__YAG__laser_lithotripsy__a_comprehensive_study_encompassing_different_frequencies_pulse_energies_total_power_levels_and_laser_fibre_diameters_ L2 - https://doi.org/10.1111/bju.12567 DB - PRIME DP - Unbound Medicine ER -