Durak Evren, Hruby Greg, Mitchell Rob, Marruffo Franzo, Abundez Jorge O, Landman Jaime
Department of Urology, Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY 10032, USA.
J Endourol. 2008 Jan;22(1):57-60. doi: 10.1089/end.2006.0394.
Despite the obvious utility of the holmium laser, laser fibers frequently damage flexible ureteroscope components, such as the working channel, flexible component cable system, and fiber optical systems during routine ureteroscopic procedures. As such, we investigated the effects of the use of a flexible protective sheath on ureteroscope operation and its ability to protect ureteroscopes from laser fiber damage.
The effects of insertion of the FlexGuard sheath into the working channel on endoscope deflection and irrigant flow rate were documented. Additionally, the force required to advance the laser fiber through a fully deflected endoscope, as well as the amount of laser energy required to penetrate the FlexGuard sheath, were assessed using two different ureteroscopes.
The FlexGuard sheath was easily inserted through the maximally deflected ureteroscopes. The presence of the laser sheath and a laser fiber in the working channel decreased the maximum deflection angle of the ureteroscopes by a mean of 7 degrees (from 73 degrees to 66 degrees). FlexGuard sheath insertion into the working channel also significantly diminished irrigant flow rates, from 0.55 mL/sec to 0.02 mL/sec, at an irrigation pressure of 100 cm H(2)O. The FlexGuard sheath reduced the amount of maximum force required to insert the laser fiber through each ureteroscope from 0.8 N to 0.2 N. The FlexGuard sheath was unable to protect the ureteroscope from laser energy damage.
The FlexGuard laser sheath significantly reduced the amount of force required to insert the laser fiber through the working channel. This reduction in force may have be protective against mechanical damage caused by laser fiber insertion. However, deployment of the sheath significantly diminished the rate of irrigant flow and the maximal deflection of the two ureteroscopes tested. Also, the sheath does not protect the ureteroscope from damage caused by laser energy. In each case the urologist will need to determine if the mechanical protective value of the sheath outweighs the negative impact on flow and deflection.
尽管钬激光具有明显的实用价值，但在常规输尿管镜检查过程中，激光光纤经常会损坏柔性输尿管镜组件，如工作通道、柔性组件电缆系统和光纤光学系统。因此，我们研究了使用柔性保护鞘对输尿管镜操作的影响及其保护输尿管镜免受激光光纤损伤的能力。
记录将FlexGuard鞘插入工作通道对内镜偏转和冲洗液流速的影响。此外，使用两种不同的输尿管镜评估将激光光纤推进至完全偏转的内镜所需的力，以及穿透FlexGuard鞘所需的激光能量。
FlexGuard鞘很容易通过最大偏转的输尿管镜插入。工作通道中存在激光鞘和激光光纤使输尿管镜的最大偏转角平均减小了7度（从73度降至66度）。在100 cm H₂O的冲洗压力下，将FlexGuard鞘插入工作通道也显著降低了冲洗液流速，从0.55 mL/秒降至0.02 mL/秒。FlexGuard鞘将通过每个输尿管镜插入激光光纤所需的最大力从0.8 N降至0.2 N。FlexGuard鞘无法保护输尿管镜免受激光能量损伤。
FlexGuard激光鞘显著降低了通过工作通道插入激光光纤所需的力。这种力的降低可能有助于防止激光光纤插入造成的机械损伤。然而，鞘的使用显著降低了冲洗液流速和所测试的两种输尿管镜的最大偏转。此外，该鞘不能保护输尿管镜免受激光能量造成的损伤。在每种情况下，泌尿外科医生都需要确定鞘的机械保护价值是否超过其对流速和偏转的负面影响。
