Department of Urology and Uro-oncology, Hannover Medical School (MHH), Hannover, Germany.
J Endourol. 2010 Nov;24(11):1747-51. doi: 10.1089/end.2009.0298.
It has been postulated that laser insertion sheaths prevent mechanical damage to the inside of working channels of flexible ureteroscopes. The presented study, for the first time, aims at confirming this hypothesis and visualized the damage of the endoscopic working channel by video-endoluminal observation after a series of laser fiber passages with or without the protection of a laser fiber insertion sheath.
Four nonassembled working channels of two different manufacturers (Olympus™, Wolf™) were tested in a deflection model (50° and 180°). Flexifib™ laser fibers (LISA laser products) with an optical core diameter of 273 μm were inserted through 0.9% NaCl irrigated working channels in cycles of 10 insertions either with or without protection of the Flexgard™ insertion sheath. After 30 insertions, the examination cycle was reduced to 5 insertions each cycle until breakage. Test cycles were followed by endoluminal video examination of the working channel with the 2.4F flexible fiber scope by Polydiagnost™. Damage to the working channel was classified as streaks with superficial stress marks of the surface, scratches with embossed margins, or perforations.
No scratching or perforation occurred in the insertion sheath group in up to 150 insertions in all working channels and both deflection grades. In the group without insertion sheaths, scratches were visible after 40 to 50 insertions with 50° deflection and 30 insertions with 180° deflection. Perforations of the working channels were seen after 95 insertions with 50° and 60 insertions with 180° deflection.
Severe damage to working channels depends on the degree of deflection and may occur after 30 insertions only. Relevant damage to the working channel may be avoided by using a laser fiber insertion sheath.
有人假设激光插入鞘可防止柔性输尿管镜工作通道内部的机械损伤。本研究首次旨在证实这一假设，并通过视频内镜观察，在有无激光光纤插入鞘保护的情况下，对一系列激光光纤通过后，观察内镜工作通道的损伤。
在偏转模型（50°和 180°）中测试了来自两个不同制造商（Olympus™，Wolf™）的四个未组装的工作通道。使用带有 273μm 光学芯直径的 Flexifib™激光光纤（LISA 激光产品），在 0.9%NaCl 冲洗的工作通道中以 10 次插入为一个周期进行插入，要么有 Flexgard™插入鞘保护，要么没有。进行 30 次插入后，将每个周期的检查循环减少到 5 次插入，直到断裂。测试循环后，使用 Polydiagnost™的 2.4F 柔性纤维镜进行内镜视频检查工作通道。将工作通道的损伤分类为表面有浅压痕的条纹、有压痕边缘的划痕或穿孔。
在所有工作通道和两个偏转等级中，插入鞘组在多达 150 次插入中均未出现划痕或穿孔。在无插入鞘组中，50°偏转时在 40 到 50 次插入后可见划痕，180°偏转时在 30 次插入后可见划痕。在 50°偏转时有 95 次插入和 180°偏转时有 60 次插入时，工作通道出现穿孔。
工作通道的严重损坏取决于偏转程度，可能仅在 30 次插入后发生。使用激光光纤插入鞘可以避免工作通道的相关损伤。
