Department of Urology, The Ohio State University Wexner Medical Center, Columbus, OH 43212, USA.
J Endourol. 2013 Apr;27(4):475-9. doi: 10.1089/end.2012.0513.
Numerous holmium:yttrium-aluminum-garnet laser fibers are available for flexible ureteroscopy. Performance and durability of fibers can vary widely among different manufacturers and their product lines with differences within a single product line have been reported. We sought to evaluate a newly developed nontapered, single-use 240-μm fiber, Flexiva™ 200 (Boston Scientific, Natick, MA), during clinical use and in a bench-testing model.
A total of 100 new fibers were tested after their use in 100 consecutive flexible ureteroscopic lithotripsy procedures by a single surgeon (B.K.). Prospectively recorded clinical parameters were laser pulse energy and frequency settings, total energy delivered and fibers failure. Subsequently, each fiber was bench-tested using an established protocol. Parameters evaluated for were fibers true diameter, flexibility, tip degradation, energy transmission in straight and 180° bend configuration and fibers failure threshold with stress testing.
The mean total energy delivered was 2.20 kJ (range 0-18.24 kJ) and most common laser settings used were 0.8 J at 8 Hz, 0.2 J at 50 Hz, and 1.0 J at 10 Hz, respectively. No fiber fractured during clinical procedures. The true fiber diameter was 450 μm. Fiber tips burnt back an average of 1.664 mm, but were highly variable. With laser setting of 400 mJ at 5 Hz, the mean energy transmitted was 451 and 441 mJ in straight and 180° bend configuration, respectively. Thirteen percent of fibers fractured at the bend radius of 0.5 cm with a positive correlation to the total energy transmitted during clinical use identified.
Fiber performance was consistent in terms of energy transmission and resistance to fracture when activated in bent configuration. Fiber failure during stress testing showed significant correlation with the total energy delivered during the clinical procedure. The lack of fiber fracture during clinical use may reduce the risk of flexible endoscope damage due to fiber failure.
目前有多种钬激光光纤可用于软性输尿管镜检查。不同制造商生产的光纤性能和耐用性差异很大，同一产品线上的产品也存在差异。我们旨在评估一种新开发的非锥形、一次性使用的 240μm 光纤，即 Flexiva™ 200（波士顿科学公司，马萨诸塞州纳提克），并在临床使用和 bench 测试模型中进行测试。
总共对 100 根新光纤进行了测试，这些光纤在一位外科医生（B.K.）连续进行的 100 例软性输尿管镜碎石术治疗中使用过。前瞻性记录的临床参数包括激光脉冲能量和频率设置、输送的总能量以及光纤失效情况。随后，按照既定方案对每根光纤进行 bench 测试。评估的参数包括光纤的真实直径、柔韧性、尖端降解、在直型和 180°弯曲配置下的能量传输以及在应力测试下的光纤失效阈值。
输送的总能量平均为 2.20kJ（范围 0-18.24kJ），最常用的激光设置分别为 0.8J 时 8Hz、0.2J 时 50Hz 和 1.0J 时 10Hz。在临床操作过程中没有光纤断裂。光纤的真实直径为 450μm。光纤尖端平均烧蚀 1.664mm，但差异较大。在激光设置为 400mJ 时 5Hz 的情况下，直型和 180°弯曲配置下的平均能量传输分别为 451mJ 和 441mJ。13%的光纤在半径为 0.5cm 的弯曲处断裂，与在临床操作过程中传输的总能量呈正相关。
在弯曲状态下激活时，光纤的能量传输和抗断裂性能一致。在应力测试中光纤失效与临床操作中输送的总能量有显著相关性。在临床使用中没有光纤断裂可能会降低由于光纤失效导致软性内窥镜损坏的风险。
