Ville Turro Division, Department of Urology, European Training Center of Endourology, IRCCS San Raffaele Hospital, Milan, Italy.
Department of Urology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA.
J Endourol. 2021 Apr;35(4):544-551. doi: 10.1089/end.2020.0222. Epub 2020 Sep 7.
There are limited data regarding the effect of thulium laser (Tm:YAG) and holmium laser (Ho:YAG) on upper urinary tract. The aim of this study was to compare soft tissue effects of these two lasers at various settings, with a focus on incision depth (ID) and coagulation area (CA). An experimental study was performed in a porcine model. The kidneys were dissected to expose the upper urinary tract and the block samples containing urothelium and renal parenchyma were prepared. The laser fiber, fixed on a robotic arm, perpendicular to the target tissue was used with a 100 W Ho:YAG and a 200 W Tm:YAG. Incisions were made with the laser tip in contact with the urothelium and in continuous movement at a constant speed of 2 mm/s over a length of 1.5 cm. Total energy varied from 5 to 30 W. Incision shape was classified as follows: saccular, triangular, tubular, and irregular. ID, vaporization area (VA), CA, and total laser area (TLA = VA + CA) were evaluated. Statistical analysis was performed using the SPSS V23 package, -values <0.05 were considered statistically significant. A total of 216 experiments were performed. Incision shapes were saccular (46%), triangular (38%), and irregular (16%) with the Ho:YAG, while they were tubular (89%) and irregular (11%) with the Tm:YAG. ID was significantly deeper with the Ho:YAG ( = 0.024), while CA and TLA were larger with the Tm:YAG ( < 0.001 and < 0.005). ID was deeper with Ho:YAG, whereas CA and TLA were larger with the Tm:YAG. Considering surgical principles for endoscopic ablation of upper tract urothelial carcinoma, these results suggest that Tm:YAG may have a lower risk profile (less depth of incision) while also being more efficient at tissue destruction. Future studies are necessary to corroborate these findings.
关于铥激光（Tm：YAG）和钬激光（Ho：YAG）对上尿路的影响，数据有限。本研究的目的是比较这两种激光在不同设置下对软组织的影响，重点是切口深度（ID）和凝固面积（CA）。 一项在猪模型中进行的实验研究。解剖肾脏以暴露上尿路，并准备包含尿路上皮和肾实质的块状样本。激光光纤固定在机械臂上，与目标组织垂直，使用 100 W Ho：YAG 和 200 W Tm：YAG。用激光尖端接触尿路上皮，并以 2mm/s 的恒定速度连续移动，长度为 1.5cm，进行切割。总能量从 5 到 30 W 不等。切口形状分为囊状、三角形、管状和不规则形。评估 ID、汽化面积（VA）、CA 和总激光面积（TLA=VA+CA）。使用 SPSS V23 包进行统计分析，-值<0.05 被认为具有统计学意义。 总共进行了 216 次实验。Ho：YAG 的切口形状为囊状（46%）、三角形（38%）和不规则形（16%），而 Tm：YAG 的切口形状为管状（89%）和不规则形（11%）。Ho：YAG 的 ID 明显更深（=0.024），而 Tm：YAG 的 CA 和 TLA 更大（<0.001 和 <0.005）。 Ho：YAG 的 ID 更深，而 Tm：YAG 的 CA 和 TLA 更大。考虑到对上尿路尿路上皮癌的内镜消融手术原则，这些结果表明 Tm：YAG 的风险可能更低（切口深度较浅），同时在组织破坏方面效率更高。需要进一步的研究来证实这些发现。
