Basulto-Martínez Mario, Proietti Silvia, Yeow Yuyi, Rapallo Ilenia, Saitta Giuseppe, Cimino Sebastiano, Luciani Lorenzo, Bellinzoni Piera, Gaboardi Franco, Giusti Guido
European Training Center in Endourology at Department of Urology. IRCCS San Raffaele Hospital. Ville Turro Division. Milan. Italy. Department of Urology. Hospital Regional de Alta Especialidad de la Península de Yucatán. Merida. Mexico.
European Training Center in Endourology at Department of Urology. IRCCS San Raffaele Hospital. Ville Turro Division. Milan. Italy.
Arch Esp Urol. 2020 Oct;73(8):735-744.
To review recent and relevant information regarding the use of high-power (HPL) and low-power (LPL) Holmium:YAG lasers (Ho:YAG) in retrograde intrarenal surgery (RIRS) for lithotripsy. METHODS: A PubMed/Embase search was conducted and recent and relevant papers on Ho:YAG for RIRS were reviewed.
Settings for Ho:YAG are pulse energy (PE), pulse frequency (PF), and pulse width. Currently, the majority of LPL can also adjust pulse-width but cannot reach PF as high as HPL, however, the higher energy outputs reached by HPL are rarely useful in lithotripsy. Higher PE might enhance ablation but generates larger fragments and higher retropulsion. Pulse width does not affect energy output but delivers energy for a longer time-length. Dusting and basketing are complementary techniques. Dusting seeks to pulverize stones into particles ≤250 μm avoiding the use of instruments for stone retrieval, whereas in fragmenting, the stones are break into smaller pieces which are then retrieved. Dusting can prevent the use of supplies such as access sheaths and baskets and also prevent the complications related to their use. However, is not always feasible in clinical practice to fully ablate a stone into dust, then the use of this supplies and popcorn technique are helpful for rendering a patient stonefree. The energy gap between HPL and LPL is wide and leaves room for a mid-power laser classification, which can overcome the main drawback of LPL, the expenses of HPL, and still holding its versatility for other procedures beyond stones.
HPL and LPL have similar effectiveness, but long-term cost-effectiveness comparisons are underexplored. Newer HPL would need to be compared to emerging technologies as the thulium fiber, and prove superiority to mid-power laser to determine how powerful is enough for Ho:YAG in the years to come.
回顾近期有关高功率（HPL）和低功率（LPL）钬激光（Ho:YAG）用于逆行性肾内手术（RIRS）碎石的相关信息。方法：进行PubMed/Embase检索，并回顾近期有关Ho:YAG用于RIRS的相关论文。
Ho:YAG的参数设置包括脉冲能量（PE）、脉冲频率（PF）和脉冲宽度。目前，大多数LPL也可调节脉冲宽度，但无法达到HPL那样高的PF，然而，HPL所达到的更高能量输出在碎石中很少有用。较高的PE可能会增强消融，但会产生更大的碎片和更强的反冲力。脉冲宽度不影响能量输出，但能在更长的时间内传递能量。粉末化和套石篮取石是互补技术。粉末化旨在将结石粉碎成≤250μm的颗粒，避免使用器械取石，而在碎解过程中，结石被破碎成更小的碎片，然后取出。粉末化可避免使用诸如通道鞘和套石篮等耗材，也可预防与其使用相关的并发症。然而，在临床实践中要将结石完全消融成粉末并不总是可行的，此时使用这些耗材和爆米花技术有助于使患者结石清除。HPL和LPL之间的能量差距很大，为中功率激光分类留出了空间，中功率激光可以克服LPL的主要缺点、HPL的成本，并且在结石以外的其他手术中仍保持其通用性。
HPL和LPL具有相似的有效性，但长期成本效益比较尚未充分探索。新型HPL需要与如掺铥光纤激光等新兴技术进行比较，并证明其优于中功率激光，以确定未来几年Ho:YAG的最佳功率。
