Panthier Frederic, Germain Thibault, Gorny Cyril, Berthe Laurent, Doizi Steeve, Traxer Olivier
GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020 Paris, France.
Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 Rue de la Chine, 75020 Paris, France.
J Clin Med. 2021 Dec 29;11(1):181. doi: 10.3390/jcm11010181.
Endocorporeal laser lithotripsy (EL) during flexible ureteroscopy (URS-f) often uses "dusting" settings with "painting" technique. The displacement velocity of the laser fiber (LF) at the stone surface remains unknown and could improve EL's ablation rates. This in vitro study aimed to define the optimal displacement velocity (ODV) for both holmium:yttrium-aluminium-garnet (Ho:YAG) and thulium fiber laser (Tm-Fiber).
A 50W-TFL (IRE Polus, Moscow, Russia) and a 30W-MH1-Ho:YAG laser (Rocamed, Signes, Provence-Alpes-Côte d'Azur, France), were used with 272 µm-Core-Diameter LF (Sureflex, Boston Scientific, San Jose, CA, USA), comparing three TFL modes, "fine dusting" (FD: 0.05-0.15 J/100-600 Hz); "dusting" (D: 0.5 J/30-60 Hz); "fragmentation" (Fr: 1 J/15-30 Hz) and two Ho:YAG modes (D: 0.5 J/20 Hz, Fr: 1 J/15 Hz). An experimental setup consisting of immerged cubes of calcium oxalate monohydrate (COM) stone phantoms (Begostone Plus, Bego, Lincoln, RI, USA) was used with a 2 s' laser operation time. LF were in contact with the stones, static or with a displacement of 5, 10 or 20 mm. Experiments were repeated four times. Stones were dried and µ-scanned. Ablation volumes (mm) were measured by 3D-segmentation.
ODV was higher in dusting compared to fragmentation mode during Ho:YAG lithotripsy (10 mm/s vs. 5 mm/s, respectively). With Tm-Fiber, dusting and fragmentation OVDs were similar (5 mm/s). Tm-Fiber ODV was lower than Ho:YAGs in dusting settings (5 mm/s vs. 10 mm/s, respectively). Without LF displacement, ablation volumes were at least two-fold higher with Tm-Fiber compared to Ho:YAG. Despite the LF-DV, we report a 1.5 to 5-fold higher ablation volume with Tm-Fiber compared to Ho:YAG.
In dusting mode, the ODV is lower compared to ODV, translating to a potential easier Tm-Fiber utilization for "painting" dusting technique. The ODV determinants remain unknown. Dynamic ablation volumes are higher to static ones, regardless of the laser source, settings or LF displacement velocity.
在软性输尿管镜检查（URS-f）期间进行体内激光碎石术（EL）时，常使用“粉末化”设置及“扫石”技术。激光光纤（LF）在结石表面的移动速度尚不清楚，而这可能会提高EL的消融率。本体外研究旨在确定钬：钇铝石榴石（Ho:YAG）激光和掺铥光纤激光（Tm-Fiber）的最佳移动速度（ODV）。
使用一台50W的TFL（IRE Polus，俄罗斯莫斯科）和一台30W的MH1-Ho:YAG激光（Rocamed，法国普罗旺斯-阿尔卑斯-蓝色海岸大区西涅），搭配直径272µm的LF（Sureflex，美国波士顿科学公司加利福尼亚州圣何塞），比较三种TFL模式：“精细粉末化”（FD：0.05 - 0.15J/100 - 600Hz）；“粉末化”（D：0.5J/30 - 60Hz）；“碎块化”（Fr：1J/15 -
