Department of Urology, Haukeland University Hospital, Bergen, Norway.
Department of Clinical Medicine (K1), University of Bergen, Bergen, Norway.
Scand J Urol. 2022 Aug;56(4):313-319. doi: 10.1080/21681805.2022.2104367. Epub 2022 Aug 3.
The aim of this study was to investigate temperature profiles in both the renal pelvis and parenchyma during Thulium Fiber Laser (TFL) and Holmium:yttrium-aluminium-garnet (Ho:YAG) laser activation in an ex-vivo porcine model.
Three porcine kidneys with intact renal pelvis and proximal ureters were used in the study. A temperature sensor was inserted through a nephrostomy tube into the renal pelvis and a second sensor was inserted directly into the renal parenchyma. Temperatures were recorded during continuous laser activation for 180 s, and for an additional 60 s after deactivation. TFL (150 μm and 200 μm) and Ho:YAG (270 μm) laser delivered power at settings of 2.4 W, 8 W, 20 W and 30 W.
Intrapelvic temperatures correlated directly to power settings. Higher power produced higher temperatures. For example, using a 150 μm fiber at 2.4 W resulted in a 2.6 °C rise from baseline ( = 0.008), whereas using the same fiber at 20 W produced a rise in temperature of 19.9 °C ( = 0.02). Larger laser fibers caused significantly higher temperatures compared to smaller fibers using equivalent power settings, e.g. mean temperature at 20 W using 150 μm was 39.6 °C compared to 44.9 °C using 200 μm, < 0.001. There was a significant increase in parenchymal temperatures when applying 20 W and 30 W of laser power with the two larger fibers.
In this ex-vivo study, renal temperatures correlated directly to power settings. Higher power produced higher temperatures. Furthermore, larger laser fibers caused higher temperatures. These findings could help guide selection of safe power settings for ureteroscopic lithotripsy, but future clinical studies are needed for confirmation.
本研究旨在探讨在猪离体模型中，钬光纤激光（TFL）和钬：钇铝石榴石（Ho：YAG）激光激活时肾盂和肾实质的温度分布。
本研究使用 3 个完整肾盂和近端输尿管的猪肾。通过经皮肾造瘘管将温度传感器插入肾盂，另一个传感器直接插入肾实质。在连续激光激活 180 秒期间记录温度，并在激光关闭后额外记录 60 秒。TFL（150μm 和 200μm）和 Ho：YAG（270μm）激光以 2.4W、8W、20W 和 30W 的设定功率输送。
肾盂内温度与功率设定直接相关。功率越高，温度越高。例如，使用 150μm 光纤在 2.4W 时，与基线相比，温度升高 2.6°C（ = 0.008），而在相同光纤下使用 20W 时，温度升高 19.9°C（ = 0.02）。使用相同的功率设定，较大的激光光纤会导致明显更高的温度，例如，在 20W 时使用 150μm 光纤的平均温度为 39.6°C，而使用 200μm 光纤的平均温度为 44.9°C， < 0.001。当应用 20W 和 30W 的激光功率时，两种较大的光纤都会导致肾实质温度显著升高。
在这项离体研究中，肾内温度与功率设定直接相关。功率越高，温度越高。此外，较大的激光光纤会导致更高的温度。这些发现可以帮助指导输尿管镜碎石术的安全功率设定，但需要进一步的临床研究来确认。
