Yamashita Shimpei, Inoue Takaaki, Imai Satoshi, Iwahashi Yuya, Deguchi Ryusuke, Muraoka Satoshi, Kikkawa Kazuro, Kohjimoto Yasuo, Fujisawa Masato, Hara Isao
Department of Urology, Wakayama Medical University Hospital, Wakayama, Japan.
Department of Urology, Hara Genitourinary Hospital, Hyogo, Japan.
J Endourol. 2023 Feb;37(2):179-184. doi: 10.1089/end.2022.0327.
This study aims to evaluate changes in irrigation fluid temperatures during laser activation by using thermography, with comparison between Moses mode (MM) and virtual basket mode (VBM). Experiments were performed using an unroofed pyelocaliceal model. The laser was fired for 60 seconds at 0.4 J/60 Hz. Three runs were tested per setting using short pulse mode, long pulse mode, MM contact, and VBM. The time to reach threshold of thermal injury (43°C) was evaluated using thermometer and thermography, both with and without saline irrigation (25 mL/min). These outcomes were compared between laser pulse modes. In measurement of time to reach the threshold, thermography-based time was significantly shorter than thermometer-based time in all laser modes under the condition of no irrigation. Thermography measurement results indicate that the speed of temperature rise depends on laser pulse modes, and the time to reach the threshold in MM was significantly shorter than that in VBM (9.0 seconds 14.3 seconds, = 0.03). When 25 mL/min saline irrigation was used, the peak temperatures by both thermometer and thermography measurements did not exceed the threshold during laser activation. Thermography-based evaluation suggests that irrigation temperatures near mucosa around stones can rapidly elevate during laser lithotripsy when the irrigation condition is poor. Temperature rise speed in MM may be more rapid than that in VBM. To prevent thermal injury, laser pulse modes must be used selectively according to the condition of irrigation.
本研究旨在通过热成像评估激光激活过程中冲洗液温度的变化，并比较摩西模式（MM）和虚拟篮子模式（VBM）。实验使用无顶肾盂肾盏模型进行。激光以0.4 J/60 Hz的能量发射60秒。每种设置使用短脉冲模式、长脉冲模式、MM接触模式和VBM模式进行三次测试。使用温度计和热成像评估达到热损伤阈值（43°C）的时间，有无盐水冲洗（25 mL/min）两种情况均进行评估。对这些结果在不同激光脉冲模式之间进行比较。在达到阈值时间的测量中，在无冲洗条件下，所有激光模式下基于热成像的时间显著短于基于温度计的时间。热成像测量结果表明，温度上升速度取决于激光脉冲模式，MM模式下达到阈值的时间显著短于VBM模式（9.0秒对14.3秒，P = 0.03）。当使用25 mL/min的盐水冲洗时，激光激活期间温度计和热成像测量的峰值温度均未超过阈值。基于热成像的评估表明，在激光碎石术期间，当冲洗条件较差时，结石周围黏膜附近的冲洗液温度会迅速升高。MM模式下的温度上升速度可能比VBM模式更快。为防止热损伤，必须根据冲洗情况选择性地使用激光脉冲模式。
