Department of Urology, Hospital Aleman, Buenos Aires, Argentina.
Department of Urology, IRCCS San Raffaele Hospital, Milan, Lombardia, Italy.
Lasers Med Sci. 2023 Jul 28;38(1):168. doi: 10.1007/s10103-023-03828-9.
The new pulse modality Vapor-Tunnel™ (VT) consists of a very long pulse that uses the minimum peak power, causing the energy to pass through a previously created vapor channel or tunnel. The first part of the pulse creates a vapor channel, whereas the remaining energy is discharged immediately after, passing straight through the previously created tunnel. The aim of this study is to compare the dusting efficacy between Ho:YAG laser with long pulse and Ho:YAG laser with VT for non-complex kidney stones. A retrospective comparative study of 236 patients who underwent retrograde intrarenal surgery using Ho:YAG laser (long pulse vs. VT) was performed. Stone size, stone density, laser settings, laser emission time, and total operative time were recorded. We also assessed the lithotripsy efficacy (J/mm). The stone-free rate was defined as the absence of stone fragments in a non-contrast abdominal computed tomography 4 weeks after the procedure. A total of 118 patients were included in each group. There was no significant difference in age, gender, and body mass index. Median stone volume (737 mm vs. 636 mm) and stone density (788 HU vs. 656 HU) were higher in the VT group. Total energy used (14.5 J vs. 18.2 J), the laser emission time (20 min vs. 26 min), and the total operative time (79.5 min vs. 95 min) were significantly lower in the VT group. The stone-free rate was comparable between both groups (74.5% for VT and 66.1% for the long-pulse group, p = 0.15). When we evaluated the efficacy of laser lithotripsy, a significantly lower difference was obtained in the VT group (median 12.5 J/mm vs. median 23.1 J/mm). The VT pulse modality was associated with decreased laser time and operative time. Additionally, it increased lithotripsy efficacy compared to Ho:YAG long pulse laser, but with a comparable free-stone rate.
新型脉冲模式 Vapor-Tunnel™（VT）由一个非常长的脉冲组成，该脉冲使用最小的峰值功率，使能量通过先前创建的蒸汽通道或隧道。脉冲的第一部分创建一个蒸汽通道，而其余的能量在之后立即释放，直接穿过先前创建的隧道。本研究的目的是比较 Ho:YAG 激光长脉冲和 Ho:YAG 激光 VT 治疗非复杂性肾结石的碎石效果。对 236 例接受 Ho:YAG 激光逆行肾内手术（长脉冲与 VT）的患者进行了回顾性比较研究。记录结石大小、结石密度、激光设置、激光发射时间和总手术时间。我们还评估了碎石效果（J/mm）。结石清除率定义为手术后 4 周非对比腹部 CT 无结石碎片。每组纳入 118 例患者。两组间年龄、性别和体重指数无显著差异。VT 组的中位结石体积（737mm3 比 636mm3）和结石密度（788HU 比 656HU）更高。VT 组总能量使用量（14.5J 比 18.2J）、激光发射时间（20min 比 26min）和总手术时间（79.5min 比 95min）均显著降低。两组结石清除率无显著差异（VT 组为 74.5%，长脉冲组为 66.1%，p=0.15）。当我们评估激光碎石的疗效时，VT 组的差异明显较小（中位 12.5J/mm 比中位 23.1J/mm）。VT 脉冲模式与激光时间和手术时间的减少有关。此外，与 Ho:YAG 长脉冲激光相比，它提高了碎石效果，但结石清除率相当。
