Department of Urology and Andrology, General Hospital Hall I.T, Milser Straße 10, 6060, Hall in Tirol, Austria.
Training and Research in Urological Surgery and Technology (TRUST)-Group, Hall in Tirol, Austria.
World J Urol. 2024 Feb 14;42(1):79. doi: 10.1007/s00345-024-04786-9.
PURPOSE: To identify laser settings and limits applied by experts during laser vaporization (vapBT) and laser en-bloc resection of bladder tumors (ERBT) and to identify preventive measures to reduce complications. METHODS: After a focused literature search to identify relevant questions, we conducted a survey (57 questions) which was sent to laser experts. The expert selection was based on clinical experience and scientific contribution. Participants were asked for used laser types, typical laser settings during specific scenarios, and preventive measures applied during surgery. Settings for a maximum of 2 different lasers for each scenario were possible. Responses and settings were compared among the reported laser types. RESULTS: Twenty-three of 29 (79.3%) invited experts completed the survey. Thulium fiber laser (TFL) is the most common laser (57%), followed by Holmium:Yttrium-Aluminium-Garnet (Ho:YAG) (48%), continuous wave (cw) Thulium:Yttrium-Aluminium-Garnet (Tm:YAG) (26%), and pulsed Tm:YAG (13%). Experts prefer ERBT (91.3%) to vapBT (8.7%); however, relevant limitations such as tumor size, number, and anatomical tumor location exist. Laser settings were generally comparable; however, we could find significant differences between the laser sources for lateral wall ERBT (p = 0.028) and standard ERBT (p = 0.033), with cwTm:YAG and pulsed Tm:YAG being operated in higher power modes when compared to TFL and Ho:YAG. Experts prefer long pulse modes for Ho:YAG and short pulse modes for TFL lasers. CONCLUSION: TFL seems to have replaced Ho:YAG and Tm:YAG. Most laser settings do not differ significantly among laser sources. For experts, continuous flow irrigation is the most commonly applied measure to reduce complications.
目的:确定专家在激光汽化( vapBT )和膀胱肿瘤整块激光切除( ERBT )过程中应用的激光设置和限制,并确定预防措施以减少并发症。
方法:在有针对性的文献检索以确定相关问题后,我们进行了一项调查( 57 个问题),并将其发送给激光专家。专家的选择基于临床经验和科学贡献。参与者被要求提供使用的激光类型、特定情况下的典型激光设置以及手术中应用的预防措施。对于每个场景,最多可以为 2 种不同的激光设置。报告的激光类型之间比较了设置和设置。
结果:邀请的 29 位专家中有 23 位( 79.3% )完成了调查。掺铥光纤激光( TFL )是最常见的激光( 57% ),其次是钬:钇铝石榴石( Ho : YAG )( 48% )、连续波( cw )掺铥:钇铝石榴石( Tm : YAG )( 26% )和脉冲掺铥:钇铝石榴石( 13% )。专家更喜欢 ERBT ( 91.3% )而不是 vapBT ( 8.7% );然而,存在肿瘤大小、数量和解剖肿瘤位置等相关限制。激光设置通常具有可比性;然而,我们可以在侧向壁 ERBT ( p = 0.028 )和标准 ERBT ( p = 0.033 )之间的激光源之间找到显著差异,与 TFL 和 Ho : YAG 相比, cwTm : YAG 和脉冲 Tm : YAG 以更高的功率模式运行。专家更喜欢 Ho : YAG 的长脉冲模式和 TFL 激光的短脉冲模式。
结论: TFL 似乎已经取代了 Ho : YAG 和 Tm : YAG 。大多数激光设置在激光源之间没有显著差异。对于专家来说,连续流动冲洗是减少并发症最常用的措施。
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