Urology Department, Hospital Clínic de Barcelona, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain.
Sorbonne University GRC Urolithiasis No. 20 Tenon Hospital, 75020, Paris, France.
World J Urol. 2024 Aug 19;42(1):487. doi: 10.1007/s00345-024-05102-1.
To evaluate the stone ablation rate and direct thermal damage from thulium fiber laser (TFL) lithotripsy using continuous (C) and burst (B) lasing techniques on an in vitro ureteral model.
The TFL Drive (Coloplast, Humlebaek, Denmark) was used in an in vitro saline-submerged ureteral model. Ten participants, including five junior and five experienced urologists, conducted the experimental setup with 7 different settings comparing two lasing techniques: steady-state lasing (0.5 J/10 Hz = 5W for 300 s and 0.5 J/20 Hz = 10W for 150 s) and burst, intermittent 5 s on/off lasing (0.5 J/20 Hz, 0.5 J/30 Hz, 0.5 J/60 Hz, 0.1 J/200 Hz, and 0.05 J/400 Hz) with a target cumulative energy of 1500 J using cubic 125 mm phantom BegoStonesTM. Ureteral damage was graded 1-3 based on the severity of burns and holes observed on the surface of the ureteral model.
The were no significant differences in stone ablation mass neither between C and B lasing techniques, nor between expertise levels. At C lasing technique had only mild ureteral lesions with no significant differences between expertise levels (p: 0.97) or laser settings (p: 0.71). At B lasing technique, different types of thermal lesions were found with no expertise (p: 0.11) or setting (p: 0.83) differences. However, B laser setting had higher grade direct thermal lesions than C (p: 0.048).
Regarding efficacy, C and B lasing techniques achieve comparable stone ablation rates. Safety-wise, B lasing mode showed higher grade of direct thermal lesions. These results should be further investigated to verify which of the lasing mode is the safest in vivo. Until then and unless proven otherwise, a C mode with low frequency should be recommended to avoid ureteral wall lesions.
评估钬纤维激光（TFL）碎石术在体外输尿管模型中使用连续（C）和爆发（B）激光技术的碎石率和直接热损伤。
在体外盐水浸没的输尿管模型中使用 TFL Drive（丹麦科宝）。10 名参与者，包括 5 名初级和 5 名经验丰富的泌尿科医生，进行了实验设置，比较了两种激光技术：稳态激光（0.5 J/10 Hz = 5W 持续 300s 和 0.5 J/20 Hz = 10W 持续 150s）和爆发式、间歇性 5s 开/关激光（0.5 J/20 Hz、0.5 J/30 Hz、0.5 J/60 Hz、0.1 J/200 Hz 和 0.05 J/400 Hz），使用立方 125mm 幻影 BegoStonesTM，目标累积能量为 1500J。根据输尿管模型表面观察到的烧伤和孔的严重程度，将输尿管损伤分级为 1-3 级。
无论是在 C 激光技术还是 B 激光技术之间，还是在专业水平之间，结石消融质量都没有显著差异。在 C 激光技术下，输尿管损伤较轻，且在专业水平（p：0.97）或激光设置（p：0.71）之间没有显著差异。在 B 激光技术下，发现了不同类型的热损伤，在专业水平（p：0.11）或设置（p：0.83）之间没有差异。然而，B 激光设置的直接热损伤等级高于 C（p：0.048）。
在疗效方面，C 和 B 激光技术可达到相似的碎石率。在安全性方面，B 激光模式显示出更高等级的直接热损伤。这些结果应进一步研究，以验证哪种激光模式在体内更安全。在这之前，除非有其他证明，否则应推荐使用低频率的 C 模式，以避免输尿管壁损伤。
