Laser lithotripsy

Last updated
Laser lithotripsy
Specialty Urology
ICD-9-CM 98
MeSH D017602

Laser lithotripsy (LL) is a surgical procedure which uses lasers to break down and remove stones from the urinary tract, such as in the kidney, ureter, bladder, or urethra. [1] When it involves a ureteroscopy, the procedure is more specifically called ureteroscopic laser lithotripsy (ULL). [2]

Contents

History

Laser lithotripsy was invented at the Wellman Center for Photo Medicine at Massachusetts General Hospital in the 1980s to remove impacted urinary stones. Optical fibers carry light pulses that pulverize the stone. Candela licensed the technology and released the first commercial laser lithotripsy system. [3] [ better source needed ]

Procedure

A urologist inserts a scope into the urinary tract to locate the stone. The scope may be a cystoscope, ureteroscope, renoscope or nephroscope. An optical fiber is inserted through the working channel of the scope, and laser light is directly emitted to the stone. The stone is fragmented and the remaining pieces are collected in a "basket" or washed out of the urinary tract, along with the finer particulate "dust". [4]

The procedure is done under either local or general anesthesia and is considered a minimally-invasive procedure. It is widely available in most hospitals in the world.

Comparison with extracorporeal shockwave therapy

Laser lithotripsy has been evaluated against extracorporeal shockwave therapy (ESWT), finding both to be safe and effective. [5] [6] ESWT may be safer for small stones (<10 mm), but less effective for 10–20 mm stones. [5] A 2013 meta-analysis found LL can treat larger stones (> 2 cm) with good stone-free and complication rates. [7]

Holmium laser lithotripsy had superior initial success and re-treatment rate compared to ESWT in a 2013 trial. [8]

Lasers

Pulsed dye lasers have been used with fiber diameters of 200–550 microns [9] for lithotripsy of biliary and urinary stones. [10]

Initially 504 nm dye lasers were used, then holmium lasers were studied in the 1990s.[ citation needed ]

Holmium:YAG (Ho:YAG) lasers are a type of solid-state laser; they have a wavelength of 2,100 nm (infrared) and are used for medical procedures in urology and other areas. Ho:YAG lasers have been considered the "gold-standard laser for lithotripsy" since the mid-1990s. [4] Ho:YAG laser machines are loud, contain fragile components including lenses and mirrors, consume a large amount of electricity, and usually require a dedicated power source. [4]

They have qualities of CO2 and Nd:YAG lasers, with ablative and coagulation effects. [11] Holmium laser use results in smaller fragments than those produced by 320- or 365-micron pulsed-dye lasers, as well as electrohydraulic and mechanical methods. [12]

Still-experimental thulium fiber lasers (TFLs) are also being studied as a potential alternative to Ho:YAG lasers for the treatment of kidney stones. [13] [14] [15] [16] [17] TFLs have several potential advantages compared to Ho:YAG lasers, including a four times lower ablation threshold, a near single-mode beam profile, less dust production, and higher pulse rates, resulting in faster overall procedure times. [15] The frequency of TFLs increased during the start of the 21st century. [4] TFL devices are also smaller and lighter than comparable Ho:YAG devices, and use just 10% of the electricity that a Ho:YAG laser would, potentially allowing for the use of multiple laser devices on a single circuit. [4]

See also

References

  1. ↑ "Laser Lithotripsy | Winchester Hospital".
  2. ↑ Tu, Hin Yu Vincent; Matsumoto, Edward (1 April 2015). "MP80-12 COST ANALYSIS OF URETERAL STENTING AFTER UNCOMPLICATED URETEROSCOPIC LASER LITHOTRIPSY FOR UROLITHIASIS: A DECISION MODEL ANALYSIS". The Journal of Urology . 193 (45): e1023 –e1024. doi:10.1016/j.juro.2015.02.2848.
  3. ↑ "Research Discoveries". Wellman Center for Photomedicine. Archived from the original on 15 April 2013. Retrieved 30 April 2011.
  4. 1 2 3 4 5 Giusti, Guido; Pupulin, Matheus; Proietti, Silvia (19 August 2022). "Which Is the Best Laser for Lithotripsy? The Referee Point of View". European Urology Open Science . 44: 20–22. doi:10.1016/j.euros.2022.07.014. PMID   36043189.
  5. 1 2 Kumar A, Vasudeva P, Nanda B, Kumar N, Das MK, Jha SK (Nov 18, 2014). "A Prospective Randomized Comparison Between Shock Wave Lithotripsy and Flexible Ureterorenoscopy for Lower Caliceal Stones ≤2 cm: A Single-Center Experience". J. Endourol. 29 (5): 575–579. doi:10.1089/end.2013.0473. PMID   25203489.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  6. ↑ Cecen K, Karadag MA, Demir A, Bagcioglu M, Kocaaslan R, Sofikerim M (Sep 24, 2014). "Flexible Ureterorenoscopy versus Extracorporeal Shock Wave Lithotripsy for the treatment of upper/middle calyx kidney stones of 10-20 mm: a retrospective analysis of 174 patients". SpringerPlus. 3 (1): 557. doi: 10.1186/2193-1801-3-557 . PMC   4190185 . PMID   25332859.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  7. ↑ Aboumarzouk OM, Monga M, Kata SG, Traxer O, Somani BK (Oct 2012). "Flexible ureteroscopy and laser lithotripsy for stones >2 cm: a systematic review and meta-analysis". J. Endourol. 26 (10): 1257–63. doi:10.1089/end.2012.0217. PMID   22642568.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  8. ↑ Khalil M (Apr 2013). "Management of impacted proximal ureteral stone: Extracorporeal shock wave lithotripsy versus ureteroscopy with holmium: YAG laser lithotripsy". Urol. Ann. 5 (2): 88–92. doi: 10.4103/0974-7796.110004 . PMC   3685752 . PMID   23798864.
  9. ↑ Grasso M, Bagley DH (Feb 1994). "Endoscopic pulsed-dye laser lithotripsy: 159 consecutive cases". J. Endourol. 8 (1): 25–7. doi:10.1089/end.1994.8.25. PMID   8186779.
  10. ↑ Grasso M, Bagley D, Sullivan K (October 1991). "Pulsed dye laser lithotripsy--currently applied to urologic and biliary calculi". J. Clin. Laser Med. Surg. 9 (5): 355–9. doi:10.1089/clm.1991.9.355. PMID   10150133.
  11. ↑ Chun SS, Razvi HA, Denstedt JD (Winter 1995). "Laser prostatectomy with the holmium: YAG laser". Tech. Urol. 1 (4): 217–21. PMID   9118394.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  12. ↑ Teichman Joel M.H. (January 1998). "Holmium:YAG lithotripsy yields smaller fragments than lithoclast, pulsed dye laser or electrohydraulic lithotripsy". J. Urol. 159 (1): 17–23. doi:10.1016/s0022-5347(01)63998-3. PMID   9400428.
  13. ↑ Wilson CR, Hardy LA, Irby PB, Fried NM (July 2015). "Collateral damage to the ureter and Nitinol stone baskets during thulium fiber laser lithotripsy". Lasers Surg. Med. 47 (5): 403–10. doi:10.1002/lsm.22348. PMID   25872759. S2CID   35302695.
  14. ↑ Wilson CR, Hutchens TC, Hardy LA, Irby PB, Fried NM (October 2015). "A Miniaturized, 1.9F Integrated Optical Fiber and Stone Basket for Use in Thulium Fiber Laser Lithotripsy". J. Endourol. 29 (10): 1110–4. doi:10.1089/end.2015.0124. PMID   26167738.
  15. 1 2 Hardy, L.A; Wilson, C.R.; Irby, P.B.; Fried, N.M. (2014). "Rapid vaporization of kidney stones, ex vivo , using a Thulium fiber laser at pulse rates up to 500 Hz with a stone basket". In Choi, Bernard; Kollias, Nikiforos; Zeng, Haishan; Kang, Hyun Wook; Wong, Brian J. F.; Ilgner, Justus F.; Tearney, Guillermo J.; Gregory, Kenton W.; Marcu, Laura; Mandelis, Andreas; Morris, Michael D. (eds.). Photonic Therapeutics and Diagnostics X. Vol. 8926. pp. 89261H. CiteSeerX   10.1.1.819.6910 . doi:10.1117/12.2037263. S2CID   121794649.{{cite book}}: |journal= ignored (help)
  16. ↑ Hardy L.A, Wilson C.R., Irby P.B., Fried N.M. (2014). "Thulium fiber laser lithotripsy in an in vitro ureter model". J. Biomed. Opt. 19 (12): 128001. Bibcode:2014JBO....19l8001H. doi: 10.1117/1.jbo.19.12.128001 . PMID   25518001. S2CID   12424266.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  17. ↑ Blackmon R.L., Hutchens T.C., Hardy L.A., Wilson C.R., Irby P.B., Fried N.M. (2015). "Thulium fiber laser ablation of kidney stones using a 50-μm-core silica optical fiber". Opt. Eng. 54 (1): 011004. Bibcode:2015OptEn..54a1004B. doi:10.1117/1.oe.54.1.011004. S2CID   120650738.{{cite journal}}: CS1 maint: multiple names: authors list (link)
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