Laser lithotripsy

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

Laser lithotripsy is a surgical procedure to remove stones from urinary tract, i.e., kidney, ureter, bladder, or urethra. [1]

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. [2] [ better source needed ] Initially 504 nm dye lasers were used, then holmium lasers were studied in the 1990s.[ citation 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" and/or washed out of the urinary tract, along with the finer particulate "dust."[ citation needed ]

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

Laser lithotripsy (LL) has been evaluated against Extracorporeal Shock Wave lithotripsy (ESWL), finding both to be safe and effective. [3] [4] ESWL may be safer for small stones (<10 mm), but less effective for 10–20 mm stones. [3] A 2013 meta-analysis found LL can treat larger stones (> 2 cm) with good stone-free and complication rates. [5]

Holmium laser lithotripsy had superior initial success and re-treatment rate compared to extracorporeal shock wave lithotripsy (ESWL) in a 2013 trial. [6]

The experimental thulium fiber laser (TFL) is being studied as a potential alternative to the holmium:YAG (Ho:YAG) laser for the treatment of kidney stones. The TFL has several potential advantages compared to Ho:YAG laser for lithotripsy, including a four times lower ablation threshold, a near single-mode beam profile, and higher pulse rates, resulting in up to four times as fast ablation rates and faster procedural times. [7]

Lasers

Pulsed dye lasers have been used with fiber diameters of 200–550 microns [8] for lithotripsy of biliary and urinary stones. [9]

Ho:YAG lasers have wavelength of 2100 nm (infrared) and are used for medical procedures in urology and other areas. They have qualities of CO2 and Nd:Yag lasers, with ablative and coagulation effects. [10] Holmium laser use results in smaller fragments than 320 or 365 micron pulsed dye lasers or electrohydraulic and mechanical methods. [11]

Thulium fiber lasers are being investigated. [12] [13] [7] [14] [15]

See also

Related Research Articles

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<span class="mw-page-title-main">Kidney stone disease</span> Formation of mineral stones in the urinary tract

Kidney stone disease, also known as renal calculus disease, nephrolithiasis or urolithiasis, is a crystallopathy where a solid piece of material develops in the urinary tract. Renal calculi typically form in the kidney and leave the body in the urine stream. A small calculus may pass without causing symptoms. If a stone grows to more than 5 millimeters, it can cause blockage of the ureter, resulting in sharp and severe pain in the lower back that often radiates downward to the groin. A calculus may also result in blood in the urine, vomiting, or painful urination. About half of people who have had a renal calculus are likely to have another within ten years.

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<span class="mw-page-title-main">Extracorporeal shockwave therapy</span> Ultrasonic, non-invasive, outpatient treatment

Extracorporeal shockwave therapy (ESWT) is a treatment using powerful acoustic pulses which is mostly used to treat kidney stones and in physical therapy and orthopedics.

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A medical procedure is defined as non-invasive when no break in the skin is created and there is no contact with the mucosa, or skin break, or internal body cavity beyond a natural or artificial body orifice. For example, deep palpation and percussion are non-invasive but a rectal examination is invasive. Likewise, examination of the ear-drum or inside the nose or a wound dressing change all fall outside the definition of non-invasive procedure. There are many non-invasive procedures, ranging from simple observation, to specialised forms of surgery, such as radiosurgery. Extracorporeal shock wave lithotripsy is a non-invasive treatment of stones in the kidney, gallbladder or liver, using an acoustic pulse. For centuries, physicians have employed many simple non-invasive methods based on physical parameters in order to assess body function in health and disease, such as pulse-taking, the auscultation of heart sounds and lung sounds, temperature examination, respiratory examination, peripheral vascular examination, oral examination, abdominal examination, external percussion and palpation, blood pressure measurement, change in body volumes, audiometry, eye examination, and many others.

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Electrohydraulic Lithotripsy (EHL) is a medical procedure which uses targeted shockwaves to break up kidney stones and gallstones. This form of extracorporeal lithotripsy is unique in that the shockwaves are produced by a vaporization bubble expanding and collapsing repeatedly, creating a pressure wave. The procedure is non-invasive and has a 90% success rate, which makes it a first-line treatment for smaller kidney stones.

References

  1. ↑ "Laser Lithotripsy | Winchester Hospital".
  2. ↑ "Research Discoveries". Wellman Center for Photomedicine. Archived from the original on 15 April 2013. Retrieved 30 April 2011.
  3. 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)
  4. ↑ 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)
  5. ↑ 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)
  6. ↑ 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.
  7. 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)
  8. ↑ 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.
  9. ↑ 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.
  10. ↑ 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)
  11. ↑ 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.
  12. ↑ 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.
  13. ↑ 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.
  14. ↑ 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)
  15. ↑ 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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