How much energy do we need to ablate 1 mm 3 of stone during Ho:YAG laser lithotripsy? An in vitro study
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ORIGINAL ARTICLE
How much energy do we need to ablate 1 mm3 of stone during Ho:YAG laser lithotripsy? An in vitro study Frédéric Panthier1,2,3 · Eugenio Ventimiglia1,2,4 · Laurent Berthe3 · Catherine Chaussain5 · Michel Daudon1,6 · Steeve Doizi1,2 · Olivier Traxer1,2 Received: 26 October 2019 / Accepted: 9 January 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Introduction Holmium:yttrium–aluminium–garnet (Ho:YAG) is currently the gold standard for lithotripsy for the treatment of all known urinary stone types. Stone composition and volume are major determinants of the lithotripsy. This in vitro study evaluated the required energy to ablate 1 mm3 of various stone types with different laser settings using Ho:YAG. Methods 272 µm core-diameter laser fibers (Boston S cientific©) were connected to a 30 Watt MH1 Ho:YAG generator (Rocamed®). An experimental setup consisting of immerged human stones of calcium oxalate monohydrate (COM), uric acid (UA) or cystine (Cys) was used with a single pulse lasing emission (0.6/0.8/1 J), in contact mode. Stones were dried out before three-dimensional scanning to measure ablation volume per pulse (AVP) and required energy to treat 1 mm3 (RE). Results All settings considered, ablation volumes per pulse (AVP) for COM were significantly lower than those for UA and Cys (p = 0.002 and p = 0.03, respectively), whereas AVP for Cys was significantly lower than those for UA (p = 0.03). The mean REs at 0.6 J pulse energy (PE) for COM, Cys and UA were 34, 8.5 and 3.2 J, respectively The mean REs at 1 J PE for COM, Cys and UA were 14.7, 6.4 and 2 J, respectively. At 0.6 J PE, RE for COM was more than tenfold and fivefold higher than those for UA and Cys, respectively. Conclusion This in vitro study shows for the first time a volumetric evaluation of Ho:YAG efficiency by the ablation volume per pulse on human stone samples, according to various pulse energies. The REs for COM, UA and Cys should be considered in clinical practice. Keywords Holmium YAG · Laser · Lithotripsy · Volume
Introduction Over the past three decades, holmium:yttrium–aluminium–garnet (Ho:YAG) laser has become the main player among lasers currently used for lithotripsy, due to its effectiveness, versatility, and safety profile [1]. Although Ho:YAG represents an effective alternative for the treatment of all known urinary stone types [2], stone composition itself is still one of the main determinants of lithotripsy Frédéric Panthier and Eugenio Ventimiglia Equal contribution Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00345-020-03091-5) contains supplementary material, which is available to authorized users. * Olivier Traxer [email protected] Extended author information available on the last page of the article
efficacy itself [3]. Despite this, stone composition and stone volume are not taken in consideration in pre-operative planning tools [4-8]. Moreover, international guidelines as well do not include stone composition and vo
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