Comparison of holmium:YAG and thulium fiber laser lithotripsy: ablation thresholds, ablation rates, and retropulsion effects.
Identifieur interne : 000489 ( Ncbi/Checkpoint ); précédent : 000488; suivant : 000490Comparison of holmium:YAG and thulium fiber laser lithotripsy: ablation thresholds, ablation rates, and retropulsion effects.
Auteurs : Richard L. Blackmon [États-Unis] ; Pierce B. Irby ; Nathaniel M. FriedSource :
- Journal of biomedical optics [ 1560-2281 ] ; 2011.
Descripteurs français
- KwdFr :
- MESH :
- usage thérapeutique : Lasers à solide.
- Calculs urinaires, Fantômes en imagerie, Fibres optiques, Humains, Lithotritie par laser, Oxalate de calcium, Phénomènes optiques, Techniques in vitro, Thulium.
English descriptors
- KwdEn :
- MESH :
- chemical : Calcium Oxalate, Thulium.
- chemistry : Urinary Calculi.
- methods : Lithotripsy, Laser.
- therapeutic use : Lasers, Solid-State.
- therapy : Urinary Calculi.
- Humans, In Vitro Techniques, Optical Fibers, Optical Phenomena, Phantoms, Imaging.
Abstract
The holmium:YAG (Ho:YAG) laser lithotriptor is capable of operating at high pulse energies, but efficient operation is limited to low pulse rates (∼10 Hz) during lithotripsy. On the contrary, the thulium fiber laser (TFL) is limited to low pulse energies, but can operate efficiently at high pulse rates (up to 1000 Hz). This study compares stone ablation threshold, ablation rate, and retropulsion for the two different Ho:YAG and TFL operation modes. The TFL (λ = 1908 nm) was operated with pulse energies of 5 to 35 mJ, 500-μs pulse duration, and pulse rates of 10 to 400 Hz. The Ho:YAG laser (λ = 2120 nm) was operated with pulse energies of 30 to 550 mJ, 350-μs pulse duration, and a pulse rate of 10 Hz. Laser energy was delivered through 200- and 270-μm-core optical fibers in contact mode with human calcium oxalate monohydrate (COM) stones for ablation studies and plaster-of-Paris stone phantoms for retropulsion studies. The COM stone ablation threshold for Ho:YAG and TFL measured 82.6 and 20.8 J∕cm(2), respectively. Stone retropulsion with the Ho:YAG laser linearly increased with pulse energy. Retropulsion with TFL was minimal at pulse rates less than 150 Hz, then rapidly increased at higher pulse rates. For minimal stone retropulsion, Ho:YAG operation at pulse energies less than 175 mJ at 10 Hz and TFL operation at 35 mJ at 100 Hz is recommended, with both lasers producing comparable ablation rates. Further development of a TFL operating with both high pulse energies of 100 to 200 mJ and high pulse rates of 100 to 150 Hz may also provide an alternative to the Ho:YAG laser for higher ablation rates, when retropulsion is not a primary concern.
DOI: 10.1117/1.3564884
PubMed: 21806249
Affiliations:
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pubmed:21806249Le document en format XML
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<affiliation wicri:level="1"><nlm:affiliation>University of North Carolina at Charlotte, Department of Physics and Optical Science, 9201 University City Avenue, Charlotte, North Carolina 28223-0001, USA.</nlm:affiliation>
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<series><title level="j">Journal of biomedical optics</title>
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<term>Lasers, Solid-State (therapeutic use)</term>
<term>Lithotripsy, Laser (methods)</term>
<term>Optical Fibers</term>
<term>Optical Phenomena</term>
<term>Phantoms, Imaging</term>
<term>Thulium</term>
<term>Urinary Calculi (chemistry)</term>
<term>Urinary Calculi (therapy)</term>
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<keywords scheme="KwdFr" xml:lang="fr"><term>Calculs urinaires ()</term>
<term>Fantômes en imagerie</term>
<term>Fibres optiques</term>
<term>Humains</term>
<term>Lasers à solide (usage thérapeutique)</term>
<term>Lithotritie par laser ()</term>
<term>Oxalate de calcium</term>
<term>Phénomènes optiques</term>
<term>Techniques in vitro</term>
<term>Thulium</term>
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<term>Thulium</term>
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<keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Lithotripsy, Laser</term>
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<keywords scheme="MESH" qualifier="therapeutic use" xml:lang="en"><term>Lasers, Solid-State</term>
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<keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Urinary Calculi</term>
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<term>In Vitro Techniques</term>
<term>Optical Fibers</term>
<term>Optical Phenomena</term>
<term>Phantoms, Imaging</term>
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<term>Fantômes en imagerie</term>
<term>Fibres optiques</term>
<term>Humains</term>
<term>Lithotritie par laser</term>
<term>Oxalate de calcium</term>
<term>Phénomènes optiques</term>
<term>Techniques in vitro</term>
<term>Thulium</term>
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<front><div type="abstract" xml:lang="en">The holmium:YAG (Ho:YAG) laser lithotriptor is capable of operating at high pulse energies, but efficient operation is limited to low pulse rates (∼10 Hz) during lithotripsy. On the contrary, the thulium fiber laser (TFL) is limited to low pulse energies, but can operate efficiently at high pulse rates (up to 1000 Hz). This study compares stone ablation threshold, ablation rate, and retropulsion for the two different Ho:YAG and TFL operation modes. The TFL (λ = 1908 nm) was operated with pulse energies of 5 to 35 mJ, 500-μs pulse duration, and pulse rates of 10 to 400 Hz. The Ho:YAG laser (λ = 2120 nm) was operated with pulse energies of 30 to 550 mJ, 350-μs pulse duration, and a pulse rate of 10 Hz. Laser energy was delivered through 200- and 270-μm-core optical fibers in contact mode with human calcium oxalate monohydrate (COM) stones for ablation studies and plaster-of-Paris stone phantoms for retropulsion studies. The COM stone ablation threshold for Ho:YAG and TFL measured 82.6 and 20.8 J∕cm(2), respectively. Stone retropulsion with the Ho:YAG laser linearly increased with pulse energy. Retropulsion with TFL was minimal at pulse rates less than 150 Hz, then rapidly increased at higher pulse rates. For minimal stone retropulsion, Ho:YAG operation at pulse energies less than 175 mJ at 10 Hz and TFL operation at 35 mJ at 100 Hz is recommended, with both lasers producing comparable ablation rates. Further development of a TFL operating with both high pulse energies of 100 to 200 mJ and high pulse rates of 100 to 150 Hz may also provide an alternative to the Ho:YAG laser for higher ablation rates, when retropulsion is not a primary concern.</div>
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<country name="États-Unis"><noRegion><name sortKey="Blackmon, Richard L" sort="Blackmon, Richard L" uniqKey="Blackmon R" first="Richard L" last="Blackmon">Richard L. Blackmon</name>
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