Abstract
PurposeThe aim of this study was to compare the enucleation performances of four different types of laser devices in an ex-vivo experiment: a novel, pulsed Tm:YAG solid-state laser evaluation model (p-Tm:YAG), chopped thulium fibre laser (TFL), low-power Ho:YAG laser (LP-Ho:YAG), and a high-power Ho:YAG laser (HP-Ho:YAG).MethodsOur primary aim was to endoscopically separate the fascial layers of a porcine belly using laser fibres within a time period of 60 s. The size of a “tissue pocket” was assessed numerically. The enucleation characteristics reflecting the surgeon’s experience were evaluated via the NASA Task Load Index (TLX) questionnaire and a questionnaire based on Likert scale.ResultsHP-Ho:YAG achieved with the available laser settings the largest overall “tissue pocket” (31.5 cm2) followed by p-Tm:YAG (15 cm2), TFL (12 cm2), and LP-Ho:YAG (6 cm2). The coagulation performances of p-Tm:YAG and TFL were rated the best. In the performance evaluation by the Likert questionnaire, HP-Ho:YAG (average score of 4.06) was rated highest, followed by p-Tm:YAG (3.94), TFL (3.38), and LP-Ho:YAG (3.25). The evaluation of the NASA-TLX performance questionnaire revealed average scores for HP-Ho:YAG, LP-Ho:YAG, TFL and p-Tm:YAG of 4.38, 4.09, 3.92 and 3.90, respectively.ConclusionWe are the first to compare different laser devices and settings in an ex-vivo study. We found that the surgeons were most satisfied with the HP-Ho:YAG laser device, followed by the p-Tm:YAG. These findings could be highly relevant for future research and for the practical utilisation of laser systems in endourology.
Highlights
Due to the progress made in laser technologies, endoscopic enucleation of the prostate (EEP) has become increasingly popular in the surgical treatment of benign prostate hyperplasia (BPH) [1]
The maximum pocket size formed by the pulsed Tm:YAG solid-state laser evaluation model (p-Tm):YAG laser system was 15 c m2 at 3 J, 25 Hz, 75 W, and 0.86 ms pulse duration
Our results reveal that the high-power Ho:YAG laser (HP-Ho):YAG formed the overall the largest tissue pocket under experimental ex-vivo conditions, followed by the p-Tm:YAG, thulium fibre laser (TFL) and LP-Ho:YAG
Summary
Due to the progress made in laser technologies, endoscopic enucleation of the prostate (EEP) has become increasingly popular in the surgical treatment of benign prostate hyperplasia (BPH) [1]. World Journal of Urology with the surroundings via thermal or mechanical interactions [5]. This process should be easy to control by well-judged energy dosage and application, resulting in negligible collateral effects. In addition to the surgical technique, enucleation safety and efficiency could be substantially dependent on the laser system and its setting. It is essential to be aware of the effects of laser-tissue interaction and select optimum settings to increase the efficacy of enucleation and prevent complications
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