In Vitro Evaluation of ScopeSafe Fibers and the Scope Guardian Sheath in Prevention of Ureteroscope Endolumenal Working Damage

Abstract

Ureteroscope breakage is commonly related to laser fiber damage. Often, the damage is mechanical and not energy related. As such, we evaluated a novel laser fiber and sheath system in preventing mechanical ureteroscope damage during fiber insertion. We assessed 200-μm/272/3-μm laser fibers with the laser sheath in a flexible ureteroscope. Diminishment of active deflection and irrigation flow rates were compared with a standard laser fiber alone. Eight nonassembled working channel components were tested in a 0-degree/90-degree/210-degree deflection model. After insertion cycles, external and endolumenal damage to the working channel were classified. We also tested the sheath system in a 0-degree/90-degree/210-degree deflection model for fiber failure and laser damage. In all test trials with the sheath and for standard laser fibers in the 0-degree model, there were no channel perforations or damage. With standard laser fibers, in the 210-degree model, superficial scratches and demarcated abrasions were visible after 10 and 60 to 70 insertions for the 273-μm laser fiber and after 30 insertions (superficial scratches) for the 200-μm laser fiber. In the 90-degree model, superficial scratches occurred after 20 insertions for the 273-μm fibers and after 40 insertions for the 200-μm laser fibers. No demarcated abrasions were seen after 100 insertions. In the 210-degree model, there was one perforation with the 272-μm fiber, but none with 200-μm fiber. There were no fiber failures with sheath use; however, the sheath did not prevent laser energy damage. The laser sheath resulted in a 4.7-degree/3.8-degree (1.2%/1.5%) diminishment in deflection (up/down) for the 200 μm and a 3.5-degree/4.3-degree (1.8%/1.5%) diminishment for 272-μm laser fiber compared with standard 200/272-μm laser fiber. Irrigation flow was diminished with the sheath on both the 200-μm and 272-μm laser fiber by 28.7% and 32.6%, respectively. The Scope Guardian Sheath prevented mechanical working channel damage with minimal diminishment of deflection and irrigation flow.