PD19-04 NOBODY LIKES BURNT POPCORN: THE MOST EFFICIENT POPCORNING SETTINGS IN A NOVEL 3D-KIDNEY MODEL THAT LIMITS THERMAL INJURY

Abstract

You have accessJournal of UrologyCME1 May 2022PD19-04 NOBODY LIKES BURNT POPCORN: THE MOST EFFICIENT POPCORNING SETTINGS IN A NOVEL 3D-KIDNEY MODEL THAT LIMITS THERMAL INJURY Christian Tabib, Zachary Dionise, Sabrina Tran, Francois Soto-Palou, Pei Zhong, Glenn Preminger, and Michael Lipkin Christian TabibChristian Tabib More articles by this author , Zachary DioniseZachary Dionise More articles by this author , Sabrina TranSabrina Tran More articles by this author , Francois Soto-PalouFrancois Soto-Palou More articles by this author , Pei ZhongPei Zhong More articles by this author , Glenn PremingerGlenn Preminger More articles by this author , and Michael LipkinMichael Lipkin More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002557.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: When stone popcorning, the use of higher energy with little to no irrigation is preferred. However, this combination of high power with low flow can lead to increased risk of thermal damage with longer laser firing times. Using predetermined lasering and irrigation ‘cool down’ durations within a novel, anatomically accurate 3D kidney model, our aim was to identify the laser settings that produce the most efficient popcorning without reaching thermal dose (t43) that causes tissue damage. METHODS: Hard Begostone phantoms, mimicking calcium oxalate monohydrate stones, were crushed and sieved to 2-4mm fragments. Fragments were then separated by size measuring 2-2.8mm, 2.8-3.35mm, and 3.35-4mm and mixed by mass at a ratio of 2:2:1, respectively. Approximately 0.5g of fragments were placed in the upper pole of our anatomical 3D-printed kidney model. Each triplicate trial consisted of iterative laser/irrigation cooling cycles for two minutes using a MosesTM 120H 2.0 laser (Table). Laser firing and cooling times were determined by measuring t43 with each laser setting, allowing for maximal laser to cooling ratio that would not exceed tissue injury threshold (t43 70 min). After treatment, stones were dried and sieved into <1mm, 1-2mm, 2-2.8mm, 2.8-3.35, and 3.35-4mm fragments, which were then weighed. Ablation efficiency was calculated as post-treatment mass <1mm, with comparisons by ANOVA and Tukey post-hoc tests. RESULTS: Overall, the most efficient setting was 0.5J/90Hz with no irrigation; while the most efficient setting using low irrigation were 0.4J/110Hz and 0.5/J/80Hz SP (Figure). Even with shorter laser times, popcorning was more efficient with no irrigation, especially at high powers (all p<0.05). CONCLUSIONS: When accounting for thermal dose, 0.5J/90Hz without irrigation provides the most efficient popcorning, despite shorter laser times. When thermal injury is of special concern and the surgeon prefers low flow, 0.4J/110Hz appears most efficient. Last, if extended frequency is unavailable, 0.6J/80Hz without irrigation should be used. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e350 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christian Tabib More articles by this author Zachary Dionise More articles by this author Sabrina Tran More articles by this author Francois Soto-Palou More articles by this author Pei Zhong More articles by this author Glenn Preminger More articles by this author Michael Lipkin More articles by this author Expand All Advertisement PDF DownloadLoading ...