Quantification of Holmium:Yttrium Aluminum Garnet Optical Tip Degradation

Abstract

Optical laser fibers are utilized to transmit energy to the surface of a stone during holmium:yttrium aluminum garnet (Ho:YAG) laser lithotripsy. During lithotripsy, fiber tip degradation (burn back) can occur. Fiber burn back may diminish fragmentation efficiency, increase operative time, and increase cost because of fiber replacement. We hypothesize that fiber tip degradation (burn back) varies among different commercially available Ho:YAG laser fibers. Fibers of varying core diameter sizes for Ho:YAG lithotripsy were evaluated from different manufacturers. Fibers were cleaved, stripped, polished, and inspected for tip uniformity. Fibers were initially tested without contact followed by contact testing using artificial Bego stones. Pre- and postcontact energy outputs were measured by energy detector. Distal tip degradation (burn back) was measured by digital micrometer. Testing was performed on two Ho:YAG lasers (Lumenis VersaPulse 100W and Dornier Medilas H20). All fibers were tested while submerged in water. No burn back was observed in any fiber tested in still water (without contact). Before and after lithotripsy, a trend existed with fibers demonstrating high burn back and high preablation energy outputs. The majority of these fibers were <300 microm diameter. Conversely, fibers with low burn back showed low preablation energy outputs and were >300 microm diameter. Fiber burn back and energy transmission varied among the fibers tested. Burn back only occurred during lithotripsy. Burn back may be reduced by fiber selection or using low pulse energy. Fiber burn back may affect the efficiency of fragmentation and contribute to decreased longevity of the fiber.