Radiopaque Laser Fiber for Holmium: Yttrium-Aluminum-Garnet Laser Lithotripsy: Critical Evaluation

Abstract

Laser energy has gained widespread use, not only in stone treatment, but also in multiple endourologic procedures such as endopyelotomy and incision of ureteral strictures. Furthermore, laser use gains access to open, laparoscopic, and robot-assisted surgery. Therefore, potential complications, such as fiber breakage and detection of these radiolucent fiber remainders, may become of interest. The aim of this study was to evaluate a prototype of a radiopaque laser fiber that was designed for lithotripsy with a holmium:yttrium-aluminum-garnet laser. A gold-clad 200-μm optical laser fiber was evaluated for its influence on deflection, fiber degradation, as well as radiopaque property in vitro and in vivo. The results were compared with a commercially available 200 μm optical core lithotripsy fiber. The gold-clad prototype fiber showed radiopaque property in vitro as well as in vivo, although high body mass index reduces visibility. Introducing the fiber into a flexible ureteroscope had no influence on deflection properties or the diameter of the fully deflected tip. Fiber burn was considerably low and comparable to that of the standard fiber. The 200 μm optical core gold-cladd fiber prototype offers comparable performance to a commercially available fiber of the same optical core diameter. Radiopaque property was proven in vitro as well as intracorporeally, thereby adding an additional safety feature to laser treatment in endourology as well as in laparoscopic and robotic surgery.