Abstract
The risk of thermal damage increases with the introduction of high-power lasers during holmium laser lithotripsy. This study aimed to quantitatively evaluate the temperature change of renal calyx in the human body and the 3D printed model during high-power flexible ureteroscopic holmium laser lithotripsy and map out the temperature curve. The temperature was continuously measured by a medical temperature sensor secured to a flexible ureteroscope. Between December 2021 and December 2022, willing patients with kidney stones undergoing flexible ureteroscopic holmium laser lithotripsy were enrolled. High frequency and high-power settings (24 W, 80Hz/0.3J and 32 W, 80Hz/0.4J) were performed for each patient with room temperature (25°C) irrigation. In the 3D printed model, we studied more holmium laser settings (24 W, 80Hz/0.3J, 32 W, 80Hz/0.4J and 40 W, 80Hz/0.4J) with warmed (37°C) and room temperature (25°C) irrigation. Twenty-two patients were enrolled in our study. With 30ml/min or 60ml/min irrigation, the local temperature of the renal calyx did not reach 43°C in any patient under 25°C irrigation after 60s laser activation. There were similar temperature changes in the 3D printed model with the human body under the irrigation of 25°C. Under the irrigation of 37°C, the temperature rise slowed down, but the temperature in the renal calyces was close to or even exceeded the 43°C at the setting of 32 W, 30ml/min and 40 W, 30ml/min after continuing laser activation. In the irrigation of 60ml/min, the temperature in the renal calyces can still be maintained within a safe range after continuous activation of a holmium laser up to 40 W. However, continuous activation of 32W or higher power holmium laser in the renal calyces for more than 60s in the limited irrigation of 30ml/min can cause excessive local temperature, in such situation room temperature perfusion at 25 ℃ may be a relatively safer option.
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