Thermal effects of Ho: YAG laser lithotripsy: real-time evaluation in an in vitro model.

Abstract

To evaluate the thermal effect of Ho:YAG laser lithotripsy in a standardized in vitro model via real-time temperature measurement. Our model comprised a 20ml test tube simulating the renal pelvis that was immersed in a 37°C water bath. Two different laser fibers [FlexiFib (15-45W), RigiFib 1000 (45-100W), LISA laser products OHG, Katlenburg-Lindau, Germany] were placed in the test tube. An Ho:YAG 100W laser was used in all experiments (LISA). Each experiment involved 120s of continuous laser application, and was repeated five times. Different laser settings (high vs. low frequency, high vs. low energy, and long vs. short pulse duration), irrigation rates (0 up to 100ml/min, realized by several pumps), and human calcium oxalate stone samples were analyzed. Temperature data were acquired by a real-time data logger with thermocouples (PICO Technology, Cambridgeshire, UK). Real-time measurements were assessed using MatLab®. Laser application with no irrigation results in a rapid increase in temperature up to ∆28K, rising to 68°C at 100W. Low irrigation rates yield significantly higher temperature outcomes. Higher irrigation rates result immediately in a lower temperature rise. High irrigation rates of 100ml/min result in a temperature rise of 5K at the highest laser power setting (100W). Ho:YAG laser lithotripsy might be safe provided that there is sufficient irrigation. However, high power and low irrigation resulted in potentially tissue-damaging temperatures. Laser devices should, therefore, always be applied in conjunction with continuous, closely monitored irrigation whenever performing Ho:YAG laser lithotripsy.