To better understand physical mechanisms of stone comminution in Holmium:YAG laser lithotripsy, high-speed microphotography was used to study the breakage of dry stones in air and hydrated stones in water. Surgically retrieved urinary calculi and hydroxyapatite pellets were pulsed with a Holmium:YAG laser at 0.2–1 J and recorded at ∼250 000 fps using a high-speed camera (Shimadzu HPV-X2) mounted to a Nikon microscope. In air, direct light–stone interactions were seen to produce photothermal melting, vaporization, and micro-explosions. The most apparent damage to stones was due to the micro-explosions, which erupt the stone surface producing craters and pits. The micro-explosions, however, were observed to progressively diminish with number of laser shots, typically stalling after several shots. Increasing the laser energy or moving the fiber tip to a new position was seen to restore the occurrence of micro-explosions before stalling a second time. In water, the laser produced cavitation bubbles, the collapse of which continued to fragment, pit, and erode the stone after each laser pulse. This study suggests that cavitation bubbles contribute strongly to stone comminution. Cavitation bubbles may have a particularly important role in sustaining micro-explosions after initial laser shots.To better understand physical mechanisms of stone comminution in Holmium:YAG laser lithotripsy, high-speed microphotography was used to study the breakage of dry stones in air and hydrated stones in water. Surgically retrieved urinary calculi and hydroxyapatite pellets were pulsed with a Holmium:YAG laser at 0.2–1 J and recorded at ∼250 000 fps using a high-speed camera (Shimadzu HPV-X2) mounted to a Nikon microscope. In air, direct light–stone interactions were seen to produce photothermal melting, vaporization, and micro-explosions. The most apparent damage to stones was due to the micro-explosions, which erupt the stone surface producing craters and pits. The micro-explosions, however, were observed to progressively diminish with number of laser shots, typically stalling after several shots. Increasing the laser energy or moving the fiber tip to a new position was seen to restore the occurrence of micro-explosions before stalling a second time. In water, the laser produced cavitation bubbles, the colla...
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