Use Of Holmium Research Articles

Does the holmium laser have a place in the treatment of pilonidal cysts? (Pilolas study).

Recently, a minimally invasive procedure based on a laser technique (SiLaT) has been developed for the treatment of pilonidal cysts. Although less invasive and less painful than surgery, this solution is nevertheless limited by its high cost. Other more affordable laser devices, such as the holmium laser, are also used in minimally invasive surgery. The objective of this study was to evaluate the possibility of using the holmium laser instead of the SiLaT laser in the treatment of pilonidal cysts. Retrospective cohort study with the primary endpoint being the cure rate one month after treatment. Median duration of local care was 21days (mean = 22 ± 7.5) and healing rate at 1month was 90.7%. During follow-up, 102 patients (44.9%) experienced pain in the coccygeal region often exacerbated by sitting and significantly more common in people with a small frame, overwhelmingly female. A surgical site infection was reported in 36 patients (15.9%). Recurrence, occurred in 39 patients (17.2%), was related to cyst type (type 1 do not recur, type 3 recur twice three time than type 2). Holmium laser does not differ from SiLaT laser in the healing rate of pilonidal cysts after treatment. However, it is characterised by a moderately higher incidence of complications, foremost of which is the occurrence of pain that can persist for up to a year after the procedure and which could be related to an increase in heat inherent to the use of holmium. As a result, this procedure does not seem to represent an alternative to SiLaT.

Safety Parameters for the Use of Holmium:YAG Laser in the Treatment of Biliary Calculi: The Ex-Vivo Model.

Background and Objectives: While studies have demonstrated the efficacy of cholangioscopy-guided Holmium-Yttrium aluminum garnet (Ho:YAG) laser lithotripsy for the treatment of refractory bile duct stones, data regarding the safety of the operating parameters for laser lithotripsy are lacking. The aim of this study was to determine safe, yet effective, energy settings for Ho:YAG laser in the ex-vivo model. Materials and Methods: This ex vivo experimental study utilized the Ho:YAG laser on porcine bile duct epithelium and human gallstones. Ho:YAG laser lithotripsy was applied in different power settings from 8 to 15 Watts (W) to six explanted porcine bile ducts. Settings that appeared safe were then utilized to fragment seventy-three human gallstones. Results: The median bile duct perforation times with the Ho:YAG laser between 8-15 W were: >60 s (8 W); 23 s (9 W); 29 s (10 W); 27 s (12 W); 12 s (14 W); and 8 s (15 W). Statistically significant differences in the median perforation times were noted between 8 W vs. 15 W, 9 W vs. 15 W, 10 W vs. 15 W, and 12 W vs. 15 W (p < 0.05). When using a 365 µm Ho:YAG laser probe at 8-12 W, the fragmentation rates on various size stones were: 100% (<1.5 cm); 80-100% (1.6-2.0 cm) and 0-32% (>2.0 cm). Optimal fragmentation was seen utilizing 12 W with high energy (2.4 J) and low frequency (5 Hz) settings. Using a larger 550 µm probe at these settings resulted in 100% fragmentation of stones larger than 2 cm. Conclusions: The Ho:YAG laser appears to be safe and effective in the treatment of large bile duct stones when used between 8-12 W in 5 s bursts in an ex vivo model utilizing porcine bile ducts and human gallstones.

Holmium: YAG Laser-Assisted Removal of a Lamb Bone Impacted in the Upper Oesophagus.

This article reports an innovative and unprecedented use of Holmium: YAG laser in the extraction of a foreign body impacted in the upper oesophagus without complications. Hence, Holmium-YAG laser can be a safe, efficient and successful aid to fragment the impacted foreign bodies to assist in their removal.

Лазерные технологии в лечении доброкачественной гиперплазии предстательной железы.

Introduction. Benign prostatic hyperplasia (BPH) is a common disease among men over 40 years old. Transurethral resection of the prostate has traditionally been considered the «gold standard» for surgical treatment of patients with BPH. The emergence and popularization of laser energy has led to the development of surgical technologies that can closely approach, and in some cases even exceed the effectiveness and safety of TURP. Materials and тethods. The data were searched in the PubMed, Web of Scince. databases of Google Scholar and the scientific electronic library eLibrary.RU using the following keywords: benign prostatic hyperplasia, surgical treatment; transurethral resection of the prostate; tulium laser; holmium laser; photoselective vaporization; GreenLight system; laser energy; cost-effectiveness. Among all currently available laser energies the greatest number of publications is devoted to the use of holmium and thulium energy for laser enucleation of the prostate (HoLEP and THuLEP). Results. The effectiveness of HoLEP has been well studied with papers on the use of this technique, including numerous randomized controlled trials. The safety and efficacy of surgical intervention in patients with a large prostate volume (&gt;100 g) was confirmed in 2000. The efficacy of the procedure was comparable to open surgery, while perioperative morbidity was lower in the group of patients who underwent HoLEP. The Tulium laser has a wavelength of 2013 nm and a penetration depth of 0.25 mm, using water as an absorbing chromophore. Unlike the holmium laser, energy is released in a continuous visible mode. This energy for the treatment of patients with BPH was first used in 2015. ThuLEP was studied in a metaanalysis by Kyriazis et al. Four studies (two randomized studies comparing ThuLEP with TURP or HoLEP and two prospective cohort studies with a follow-up period of 3-24 months) were included in this work. The authors reported an 87% reduction in prostate volume, a significant change in Qmax and IPSS, on par with TURP. Conclusion. A large variety of laser surgical systems are currently available, differing in the types of laser energy used. Surgical treatment of BPH can be performed using any method of laser surgery. The most promising and safe method for BPH treatment is the use of tulium laser energy. However, there is insufficient data on the cost-effectiveness of laser technologies.

A multicenter-based critical analysis of laser settings during intrarenal laser lithotripsy by the Turkish academy of urology prospective study group (ACUP study).

In this multicenter prospective study, we aimed to evaluate the use of holmium:yttrium-- aluminum-garnet laser during retrograde intrarenal surgery for kidney stones and the relationship between laser-related parameters and procedure-related perioperative parameters. The 769 patients whose laser setting parameters (fiber thickness, number of shots, frequency (max.), laser power (max.), and total energy) were completely registered were included in this study program. The intraoperative ureteral lesions were evaluated using postureteroscopic lesion scale (PULS) scores and the postoperative complications with the modified Clavien-Dindo classification system. The maximum levels of laser power and the frequency were used in the middle calyceal stones; the value of total energy consumed was found to be higher gain in cases with multiple stones (all parameters P < .05). There was a significant positive correlation among (mean number of shots [P < .001, r ¼ 0.46], frequency [P ¼ .009, r ¼ 0.1], maximum power [P < .001, r ¼ 0.11], total energy [P < .001, r ¼ 0.25]), anesthesia time (P < .001, r ¼ 0.42), surgery time (P < .001, r ¼ 0.47), and stone size. The mean number of shots increased (P < .001, r ¼ 0.25), and the frequency level decreased (P < .001, r ¼ -0.17) significantly with increasing Hounsfield unit (HU) values. Again, the mean number of shots and maximum laser power increased in correlation with the increasing hospitalization time (P ¼ .004, r ¼ 0.09 and P ¼ .02, r ¼ 0.07, respectively). In addition, it was observed that higher laser subparameter values and thicker fibers were used in PULS grade 2. As the stone size and HU values increased, laser-setting parameters were found to show significant variability. The increase in different parameters of the laser setting was found to be associated with longer anesthesia time, surgery time, and hospitalization period and increased risk of local trauma with PULS grade.

Holmium: Yttrium-aluminum-garnet laser for endoscopic decompression of ureterocele in the first months of life: A comparison with electrosurgery.

Introduction:Few case series report the use of holmium: yttrium-aluminum-garnet (Ho:YAG) laser to decompress ureterocele (UC) in pediatric population, and only two studies compared its outcomes with electrosurgery. This study aims to compare outcomes of Ho:YAG laser transurethral endoscopic puncture (TUP) versus electrosurgery TUP of UC in the 1st month of life, analyzing incidence of secondary surgery, redo TUP, and iatrogenic vesicoureteral reflux (VUR).Patients and Methods:A retrospective study of patients treated by TUP of UC from 2008 to 2017 was performed. Those undergoing Ho:YAG laser TUP were included in Group A, those undergoing electrocautery TUP were included in Group B. Data were compared using Fisher's exact test.Results:Group A included seven patients (mean follow-up 4 years). Two required a redo TUP. Two had preoperative VUR, which resolved after TUP. Two developed VUR after TUP, which resolved spontaneously. No secondary surgery was required. Group B included nine patients (mean follow-up: 9.5 years). One required a redo TUP. Preoperative VUR was detected in 4/9 and persisted after TUP in 2. Three developed post-TUP VUR, which persisted. Five required further surgery because of persistent and symptomatic VUR. Secondary surgery was significantly lower after Ho:YAG laser compared to electrocautery TUP (P < 0.05). The incidences of both redo TUP and postoperative VUR were not significantly different between the two groups (P = ns).Conclusion:Ho:YAG laser TUP seems to be safe and effective in the decompression of obstructive UCs and maybe advantageous over electrocautery puncture. However, further studies with larger cohort are needed to corroborate our preliminary results.

Stone Retropulsion with Ho: YAG and Tm: YAG Lasers: A Clinical Practice-Oriented Experimental Study.

To compare the retropulsion of stones with the use of holmium: yttrium aluminum garnet (Ho: YAG) laser and thulium: yttrium aluminum garnet (Tm: YAG) laser in settings that could be used in clinical practice. The experimental configuration included a glass tube set in a water bath filled with physiologic saline. Plaster of Paris stones were inserted in the tube. Tm: YAG and Ho: YAG laser systems were used along with a high-speed slow-motion camera. The lasers were activated with different settings. The displacement of the stone was measured according to a custom-made algorithm. Ho: YAG: the retropulsion of stones was the lowest with the energy setting of 0.5 J and the frequency of 20 Hz with long pulse duration. The highest retropulsion was observed in the case of 3 J, 5 Hz, and short pulse. Tm: YAG: the retropulsion of stones was the lowest with the energy setting of 1 J and the frequency of 10 Hz with either long or short pulse duration. Practically, there was no retropulsion at all. The highest retropulsion was observed in the case of 8 J, 5 Hz, and short pulse. Ho: YAG laser has a linear increase in stone retropulsion with increased pulse energy. On the other hand, the retropulsion rate was kept to the minimum with Tm: YAG as much as the energy level of 8 J. The activation of lasers with short pulse resulted in further displacement of the stone. Lower frequency with the same power setting seemed to result in further stone retropulsion. Higher power with the same frequency setting resulted in further displacement of the stone.

Laparoscopic transcystic laser lithotripsy for common bile duct stone clearance.

Laparoscopic transcystic common bile duct (CBD) exploration is a safe single-stage procedure for CBD stone clearance. The aim of this report was to describe our experience of transcystic laser lithotripsy in patients with complex CBD stones. Data from consecutive patients treated with transcystic holmium:YAG laser lithotripsy was collected and analyzed concerning age, sex, number of stones, duct clearance, conversions, operation time, complications, and hospital stay. Duct clearance was achieved in all (n=8) patients as a single-stage procedure, although 1 had to be converted to open surgery. Median operation time was 225 minutes and hospital stay was 2 days. There was no postoperative morbidity or mortality. Laparoscopic transcystic use of holmium:YAG laser for complex CBD stones seems safe and efficient even though operation time is long. The technique has the potential of completing the treatment armamentarium for transcystic laparoscopic clearance of difficult CBD stones.

Use of holmium:YAG laser in posterior urethral valves: Another method of fulguration

ObjectiveTo evaluate the use of holmium:YAG laser for posterior urethral valve (PUV) fulguration and compare with electro-fulguration. MethodsForty boys underwent primary fulguration of PUV using 20–25 W holmium laser (Group 1) from January 2009 to December 2011. Data of last 40 boys (retrospective cohort: January 2005 to December 2008) who underwent electro-fulguration (Group 2) for PUV were compared with group 1. Ultrasonography was done at 2 weeks and 3 months and voiding cystourethrography at 3 and 6 months respectively after fulguration and as needed thereafter. DTPA scan and urodynamic study were performed during follow-up in select patients, as required. ResultsPre-operative parameters were comparable between groups. Improvement in voiding occurred in 38 and 34 boys in group 1 and 2, respectively. Hydroureteronephrosis and vesico-ureteric reflux resolved in 53% and 60% in group 1 and 51% and 53% in group 2, respectively. Boys in group 1 had statistically significant greater success in voiding after catheter removal (40 vs 32), shorter period of catheterization (1 vs 1.8 days), lower mean operative time (15 vs 20 min), needed re-fulguration less commonly (2 vs 6), and were less likely to develop urethral stricture (0 vs 2) and urinary incontinence (0 vs 1). ConclusionPUV fulguration using holmium:YAG laser is a feasible, safe and effective alternative for endoscopic transurethral ablation with similar success, and appears to have fewer complications than electro-fulguration.

UP-02.99: Use of holmium:YAG laser for endoscopic lithotripsy

For stone fragmentation a variety of lithotripter can be used. Though widely used, urologists are facing various complications with pneumatic lithotripsy eg. ureteral injury, bleeding and ureteral perforations during the procedure. Since 1990 the Holmium:YAG Laser has been used in urology for stone fragmentation with better outcome because thermal effect is limited to a few millimeters with a penetration depth of only 0.5 mm. The purpose of this study is to evaluate the lithotripsy quality with the use Holmium: YAG Laser and its outcome for the treatment of ureteral stone.

Use of Holmium:YAG Laser to Facilitate Removal of Intravesical Foreign Bodies

Foreign bodies in the bladder present a challenge to the urologist. Previously, endoscopic extraction, with or without perineal urethrotomy, or open cystotomy were the only treatment choices. We describe a novel use of the Ho:YAG laser for the removal of intravesical foreign bodies. We further tested the laser on objects that have been reported in the literature to necessitate open cystotomy to determine their suitability for endoscopic removal. The Ho:YAG laser is introduced through the cystoscope and used to cut large foreign bodies into a size that can be extracted through the urethra. We tested the Ho:YAG laser ex vivo on other objects that have been reported as intravesical foreign bodies. We removed a large complex foreign body with the laser that would otherwise have necessitated open cystotomy. No injury or sequela was observed. Many commonly reported intravesical foreign objects seem amenable to similar treatment. The Ho:YAG laser should be considered for use to facilitate removal of foreign bodies from the bladder.

Quartz stones: Spurious or iatrogenic?

We describe 2 cases of spurious quartz-containing calculi; the first patient-driven and the second iatrogenic. An iatrogenic etiology can occur after the use of holmium:yttrium-aluminum-garnet laser energy because the fiber tip is composed of quartz. To make the diagnosis of a spurious stone, a high degree of suspicion is essential. A quartz stone should prompt the diagnosis of a factitious disorder in the absence of the appropriate surgical history. Psychological counseling and/or referral to a pain management clinic should be considered in such cases.

Use of ureteroscopy and holmium:YAG laser in patients with bleeding diatheses

Objectives. To assess the safety and efficacy of ureteroscopy and holmium laser in patients with known bleeding diatheses and upper tract calculi or transitional cell carcinoma (TCC). Methods. Eight patients with stone disease and 1 patient with upper tract TCC were treated ureteroscopically with the holmium laser. The mean age was 58.3 years (range 42 to 74). Six patients were receiving Coumadin, with a mean international normalized ratio (INR) of 2.1 (normal INR less than 1.1). Two patients were thrombocytopenic, and 1 had von Willebrand’s disease. None of the bleeding diatheses were corrected before surgery. Semirigid or flexible ureteroscopes were used to access the ureter or intrarenal collecting system. The holmium laser was used to fragment calculi or ablate tumor. Results. Only 1 patient had a postoperative bleeding complication related to the procedure, involving an episode of oliguria secondary to a small ureteral clot. This cleared without surgical intervention. Another patient developed an episode of epistaxis after administration of ketorolac for pain. Six of 7 patients who underwent laser fragmentation for calculi were stone free on follow-up intravenous urogram at 1 month, and no tumor recurrence was noted in the patient with TCC (follow-up of 4 months). Conclusions. Ureteroscopy allowed excellent access to all regions of the upper tracts, and holmium laser fragmentation of calculi or ablation of tumor was effective in managing each particular problem. Use of the holmium laser with ureteroscopic access provides a safe and acceptable combination for treating upper tract pathology in patients with uncorrected bleeding diatheses. As a result, these patients can avoid added costs of extended hospital stay and risks associated with transfusions.