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Thermal effects of Ho:YAG laser lithotripsy during retrograde intrarenal surgery and percutaneous nephrolithotomy in an ex vivo porcine kidney model

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Abstract

Purpose

To evaluate the thermal effect of high-power holmium:yttrium–aluminum–garnet (Ho:YAG) laser lithotripsy in flexible/semirigid ureteroscopy (fURS/sURS) and percutaneous nephrolithotomy (PNL) in a standardized ex vivo porcine kidney model with real-time temperature assessment.

Methods

The experimental setup consisted of three models designed to evaluate the thermal effects of Ho:YAG laser lithotripsy in fURS, sURS and PNL, respectively. In all setups, a postmortem porcine kidney was placed in a 37 °C water bath. Three thermocouples were inserted into the renal parenchyma while a flexible thermocouple was placed 3–4 mm proximal to the laser fiber to measure temperature variations in the collecting system. The thermal impact was evaluated in relation to laser power between 5 and 100 W and various irrigation rates (37 °C, 0–100 ml/min).

Results

In all three experimental setups, sufficient irrigation was required to prevent potentially damaging temperatures into the renal pelvis and parenchyma. Even 5 W in fURS can lead to a potentially harming temperature rise if insufficient irrigation is applied. Particularly, high-power settings ≥ 30 W carry an elevated risk for critical temperature rises. The results allow the definition of a specific irrigation threshold for any power setting to prevent critical temperatures in the present study design.

Conclusions

Ho:YAG laser lithotripsy bears the risk of thermal damages to the urinary tract even at low-power settings if inadequate irrigation is applied. Sufficient irrigation is mandatory to perform safe Ho:YAG laser lithotripsy. Based on the results, we developed a formula calculating the approximate ΔT for irrigation rates ≥ 30 ml/min: ΔT = 15 K × (power [W]/irrigation [ml/min]).

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Abbreviations

fURS:

Flexible ureteroscopy

sURS:

Semirigid ureteroscopy

PNL:

Percutaneous nephrolithotomy

K:

Kelvin

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Acknowledgements

We would like to thank Michaela von Aichberger for the illustrations in this publication and the institutional funding, Faculty of Medicine, University of Freiburg, Germany.

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Authors and Affiliations

  1. Division of Urotechnology, Department of Urology, Medical Centre-University of Freiburg, Faculty of Medicine, Hugstetter Str. 55, 79106, Freiburg, Germany

    Simon Hein, Ralf Petzold, Rodrigo Suarez-Ibarrola, Philippe-Fabian Müller, Martin Schoenthaler & Arkadiusz Miernik

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  1. Simon Hein
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  2. Ralf Petzold
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  3. Rodrigo Suarez-Ibarrola
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  4. Philippe-Fabian Müller
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Contributions

SH: protocol/project development, data collection and management, data analysis, manuscript writing/editing, and illustrations; RP: data collection and management, data analysis, manuscript and figure writing/editing, and performed experiments; RS: manuscript editing; PFM: illustrations editing; MS: manuscript writing/editing and supervision; AM: protocol/project development, manuscript writing/editing, and supervision.

Corresponding author

Correspondence to Simon Hein.

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Conflict of interest

This work was supported by material support of LISA Laser products (Katlenburg-Lindau, Germany). Simon Hein: German Federal Ministry of Education and Research, Berlin, GER—research funding Germany (unrelated to the present work). Rodrigo Suarez-Ibarrola: German Federal Ministry of Education and Research, Berlin, GER—research funding Germany (unrelated to the present work). Philippe-Fabian Müller: German Federal Ministry of Education and Research, Berlin, GER—research funding Germany (unrelated to the present work). Martin Schoenthaler: consultant contracts with NeoTract Inc., Pleasanton, USA and Trokamed GmbH, Geisingen, Germany (unrelated to the present work). Arkadiusz Miernik: German Federal Ministry of Education and Research, Berlin, GER—research funding, German Association of Urology, Düsseldorf, GER—travel sponsoring, European Association of Urology, Arnhem, NL—travel sponsoring, Walter de Gruyter, Berlin, GER—royalties, RichardWolf GmbH, Knittlingen, GER—speaker’s fee, KLS Martin, Tuttlingen, GER—advisor, Avatera medical, Jena, GER—advisor, Lisa laser OHG, GER—proctor, Schoelly fiber optics GmbH, GER—advisor, Optimed GmbH, Ettlingen, GER—advisor (unrelated to the present work).

Ethical approval/Declaration of human participants/Animals involved

There are no human participants or animals involved in the study. Human stone probes were analyzed after ethical approval (IRB approved protocol number: 79/16 leading ethics committee: Ethik-Kommission der Albert-Ludwigs-Universität Freiburg, Germany) and written informed consent.

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Hein, S., Petzold, R., Suarez-Ibarrola, R. et al. Thermal effects of Ho:YAG laser lithotripsy during retrograde intrarenal surgery and percutaneous nephrolithotomy in an ex vivo porcine kidney model. World J Urol 38, 753–760 (2020). https://doi.org/10.1007/s00345-019-02808-5

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