How to reduce 'double-firing'-induced scope damage by investigating the relationship between laser fiber core degradation and fiber jacket burn?

Purpose: 'Double-firing effect' in which laser firing occurs in the fiber tip and its proximal part is caused by different breakdown rates between fiber jackets and cores. This study investigated a new safe distance concept to prevent scope damage by analyzing the breakdown of the laser fiber jacket and cores.

Methods: Laser fibers were fixed in a benchtop simulation model. The fiber tip was in contact with uniform phantom stones and submerged in saline. Four different energy settings (1.0 or 2.0J x 10Hz or 30Hz) and two different fiber sizes (200 μm and 365 μm) were tested. After three minutes of use at each energy setting, the length of fiber shortening and jacket burn were measured. The fibers were stripped to measure the length of core degradation.

Results: Mean degradation lengths were 4.2 to 7.8 mm. There was no statistical difference in the mean lengths of fiber core degradation and jacket burn. However, core degradation was longer than the jacket burn in half of the samples. The mean difference in lengths between core degradation and jacket burn was 0.49 ± 0.90 mm. Lengths of core degradation and the jacket burn were longer at the setting of high-power energy and 200 μm fiber - 2J with 30 Hz.

Conclusion: To reduce 'double-firing'-induced damage, the authors recommend that laser fiber should be cut 1.0 mm longer than visible jacket burn at high-power settings after 3-min continuous fragmentation. After cutting the fiber, the laser should be checked whether 'double-firing' is no more seen.