AI Article Synopsis
- The study aims to gather laser lithotripsy settings from experts for different clinical situations and to identify ways to minimize complications.
- A survey was conducted among laser specialists, revealing that the majority use Holmium-YAG lasers, with variations in settings for specific scenarios like middle-ureteral, pelvic, and lower pole stones.
- Experts reported a general consensus on preferred techniques, with preventive measures like power limits and intermittent activation commonly employed to reduce thermal injury risks during procedures.
Article Abstract
Purpose: To identify laser lithotripsy settings used by experts for specific clinical scenarios and to identify preventive measures to reduce complications.
Methods: After literature research to identify relevant questions, a survey was conducted and sent to laser experts. Participants were asked for preferred laser settings during specific clinical lithotripsy scenarios. Different settings were compared for the reported laser types, and common settings and preventive measures were identified.
Results: Twenty-six laser experts fully returned the survey. Holmium-yttrium-aluminum-garnet (Ho:YAG) was the primary laser used (88%), followed by thulium fiber laser (TFL) (42%) and pulsed thulium-yttrium-aluminum-garnet (Tm:YAG) (23%). For most scenarios, we could not identify relevant differences among laser settings. However, the laser power was significantly different for middle-ureteral (p = 0.027), pelvic (p = 0.047), and lower pole stone (p = 0.018) lithotripsy. Fragmentation or a combined fragmentation with dusting was more common for Ho:YAG and pulsed Tm:YAG lasers, whereas dusting or a combination of dusting and fragmentation was more common for TFL lasers. Experts prefer long pulse modes for Ho:YAG lasers to short pulse modes for TFL lasers. Thermal injury due to temperature development during lithotripsy is seriously considered by experts, with preventive measures applied routinely.
Conclusions: Laser settings do not vary significantly between commonly used lasers for lithotripsy. Lithotripsy techniques and settings mainly depend on the generated laser pulse's and generator settings' physical characteristics. Preventive measures such as maximum power limits, intermittent laser activation, and ureteral access sheaths are commonly used by experts to decrease thermal injury-caused complications.
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| http://dx.doi.org/10.1007/s00345-023-04726-z | DOI Listing |
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