Is loss of power output due to laser fiber degradation still an issue during prostate vaporization using the 180 W GreenLight XPS laser?
- 66 Downloads
To investigate whether heat-induced fiber degradation and loss of power output, which occurred during GreenLight laser vaporization (LV) of the prostate using the first- and second-generation 80 and 120 W laser, are still an issue during LV using the upgraded third generation 180 W GreenLight XPS™ laser.
Laser beam power output of 53 laser fibers was measured at baseline and after every 25 kJ of delivered energy during routine 180 W GreenLight XPS™ LV in 47 patients with prostatic bladder outflow obstruction. After the procedures, the fiber tips were microscopically examined.
The median applied energy per patient was 178 kJ [interquartile range (IQR): 106–247]. Loss of power output during the procedure was detectable in all fibers. After the application of 25, 150, and 250 kJ, the median power output decreased to 77% (IQR 59–87), 57% (IQR 32–71), and 51% (IQR 37–64) of the baseline value. Nine fibers (17%) remained on a relatively high power output level (> 80% of the initial output), while 13 fibers (25%) showed an end-of-procedure power output of less than 20%. Microscopy of the fiber tip revealed mild-to-moderate overall degradation and increasing degradation with higher energy delivered.
Despite changes in fiber design, heat-induced fiber damage and loss of power output remain an issue during 180 W GreenLight XPS™ LV. Whether modifications of the surgical technique can prevent impairment of fiber performance needs to be further evaluated.
KeywordsProstatic hyperplasia Transurethral resection of prostate Lasers Disposable equipment Equipment failure analysis Laser fiber laser prostatectomy
We thank Ms. Alexandra Veloudios for her administrative assistance.
TH: protocol/project development, data collection and management, data analysis, manuscript writing and editing. NCG: protocol/project development, data collection and management, data analysis, manuscript writing and editing. MSW: protocol/project development, data collection, manuscript writing and editing. EXK: data collection and management, manuscript writing and editing. CDF: data collection and management, manuscript writing and editing. OG: data collection and management, manuscript writing and editing. BK: data collection and management, manuscript writing and editing. ML: data collection and management, manuscript writing and editing. AHM: technical support, data collection and management, manuscript writing and editing. TS: data collection and management, manuscript writing and editing. CP: protocol/project development, data collection and management, data analysis, manuscript writing and editing.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the local ethics committee (KEK-ZH-Number: 2012-518).
Informed consent was obtained from all individual participants included in the study.
- 3.Oelke M, Bachmann A, Descazeaud A, Emberton M, Gravas S, Michel MC, N’Dow J, Nordling J, de la Rosette JJ, European Association of U (2013) EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol 64(1):118–140. https://doi.org/10.1016/j.eururo.2013.03.004 CrossRefGoogle Scholar
- 5.Thomas JA, Tubaro A, Barber N, d’Ancona F, Muir G, Witzsch U, Grimm MO, Benejam J, Stolzenburg JU, Riddick A, Pahernik S, Roelink H, Ameye F, Saussine C, Bruyere F, Loidl W, Larner T, Gogoi NK, Hindley R, Muschter R, Thorpe A, Shrotri N, Graham S, Hamann M, Miller K, Schostak M, Capitan C, Knispel H, Bachmann A (2016) A multicenter randomized noninferiority trial comparing GreenLight-XPS laser vaporization of the prostate and transurethral resection of the prostate for the treatment of benign prostatic obstruction: two-yr outcomes of the GOLIATH study. Eur Urol 69(1):94–102. https://doi.org/10.1016/j.eururo.2015.07.054 CrossRefGoogle Scholar
- 6.Bachmann A, Muir GH, Collins EJ, Choi BB, Tabatabaei S, Reich OM, Gomez-Sancha F, Woo HH (2012) 180-W XPS GreenLight laser therapy for benign prostate hyperplasia: early safety, efficacy, and perioperative outcome after 201 procedures. Eur Urol 61(3):600–607. https://doi.org/10.1016/j.eururo.2011.11.041 CrossRefGoogle Scholar
- 7.Bachmann A, Tubaro A, Barber N, d’Ancona F, Muir G, Witzsch U, Grimm MO, Benejam J, Stolzenburg JU, Riddick A, Pahernik S, Roelink H, Ameye F, Saussine C, Bruyere F, Loidl W, Larner T, Gogoi NK, Hindley R, Muschter R, Thorpe A, Shrotri N, Graham S, Hamann M, Miller K, Schostak M, Capitan C, Knispel H, Thomas JA (2015) A European multicenter randomized noninferiority trial comparing 180 W GreenLight XPS laser vaporization and transurethral resection of the prostate for the treatment of benign prostatic obstruction: 12-month results of the GOLIATH study. J Urol 193(2):570–578. https://doi.org/10.1016/j.juro.2014.09.001 CrossRefGoogle Scholar
- 11.Te AE (2006) The next generation in laser treatments and the role of the Greenlight high-performance system laser. Rev Urol 8(Suppl 3):S24–S30Google Scholar
- 12.Anson K, Nawrocki J, Buckley J, Fowler C, Kirby R, Lawrence W, Paterson P, Watson G (1995) A multicenter, randomized, prospective study of endoscopic laser ablation versus transurethral resection of the prostate. Urology 46(3):305–310. https://doi.org/10.1016/S0090-4295(99)80211-8 CrossRefGoogle Scholar
- 14.Hermanns T, Strebel DD, Hefermehl LJ, Gross O, Mortezavi A, Muller A, Eberli D, Muntener M, Michel MS, Meier AH, Sulser T, Seifert HH (2011) Lithium triborate laser vaporization of the prostate using the 120 W, high performance system laser: high performance all the way? J Urol 185(6):2241–2247. https://doi.org/10.1016/j.juro.2011.02.023 CrossRefGoogle Scholar
- 15.Hermanns T, Sulser T, Fatzer M, Baumgartner MK, Rey JM, Sigrist MW, Seifert HH (2009) Laser fibre deterioration and loss of power output during photo-selective 80-w potassium-titanyl-phosphate laser vaporisation of the prostate. Eur Urol 55(3):679–685. https://doi.org/10.1016/j.eururo.2008.03.035 CrossRefGoogle Scholar
- 18.Schwartz J, Renard J, Wolf JP, Moret M, Iselin CE (2011) High-power potassium-titanyl-phosphate laser fibres for endovaporization of benign prostatic hyperplasia: how much do they deteriorate during the procedure? BJU Int 107(12):1938–1942. https://doi.org/10.1111/j.1464-410X.2010.09760.x CrossRefGoogle Scholar
- 20.Brunken C, Munsch M, Tauber S, Schmidt R, Seitz C (2014) The 532-nm 180-W (GreenLight(R)) laser vaporization of the prostate for the treatment of lower urinary tract symptoms: how durable is the new side-fire fiber with integrated cooling system? Lasers Med Sci 29(3):1307–1312. https://doi.org/10.1007/s10103-013-1320-7 CrossRefGoogle Scholar
- 21.Hermanns T, Fankhauser CD, Hefermehl LJ, Kranzbuhler B, Wong LM, Capol JC, Zimmermann M, Sulser T, Muller A (2013) Prospective evaluation of irrigation fluid absorption during pure transurethral bipolar plasma vaporisation of the prostate using expired-breath ethanol measurements. BJU international 112(5):647–654. https://doi.org/10.1111/bju.12170 CrossRefGoogle Scholar