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Optimizing Use of the Holmium:YAG Laser for Surgical Management of Urinary Lithiasis

Abstract

The holmium:yttrium aluminum garnet (Ho:YAG, holmium) laser is an intracorporeal lithotrite that is widely used in the surgical management of urinary lithiasis. The Ho:YAG laser is capable of fragmenting urinary stones of all compositions while maintaining a wide margin of safety. The 2140-nm wavelength of energy is transmitted from the generator to the stone using specialized silica optical fibers. The effectiveness of the laser can be impacted by the type of laser fiber used, the pulse energy and frequency settings, and the composition of the stone. This paper provides an overview of Ho:YAG laser fibers utilized for lithotripsy during ureteroscopy. We will also review current data regarding optimal energy settings and discuss our experience with different fragmentation techniques.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of outstanding importance

  1. 1.

    Marks AJ, Teichman JM. Lasers in clinical urology: state of the art and new horizons. World J Urol. 2007;25(3):227–33.

    PubMed  Article  Google Scholar 

  2. 2.

    Dretler SP, Watson G, Parrish JA, Murray S. Pulsed dye laser fragmentation of ureteral calculi: initial clinical experience. J Urol. 1987;137(3):386–9.

    PubMed  CAS  Google Scholar 

  3. 3.

    Pearle MS, Sech SM, Cobb CG, Riley JR, Clark PJ, Preminger GM, et al. Safety and efficacy of the Alexandrite laser for the treatment of renal and ureteral calculi. Urology. 1998;51(1):33–8.

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Santa-Cruz RW, Leveillee RJ, Krongrad A. Ex vivo comparison of four lithotripters commonly used in the ureter: what does it take to perforate? J Endourol / Endourol Soc. 1998;12(5):417–22.

    Article  CAS  Google Scholar 

  5. 5.••

    Zarrabi A, Gross AJ. The evolution of lasers in urology. Ther Adv Urol. 2011;3(2):81–9. This article summarizes the major advances in the development of lasers and their use in urology. It includes application of lasers to treat BPH, stones, strictures, skin lesions, penis/prostate carcinoma, and tissue soldering.

    PubMed Central  PubMed  Article  CAS  Google Scholar 

  6. 6.

    Teichman JM, Vassar GJ, Glickman RD. Holmium:yttrium-aluminum-garnet lithotripsy efficiency varies with stone composition. Urology. 1998;52(3):392–7.

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    Grasso M. Experience with the holmium laser as an endoscopic lithotrite. Urology. 1996;48(2):199–206.

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    Chan KF, Vassar GJ, Pfefer TJ, Teichman JM, Glickman RD, Weintraub ST, et al. Holmium:YAG laser lithotripsy: a dominant photothermal ablative mechanism with chemical decomposition of urinary calculi. Lasers Surg Med. 1999;25(1):22–37.

    PubMed  Article  CAS  Google Scholar 

  9. 9.

    Pierre S, Preminger GM. Holmium laser for stone management. World J Urol. 2007;25(3):235–9.

    PubMed  Article  Google Scholar 

  10. 10.

    Teichman JM, Rogenes VJ, McIver BJ, Harris JM. Holmium:yttrium-aluminum-garnet laser cystolithotripsy of large bladder calculi. Urology. 1997;50(1):44–8.

    PubMed  Article  CAS  Google Scholar 

  11. 11.

    Knudsen BE, Glickman RD, Stallman KJ, Maswadi S, Chew BH, Beiko DT, et al. Performance and safety of holmium: YAG laser optical fibers. J Endourol / Endourol Soc. 2005;19(9):1092–7.

    Article  Google Scholar 

  12. 12.

    Khemees TA, Shore DM, Antiporda M, Teichman JM, Knudsen BE. Evaluation of a new 240-mum single-use holmium:YAG optical fiber for flexible ureteroscopy. J Endourol / Endourol Soc. 2013;27(4):475–9.

    Article  Google Scholar 

  13. 13.•

    Knudsen BE, Pedro R, Hinck B, Monga M. Durability of reusable holmium:YAG laser fibers: a multicenter study. J Urol. 2011;185(1):160–3. The interested reader can find detailed information regarding the durability of several new fibers.

    PubMed  Article  Google Scholar 

  14. 14.

    Marks AJ, Mues AC, Knudsen BE, Teichman JM. Holmium:yttrium-aluminum-garnet lithotripsy proximal fiber failures from laser and fiber mismatch. Urology. 2008;71(6):1049–51.

    PubMed  Article  Google Scholar 

  15. 15.

    Mues AC, Teichman JM, Knudsen BE. Quantification of holmium:yttrium aluminum garnet optical tip degradation. J Endourol / Endourol Soc. 2009;23(9):1425–8.

    Article  Google Scholar 

  16. 16.••

    Mues AC, Teichman JM, Knudsen BE. Evaluation of 24 holmium:YAG laser optical fibers for flexible ureteroscopy. J Urol. 2009;182(1):348–54. A number of commercially available fibers were tested for their performance characteristics. Although the highlights are included in the present article, the reader can find detailed information on the size, flexibility, and fiber durability in this study.

    PubMed  Article  Google Scholar 

  17. 17.

    Akar E, Knudsen BE. Evaluation of 16 new holmium:YAG laser optical fibers for ureteroscopy [abstract # 1547]. American Urological Association; May 7, 2013; San Diego, CA.

  18. 18.•

    Bach T, Herrmann TR, Gross AJ. Radiopaque laser fiber for holmium: yttrium-aluminum-garnet laser lithotripsy: critical evaluation. J Endourol / Endourol Soc. 2012;26(6):722–5. The reader can find information on the first report of a gold-cladded radiopaque laser fiber here. The authors describe both in vitro and in vivo experiences.

    Article  Google Scholar 

  19. 19.

    Sea J, Jonat LM, Chew BH, Qiu J, Wang B, Hoopman J, et al. Optimal power settings for Holmium: YAG lithotripsy. J Urol. 2012;187(3):914–9.

    Google Scholar 

  20. 20.••

    Hecht SL, Wolf Jr JS. Techniques for holmium laser lithotripsy of intrarenal calculi. Urology. 2013;81(2):442–5. This article provides detailed information on Ho:YAG lithotripsy techniques within the renal collecting system. They provide institutional experience and give suggestions and indication for dancing, chipping, fragmenting, and popcorning renal stones.

    PubMed  Article  Google Scholar 

  21. 21.

    Ursiny M, Eisner BH. Cost-effectiveness of anti-retropulsion devices for ureteroscopic lithotripsy. J Urol. 2013;189(5):1762–6.

    Google Scholar 

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Conflict of Interest

Dr. Abhishek P. Patel declares no potential conflicts of interest relevant to this article.

Dr. Bodo E. Knudsen is a consultant for Boston Scientific and Olympus Surgical.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Correspondence to Bodo E. Knudsen.

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This article is part of the Topical Collection on Minimally Invasive Surgery

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Patel, A.P., Knudsen, B.E. Optimizing Use of the Holmium:YAG Laser for Surgical Management of Urinary Lithiasis. Curr Urol Rep 15, 397 (2014). https://doi.org/10.1007/s11934-014-0397-2

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Keywords

  • Holmium
  • Laser
  • Holmium:YAG
  • Ho:YAG
  • Fiber
  • Kidney stone
  • Lithotripsy
  • Urinary lithiasis
  • Dusting
  • Basketing
  • Ureteroscopy