Mp63-03 Investigating Optimal Settings and Thermal Injury Risk of the Thulium Fiber Laser in an Anatomical Kidney Model

You have accessJournal of UrologyStone Disease: Basic Research & Pathophysiology (MP63)1 May 2024MP63-03 INVESTIGATING OPTIMAL SETTINGS AND THERMAL INJURY RISK OF THE THULIUM FIBER LASER IN AN ANATOMICAL KIDNEY MODEL Ezra J. Margolin, Arpit Mishra, Robert A. Medairos, David L. Barquin, Junqin Chen, Francois Soto-Palou, Jodi Antonelli, Glenn M. Preminger, Charles D. Scales, Gary J. Faerber, Pei Zhong, and Michael E. Lipkin Ezra J. MargolinEzra J. Margolin , Arpit MishraArpit Mishra , Robert A. MedairosRobert A. Medairos , David L. BarquinDavid L. Barquin , Junqin ChenJunqin Chen , Francois Soto-PalouFrancois Soto-Palou , Jodi AntonelliJodi Antonelli , Glenn M. PremingerGlenn M. Preminger , Charles D. ScalesCharles D. Scales , Gary J. FaerberGary J. Faerber , Pei ZhongPei Zhong , and Michael E. LipkinMichael E. Lipkin View All Author Informationhttps://doi.org/10.1097/01.JU.0001009436.52988.91.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Despite the increasing usage of the novel Thulium Fiber Laser (TFL), comprehensive evaluation of settings which maximize treatment efficacy while minimizing the risk of thermal injury is limited. We aim to identify the optimal laser settings for stone dusting while assessing the potential thermal injury risk associated with the TFL in an anatomical kidney model. METHODS: A 3D-printed anatomical kidney model, designed from human computed tomography scans, was used. A 6 x 6 mm cylindrical soft BegoStone was positioned in an upper pole calyx, and TFL lithotripsy was performed using a 200 µm fiber inserted through a flexible ureteroscope with continuous flow irrigation. The stone ablation speed (mg/s) of the complete treatment was evaluated across various pulse energy (Ep) (0.2 – 1.5 J), frequency (F) (6 to 150 Hz), and power settings (W) (10 W to 30 W). Additionally, temperature changes were recorded by placing multiple thermocouples near the tissue boundary, and the risk of tissue injury was determined by calculating the thermal dose as cumulative equivalent minutes at 43°C (CEM43°C). The experiments were timed from the start of treatment until completion, and the remaining BegoStone fragments were collected and weighed to calculate ablation speed. RESULTS: A total of 5 experiments were conducted for each setting, with an average initial stone mass of 259.57±13.21 mg. High-power settings exhibited the fastest ablation speed (Fig 1a). When power was controlled, increasing the Ep resulted in higher ablation speeds (Fig 1a). Ureteral thermal injury risk was observed with 20 W and 30 W power settings (Fig 1b), but not with the 10 W power settings. Lastly, the low Ep and high F combination led to faster temperature increases, reaching the thermal dose for tissue injury (t43=120 min) more rapidly than the high Ep / low F combination. CONCLUSIONS: High Ep, low F settings demonstrate maximum efficacy without excessive thermal toxicity for stone dusting using TFL. High power settings demonstrate considerable risk for possible thermal injury. Further studies are needed to accurately quantify the size of dust particles generated during ablation in these settings with different types of urinary stones. Download PPT Source of Funding: This project is supported by the National Institutes of Health (NIH) through grants 1P20DK135107-02 and 2R01DK052985-26 © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1031 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Ezra J. Margolin More articles by this author Arpit Mishra More articles by this author Robert A. Medairos More articles by this author David L. Barquin More articles by this author Junqin Chen More articles by this author Francois Soto-Palou More articles by this author Jodi Antonelli More articles by this author Glenn M. Preminger More articles by this author Charles D. Scales More articles by this author Gary J. Faerber More articles by this author Pei Zhong More articles by this author Michael E. Lipkin More articles by this author Expand All Advertisement PDF downloadLoading ...