Temperature profile during endourological laser activation: introducing the thermal safety distance concept

Temperature profile during endourological laser activation: introducing the thermal safety distance concept

Purpose To examine temporal-spatial distribution of heat generated upon laser activation in a bench model of renal calyx. To establish reference values for a safety distance between the laser fiber and healthy tissue during laser lithotripsy. Methods We developed an in-vitro experimental setup emplo...

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Bibliographic Details
Published in:World journal of urology Vol. 42; no. 1; p. 453
Main Authors: Ventimiglia, Eugenio, Robesti, Daniele, Keller, Etienne Xavier, Corsini, Christian, Folcia, Andrea, Fantin, Margherita, Candela, Luigi, Pozzi, Edoardo, Sierra, Alba, Pietropaolo, Amelia, Somani, Bhaskar K., Panthier, Frederic, Pauchard, Felipe, Goumas, Ioannis Kartalas, Villa, Luca, Montorsi, Francesco, Traxer, Olivier, Salonia, Andrea, Saccomandi, Paola
Format: Journal Article
Language:English
Published: Berlin/Heidelberg Springer Berlin Heidelberg 29-07-2024
Springer Nature B.V
Subjects:
Hot Temperature
Humans
Irrigation
Kidney Calices
Lasers
Lithotripsy
Lithotripsy, Laser - instrumentation
Lithotripsy, Laser - methods
Medicine
Medicine & Public Health
Nephrology
Oncology
Safety
Spatial distribution
Therapeutic Irrigation - methods
Ureter
Urology
Laser temperature
Thermal dose
model
Stone
Thermal safety
In-vitro model
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Summary:Purpose To examine temporal-spatial distribution of heat generated upon laser activation in a bench model of renal calyx. To establish reference values for a safety distance between the laser fiber and healthy tissue during laser lithotripsy. Methods We developed an in-vitro experimental setup employing a glass pipette and laser activation under various intra-operative parameters, such as power and presence of irrigation. A thermal camera was used to monitor both temporal and spatial temperature changes during uninterrupted 60-second laser activation. We computed the thermal dose according to Sapareto and Dewey’s formula at different distances from the laser fiber tip, in order to determine a safety distance. Results A positive correlation was observed between average power and the highest recorded temperature (Spearman’s coefficient 0.94, p  < 0.001). Irrigation was found to reduce the highest recorded temperature, with a maximum average reduction of 9.4 °C at 40 W ( p  = 0.002). A positive correlation existed between average power and safety distance values (Spearman’s coefficient 0.86, p  = 0.001). A thermal dose indicative of tissue damage was observed at 20 W without irrigation (safety distance 0.93±0.11 mm). While at 40 W, irrigation led to slight reduction in mean safety distance (4.47±0.85 vs. 5.22±0.09 mm, p  = 0.08). Conclusions Laser settings with an average power greater than 10 W deliver a thermal dose indicative of tissue damage, which increases with higher average power values. According to safety distance values from this study, a maximum of 10 W should be used in the ureter, and a maximum of 20 W should be used in kidney in presence of irrigation.
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ISSN:1433-8726
0724-4983
1433-8726
DOI:10.1007/s00345-024-05162-3