Optical fibers for lithotripsy are designed to deliver the maximum energy precisely to the treatment site without a decrease in performance and without increasing the risks to patients and users. One of the obstacles to constant energy delivery is burnback of the optical fiber tip. So far, researchers identified mechanical, thermal, and optical factors as mechanisms in burnback phenomena. Among mechanical factors, the force applied by urologists against a stone is expected to play a dominant role in burnback. In this study, we introduce a novel technique to measure accurately the stone depth and volume ablation under varying force. Our results show varying burnback lengths on the optical fibers and varying stone depth and volume ablation depending on the optical fiber core size. For instance, the slope of the burnback as a function of the applied force for 273 μm fibers was more than two times higher than for the 550 μm fibers. The slope of the total volume of stone ablated as function of force for 550 μm fibers was almost twice as much as for the 273 μm fibers. The data suggest urologists can maximize the stone ablation rate and minimize fiber tip burnback by controlling the applied force on the optical fiber during a lithotripsy procedure.
Q-switched (QS) Tm:YAG laser ablation mechanisms on urinary calculi are still unclear to researchers. Here, dependence of water content in calculus phantom on calculus ablation performance was investigated. White gypsum cement was used as a calculus phantom model. The calculus phantoms were ablated by a total 3-J laser pulse exposure (20 mJ, 100 Hz, 1.5 s) and contact mode with N=15 sample size. Ablation volume was obtained on average 0.079, 0.122, and 0.391 mm3 in dry calculus in air, wet calculus in air, and wet calculus in-water groups, respectively. There were three proposed ablation mechanisms that could explain the effect of water content in calculus phantom on calculus ablation performance, including shock wave due to laser pulse injection and bubble collapse, spallation, and microexplosion. Increased absorption coefficient of wet calculus can cause stronger spallation process compared with that caused by dry calculus; as a result, higher calculus ablation was observed in both wet calculus in air and wet calculus in water. The test result also indicates that the shock waves generated by short laser pulse under the in-water condition have great impact on the ablation volume by Tm:YAG QS laser.
Vaporization and coagulation are two fundamental processes that can be performed during laser-tissue ablation. We demonstrated a method allowing quasi-dynamically observing of the cross-sectional images of tissue response during ablation. The results showed that coagulation depth is relatively constant during vaporization, which supports the excellent hemostasis of green laser benign prostate hyperplasia (BPH) treatment. We also verified a new technology for real-time, in situ tissue temperature monitoring, which may be promising for in vivo tissue vaporization degree feedback during laser ablation to improve the vaporization efficiency and avoid complications.
Calculus migration is a common problem during ureteroscopic laser lithotripsy procedure to treat urolithiasis. A conventional experimental method to characterize calculus migration utilized a hosting container (e.g. a “V” grove or a test tube). These methods, however, demonstrated large variation and poor detectability, possibly attributing to friction between the calculus and the container on which the calculus was situated. In this study, calculus migration was investigated using a pendulum model suspended under water to eliminate the aforementioned friction. A high speed camera was used to study the movement of the calculus which covered zero order (displacement), 1st order (speed) and 2nd order (acceleration). A commercialized, pulsed Ho:YAG laser at 2.1 um, 365-um core fiber, and calculus phantom (Plaster of Paris, 10×10×10mm cube) were utilized to mimic laser lithotripsy procedure. The phantom was hung on a stainless steel bar and irradiated by the laser at 0.5, 1.0 and 1.5J energy per pulse at 10Hz for 1 second (i.e., 5, 10, and 15W). Movement of the phantom was recorded by a high-speed camera with a frame rate of 10,000 FPS. Maximum displacement was 1.25±0.10, 3.01±0.52, and 4.37±0.58 mm for 0.5, 1, and 1.5J energy per pulse, respectively. Using the same laser power, the conventional method showed <0.5 mm total displacement. When reducing the phantom size to 5×5×5mm (1/8 in volume), the displacement was very inconsistent. The results suggested that using the pendulum model to eliminate the friction improved sensitivity and repeatability of the experiment. Detailed investigation on calculus movement and other causes of experimental variation will be conducted as a future study.
Q-switched Tm:YAG laser ablation mechanisms on urinary calculi are still unclear to researchers. In this study, dependence of water content in calculus phantom on calculus ablation performance was investigated. White gypsum cement was used as a calculus phantom model. The calculus phantoms were ablated at single pulse and contact mode in three different conditions: dry calculus in air, wet calculus in air, and wet calculus in water. Ablation volume was obtained on average 0.006, 0.008, and 0.008 mm<sup>3</sup> in dry calculus in air, wet calculus in air, and wet calculus in water groups, respectively. There were three proposed ablation mechanisms that could explain the effect of water content in calculus phantom on calculus ablation performance, including shock wave due to bubble collapse, spallation, and microexplosion. Shock wave generation due to bubble collapse in wet calculus in water condition had negligible effect on calculus ablation as captured by a needle hydrophone and cannot be a primary mechanism for calculus ablation in this study. Increased absorption coefficient of wet calculus can cause stronger spallation process compared with that caused by dry calculus; and as a result, higher calculus ablation was observed in both wet calculus in air and wet calculus in water. Vaporization of interstitial water in porous calculus phantom can also help enhance calculus ablation efficiency. There were some limitations in this study including use of small sample size and lack of employing real urinary calculus, which should be addressed in future experiment.