Introduction: The laser is a high energy instrument which can melt metals like nitinol. So it is very important to know under which conditions it is dangerous to perform an endourologic lithotripsy. We measure the tem...Introduction: The laser is a high energy instrument which can melt metals like nitinol. So it is very important to know under which conditions it is dangerous to perform an endourologic lithotripsy. We measure the temperature increase during laser exposure in an underwater in-vitro ureter model. For comparison, temperatures with and without irrigation and with different distances from the laser fiber to the thermometer are measured. Materials and Methods: We used the Ho:YAG-laser (Vera PulseTM, Coherent) with a 365 μm laser fiber. The settings of the laser were 0.6 J with a frequency of 5 Hz which is the minimum setting for that type of laser. The experimental setup was closely aligned with the clinical situation. A metal container was filled with 0.9% sodium chloride (NaCl) solution (Temp. 36.8°) and a catheter with an inner diameter of 4 mm was attached to the rim of the container. The tip of the thermometer was attached inside the catheter through a waterproof hole. The laser fiber was guided by means of a rigid URS video device (11.5 F). We had four different settings during the measurement: 1) Distance of 0.5 cm between the laser and the thermometer;without irrigation, 2) Distance of 0.5 cm between the laser and the thermometer;with irrigation, 3) Distance of 1 cm between the laser and the thermometer;without irrigation, 4) Distance of 1 cm between the laser and the thermometer;with irrigation. Results: The maximum overall temperature was recorded in the 1) and 3) setting, both featuring no irrigation. The maximum temperature was ~50°C in both settings, with the 1) setting reaching the maximum temperature after 50 seconds and hence approximately twice as fast as the 3) setting. During measurements with a NaCl solution flow we couldn’t detect any noticeable increase in temperature, neither at short nor at long distance between the laser fiber and the thermometer. Conclusion: There is a relevant heating in the ureter beside an endourologic lithotripsy. In our model we could reproduce a maximum heating until ~50°C without irrigation and no heating with irrigation. Without irrigation there is a relevant bubble formation which should be an indicator for the surgeon to stop lithotripsy due to a temperature increase which could harm surrounding tissue.展开更多
Background: Complications after endoscopic retrieval of kidney and ureter stones are obviously related to the size of the stones as well as the experience of the surgeon and other factors. During the procedure it is s...Background: Complications after endoscopic retrieval of kidney and ureter stones are obviously related to the size of the stones as well as the experience of the surgeon and other factors. During the procedure it is sometimes difficult for surgeons to estimate stone size and therefore give prognostic advises. The visual perception of the stone size depends on the shape, colour, distance to the renoscope and dilatation of the ureter. This is the so-called binding problem, because shape, color and direction of motion are processed separately by different population of optical neurons. In order to establish a better prognostic rational especially for less experienced surgeons, we established an intra operative semi-quantitative measurement of the stone size supported by a stone basket. Materials and Methods: We modified the tipped, nitinol stone baskets from the company Urotech with diameters of 2.5, 3.0 and 4 FR. The handle of this basket has a spring mechanism, which automatically closes the basket and provides a predefined fixation force of the stones within the basket. On the handle we established a non-linear scale in mm by grabbing standardized balls or standardized screws. Result: The scales are nonlinear because of the nonlinear relation between the diameter of the stone and the distance of the slider. Also the scales differ in between the basket size, because of the different strain conditions due to the different wire sizes and materials or the spring and basket. Conclusion: This scale could be an important orientation for a surgeon during endourological procedures to estimate stone sizes. After further clinical experience a semi-quantitative visualization like green, yellow and red colors could help to predict potential complications due to large stone sizes. Finally it could bevery interesting for other disciplines like gastroenterology.展开更多
Introduction: The Ho:YAG-Laser is categorized as a potentially dangerous lithotripsy device (DIN: Class 4) for perforation which is mainly caused by the photonic energy the laser emits. Long time complications like ur...Introduction: The Ho:YAG-Laser is categorized as a potentially dangerous lithotripsy device (DIN: Class 4) for perforation which is mainly caused by the photonic energy the laser emits. Long time complications like ureteral strictures seem to be directed by thermal and mechanical injury. In this study different energy settings a) are being investigated, a DJ (double J stent) is placed beside the laser to simulate a therapy of a forgotten stent with reduction of the lumen b) due to the volume exploitation of the DJ, and direct contact between the laser fiber and the DJ in the ureter c) is simulated during laser exposure. Materials and Methods: We used the Ho:YAG-laser (Vera PulseTM, Coherent, Santa Clara USA) with a 365 μm diameter laser fiber. The settings of the laser were 0.6 J and 1 J pulse energy with a frequency of 5 Hz. The experimental setup was closely aligned with the clinical situation. The tip of the thermometer was attached inside the catheter through a puncture. The laser fiber was guided by means of a rigid URS video device (11.5 Ch). We had four different settings for a), b) and c) during the measurement: 1) Distance of 0.5 cm between the laser and the thermometer;without irrigation, 2) Distance of 0.5 cm between the laser and the thermometer;with irrigation, 3) Distance of 1 cm between the laser and the thermometer;without irrigation, 4) Distance of 1 cm between the laser and the thermometer;with irrigation. Results: The temperature in an empty ureter rises approximately by 5°C, when the laser energy is increased from 0.6 J to 1 J. When a DJ is inserted in the artificial ureter there is surprisingly almost no difference in the maximum temperature between the lower energy level (0.6 J) and the high energy level (1 J). However the time needed to reach the maximum temperature is noticibly less when using high energy levels. The reduction involume based on the placement of the DJ leads to a higher maximum temperature for the low energy setting. The third setting with direct laser fiber contact with the DJ produces the highest temperatures of up to 55°C. We think there must be a melting or burning of the DJ which leads to a temperature rise. Bubble formation was a sign of heating in the ureter in every setting without irrigation. A temperature fall off with increasing distance between the laser fiber and the thermometer is noticable when measuring without irrigation. Conclusion: There is no relevant heating with irrigation. Direct contact between the laser fiber and the DJ seems to evoke additional heating because of melting or underwater burning of the DJ. The maximum temperatures reached without irrigation are limited to a relatively small volume since the is a noticable temperature fall of when increasing the distance between the laser fiber and the thermometer.展开更多
文摘Introduction: The laser is a high energy instrument which can melt metals like nitinol. So it is very important to know under which conditions it is dangerous to perform an endourologic lithotripsy. We measure the temperature increase during laser exposure in an underwater in-vitro ureter model. For comparison, temperatures with and without irrigation and with different distances from the laser fiber to the thermometer are measured. Materials and Methods: We used the Ho:YAG-laser (Vera PulseTM, Coherent) with a 365 μm laser fiber. The settings of the laser were 0.6 J with a frequency of 5 Hz which is the minimum setting for that type of laser. The experimental setup was closely aligned with the clinical situation. A metal container was filled with 0.9% sodium chloride (NaCl) solution (Temp. 36.8°) and a catheter with an inner diameter of 4 mm was attached to the rim of the container. The tip of the thermometer was attached inside the catheter through a waterproof hole. The laser fiber was guided by means of a rigid URS video device (11.5 F). We had four different settings during the measurement: 1) Distance of 0.5 cm between the laser and the thermometer;without irrigation, 2) Distance of 0.5 cm between the laser and the thermometer;with irrigation, 3) Distance of 1 cm between the laser and the thermometer;without irrigation, 4) Distance of 1 cm between the laser and the thermometer;with irrigation. Results: The maximum overall temperature was recorded in the 1) and 3) setting, both featuring no irrigation. The maximum temperature was ~50°C in both settings, with the 1) setting reaching the maximum temperature after 50 seconds and hence approximately twice as fast as the 3) setting. During measurements with a NaCl solution flow we couldn’t detect any noticeable increase in temperature, neither at short nor at long distance between the laser fiber and the thermometer. Conclusion: There is a relevant heating in the ureter beside an endourologic lithotripsy. In our model we could reproduce a maximum heating until ~50°C without irrigation and no heating with irrigation. Without irrigation there is a relevant bubble formation which should be an indicator for the surgeon to stop lithotripsy due to a temperature increase which could harm surrounding tissue.
文摘Background: Complications after endoscopic retrieval of kidney and ureter stones are obviously related to the size of the stones as well as the experience of the surgeon and other factors. During the procedure it is sometimes difficult for surgeons to estimate stone size and therefore give prognostic advises. The visual perception of the stone size depends on the shape, colour, distance to the renoscope and dilatation of the ureter. This is the so-called binding problem, because shape, color and direction of motion are processed separately by different population of optical neurons. In order to establish a better prognostic rational especially for less experienced surgeons, we established an intra operative semi-quantitative measurement of the stone size supported by a stone basket. Materials and Methods: We modified the tipped, nitinol stone baskets from the company Urotech with diameters of 2.5, 3.0 and 4 FR. The handle of this basket has a spring mechanism, which automatically closes the basket and provides a predefined fixation force of the stones within the basket. On the handle we established a non-linear scale in mm by grabbing standardized balls or standardized screws. Result: The scales are nonlinear because of the nonlinear relation between the diameter of the stone and the distance of the slider. Also the scales differ in between the basket size, because of the different strain conditions due to the different wire sizes and materials or the spring and basket. Conclusion: This scale could be an important orientation for a surgeon during endourological procedures to estimate stone sizes. After further clinical experience a semi-quantitative visualization like green, yellow and red colors could help to predict potential complications due to large stone sizes. Finally it could bevery interesting for other disciplines like gastroenterology.
文摘Introduction: The Ho:YAG-Laser is categorized as a potentially dangerous lithotripsy device (DIN: Class 4) for perforation which is mainly caused by the photonic energy the laser emits. Long time complications like ureteral strictures seem to be directed by thermal and mechanical injury. In this study different energy settings a) are being investigated, a DJ (double J stent) is placed beside the laser to simulate a therapy of a forgotten stent with reduction of the lumen b) due to the volume exploitation of the DJ, and direct contact between the laser fiber and the DJ in the ureter c) is simulated during laser exposure. Materials and Methods: We used the Ho:YAG-laser (Vera PulseTM, Coherent, Santa Clara USA) with a 365 μm diameter laser fiber. The settings of the laser were 0.6 J and 1 J pulse energy with a frequency of 5 Hz. The experimental setup was closely aligned with the clinical situation. The tip of the thermometer was attached inside the catheter through a puncture. The laser fiber was guided by means of a rigid URS video device (11.5 Ch). We had four different settings for a), b) and c) during the measurement: 1) Distance of 0.5 cm between the laser and the thermometer;without irrigation, 2) Distance of 0.5 cm between the laser and the thermometer;with irrigation, 3) Distance of 1 cm between the laser and the thermometer;without irrigation, 4) Distance of 1 cm between the laser and the thermometer;with irrigation. Results: The temperature in an empty ureter rises approximately by 5°C, when the laser energy is increased from 0.6 J to 1 J. When a DJ is inserted in the artificial ureter there is surprisingly almost no difference in the maximum temperature between the lower energy level (0.6 J) and the high energy level (1 J). However the time needed to reach the maximum temperature is noticibly less when using high energy levels. The reduction involume based on the placement of the DJ leads to a higher maximum temperature for the low energy setting. The third setting with direct laser fiber contact with the DJ produces the highest temperatures of up to 55°C. We think there must be a melting or burning of the DJ which leads to a temperature rise. Bubble formation was a sign of heating in the ureter in every setting without irrigation. A temperature fall off with increasing distance between the laser fiber and the thermometer is noticable when measuring without irrigation. Conclusion: There is no relevant heating with irrigation. Direct contact between the laser fiber and the DJ seems to evoke additional heating because of melting or underwater burning of the DJ. The maximum temperatures reached without irrigation are limited to a relatively small volume since the is a noticable temperature fall of when increasing the distance between the laser fiber and the thermometer.
