Analysis of lithotripsy efficiency and stone retropulsion displacement according to pulse characteristics of Ho: YAG laser with Moses effect

IF 2.2 3区 医学 Q2 DERMATOLOGY Lasers in Surgery and Medicine Pub Date : 2023-11-30 DOI:10.1002/lsm.23743
Kanghae Kim PhD, Young-Seok Seo PhD, Phil-Sang Chung MD, PhD, Joo Beom Eom PhD
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Abstract

Background and Objectives

Compared to the conventional Ho: YAG laser, a Ho: YAG laser device has been reported that has a Moses effect to reduce stone retropulsion and increase lithotripsy efficiency. The principle of this equipment is to convert a single laser pulse into two pulses. Most studies on such lasers are limited to lithotripsy efficiency and the prevention of stone retropulsion; studies according to each pulse condition have not been performed. Therefore, the purpose of this study was to quantify the bubble shape, lithotripsy efficiency, and stone retropulsion displacement in a ureteral phantom according to the modulation of the first pulse characteristics of the Moses effect laser under conditions that maintained the total energy and repetition rate.

Material and Methods

In this study, a Ho: YAG laser system (Holinwon Pro, Wontech Inc., Korea) with an emission wavelength of 2.10 μm and a Moses effect was used. To verify the Moses effect based on the changes in the pulse, a water tank was fabricated, and the ureteral phantom was manufactured in a structure that could be easily installed in the water tank. Additionally, a spherical artificial stone in the ureteral phantom was prepared by mixing calcined gypsum (Cacinated Gypsum) and water at a ratio of 3:1. In the ureteral phantom, a high-speed camera (FASTCAM NOVA S12, Photron Inc.) and visible light were used to record pulse-dependent image analysis of bubbles and stone retropulsion.

Result

After mounting the artificial stone in the ureteral phantom, the pulse duration and energy of the first pulse of the Moses effect laser were varied; 30 laser shots for 3 s at a repetition rate of 10 Hz were applied to quantify the lithotripsy efficiency and stone retropulsion displacement, and the experimental values were compared. The fragmentation efficiency was confirmed by measuring the mass before and after the laser pulse application, the original position of the stone retropulsion displacement, and the distance moved. The minimum value of stone retropulsion displacement appeared when the pulse duration of the first pulse was 300 μs, the pulse energy was 100 mJ, and the value was approximately 0.28 mm. The highest fragmentation efficiency was observed under the same conditions, and the mass loss of the artificial stone at that time was approximately 3.7 mg.

Conclusion

Quantitative indices, such as lithotripsy efficiency and stone retropulsion displacement, were confirmed using ultrahigh-speed cameras to determine the effect of the first pulse energy and duration of the Ho: YAG laser with the Moses effect on stone removal. It was confirmed that the longer the duration of the primary pulse and the lower the energy, the higher the fragmentation efficiency. In this study, the possibility of manufacturing a laser with an optimal stone-removal effect was confirmed according to the first-pulse condition of the laser with the Moses effect.

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基于摩西效应的Ho: YAG激光脉冲特性对碎石效率和碎石反推位移的分析。
背景与目的:与传统的Ho: YAG激光器相比,已经报道了一种Ho: YAG激光装置,它具有摩西效应,可以减少石头的反冲,提高碎石效率。该设备的原理是将一个激光脉冲转换成两个脉冲。大多数关于这种激光器的研究都局限于碎石效率和防止石头的反冲;还没有对每一种脉搏情况进行研究。因此,本研究的目的是在保持总能量和重复率的条件下,通过调制Moses效应激光的第一脉冲特性,量化输尿管幻体中的气泡形状、碎石效率和结石退推位移。材料与方法:本研究采用发射波长为2.10 μm、具有Moses效应的Ho: YAG激光系统(Holinwon Pro, Wontech Inc., Korea)。为了验证基于脉冲变化的摩西效应,我们制作了一个水箱,并制作了一个易于安装在水箱中的输尿管幻体。此外,将煅烧石膏(Cacinated gypsum)与水按3:1的比例混合,在输尿管幻体内制备球形人工结石。在输尿管幻影中,使用高速摄像机(FASTCAM NOVA S12, Photron Inc.)和可见光记录气泡和结石退推的脉冲依赖图像分析。结果:在输尿管幻体内放置人工结石后,Moses效应激光第一脉冲的脉冲持续时间和能量发生了变化;采用重复频率为10 Hz的30次激光照射,持续3 s,量化碎石效率和石头的推退位移,并对实验值进行比较。通过测量激光脉冲施加前后的质量、石头的原始位置的反推位移和移动的距离来确定破碎效率。当第一次脉冲脉冲持续时间为300 μs,脉冲能量为100 mJ时,石推位移最小,其值约为0.28 mm;在相同的条件下,观察到最高的破碎效率,此时人造石的质量损失约为3.7 mg。结论:利用超高速摄像机确定了具有Moses效应的Ho: YAG激光第一脉冲能量和持续时间对石质去除的影响,确定了碎石效率和石质反推位移等定量指标。结果表明,主脉冲持续时间越长、能量越低,破片效率越高。在本研究中,根据Moses效应激光器的第一脉冲条件,证实了制造具有最佳脱石效果的激光器的可能性。
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来源期刊
CiteScore
5.40
自引率
12.50%
发文量
119
审稿时长
1 months
期刊介绍: Lasers in Surgery and Medicine publishes the highest quality research and clinical manuscripts in areas relating to the use of lasers in medicine and biology. The journal publishes basic and clinical studies on the therapeutic and diagnostic use of lasers in all the surgical and medical specialties. Contributions regarding clinical trials, new therapeutic techniques or instrumentation, laser biophysics and bioengineering, photobiology and photochemistry, outcomes research, cost-effectiveness, and other aspects of biomedicine are welcome. Using a process of rigorous yet rapid review of submitted manuscripts, findings of high scientific and medical interest are published with a minimum delay.
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