Vapor Channel Oscillations in Laser Lithotripsy.

Abstract

Objectives: Laser-based endoscopic procedures present special challenges to deliver energy for ablation or coagulation of target tissues. When optical fiber-target quasi-contact (< 0.5 mm distance) cannot be maintained or is undesirable, the creation of intervening vapor bubbles and channels provide for the necessary transmission of laser energy to the target. This work investigates the characteristics and the dynamics of vapor channels that directly affect ablation efficiency and ablation rate and are known to effect stone movement, all of which impact procedure efficiency and safety.

Methods: A simplified, experimental model for thulium fiber laser (1940 nm) lithotripsy consists of a water-filled cuvette and a vertically oriented laser fiber (200 μm core diameter) with its tip at 9 mm for "quasi-free" bubble generation and at vapor channel working distances 1-5 mm from and centered on the transparent cuvette bottom simulating a target's surface. Laser power transmission is recorded and synchronized with video frames from a high-speed camera (24,260 frames per second) to capture the induced vapor channels' and bubbles' development.

Results: Laser-induced channel transmission from 0% to 100% for 1, 2, and 3 mm fiber-target distances undergoes oscillations with average periods of 0.32, 0.64, and 1.0 ms, respectively, for 500 W laser output power. For fixed fiber-target distances of 0.5, 1, and 2 mm, the variation of these average oscillation frequencies across laser powers from 500 to 1000 W is much smaller, not exceeding 14%. For fiber-target distances in the range of 1-5 mm, the fraction of the 500 W laser's total pulse energy delivered to the target for 1, 2, and 3 ms pulses linearly decreases from 0.78 to less than 0.2. The channel and bubble dynamics begin with a spherical seed bubble expansion centered on the distal fiber tip that evolves into a pear shape whose surface exhibits periodic irregularities attributable to laser beam interruption by water droplets within the developing bubble.

Conclusions: The study of laser-induced channel oscillations provides quantitative information relating fiber-target distance to channel oscillation frequency and energy transmission onto a target. These oscillations directly effect ablation efficiency and ablation rates that are important parameters for the optimization of a procedure's safety and duration. Insights that may lead to further reduction in retropulsion are also presented. Lasers Surg. Med. 00:00-00, 2024. © 2024 Wiley Periodicals LLC.