Evaluation of Contemporary Holmium Laser Fibers for Performance Characteristics

Several holmium:YAG laser fibers for urologic applications are currently commercially available. We compared contemporary holmium laser fibers with different core sizes for performance characteristics, including energy transmission, fiber failure, fiber flexibility, and core diameter.

Single-use fibers from Cook, Boston Scientific, and Storz were tested in small (200 and 272/273 μm), medium (365 μm), and large (550 and 940/1000 μm) core sizes. Fibers were tested in straight and deflected configurations. All fibers were evaluated for flexibility, true fiber diameter, energy transmission, and fiber failure. For energy transmission, fibers were tested at a pulse energy of 1 J and a frequency of 10 Hz for 30 seconds. All tests were performed on a 30 W holmium laser.

For the small core fibers, Storz, Cook OptiLite, and Smart Sync had the smallest core diameter (p < 0.005). In the large core group, Cook OptiLite and Boston Scientific AccuMax showed the smallest diameter. Among the small core fibers, Storz and Cook Smart Sync showed a significant higher deflection, whereas in the 550 μm group, Boston Scientific AccuMax and Cook Smart Sync were the most flexible fibers. In the large and medium core groups, Boston Scientific AccuMax showed superior energy transmission (p = 0.007 and p = 0.001, respectively), whereas in the small core group, there was no significant difference between the fibers, except for 272/3 μm (Storz was inferior compared with the competitors [p < 0.0005]). For fiber failure, Storz, Cook OptiLite, and BS AccuTrac completed all testing without failing (200 μm, bending radius <0.5 cm). In the 365 μm group, Cook OptiLite showed superior results, whereas in the large core group, Boston Scientific AccuMax was superior.

Performance characteristics differ significantly between different laser fiber diameters and manufacturers, and fiber choice should depend on specific surgical requirements. There is a trend for less fiber fracture at long pulse, high energy, and low frequency, but this finding will require further investigation.