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Effect of Pulse Modulation on Diode-Pumped Laser Lithotripsy.

Nitesh Katta1, Katherine Sikorski1, Joel M H Teichman2

  • 1Beckman Laser Institute and Medical Clinic, University of California at Irvine, Irvine, California, USA.

Journal of Endourology
|May 27, 2025
PubMed
Summary
This summary is machine-generated.

Optimizing pulse modulation for thulium lasers (Tm:YAG and TFL) significantly enhances kidney stone lithotripsy by increasing energy transfer and stone removal. Synchronizing the second pulse with vapor bubble dynamics maximizes effectiveness.

Keywords:
TFLdiode laserlaser lithotripsypulse modulationthuliumthulium:YAG

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Area of Science:

  • Medical physics and biomedical engineering
  • Laser-tissue interaction
  • Urological device development

Background:

  • Kidney stone lithotripsy commonly uses lasers, but energy transfer efficiency through saline can be a limiting factor.
  • Thulium lasers, including Tm:YAG and Thulium Fiber Lasers (TFL), are utilized for their specific wavelengths in stone fragmentation.
  • Pulse modulation strategies are being explored to improve laser ablation efficiency and stone removal.

Purpose of the Study:

  • To investigate the impact of pulse duration, energy, and interpulse delay on energy transfer for kidney stone lithotripsy.
  • To determine if an optimal pulse modulation profile maximizes radiant energy transfer (RETE).
  • To assess if enhanced energy transfer via pulse modulation leads to greater stone volumetric removal.

Main Methods:

  • Radiant energy transmission efficiency (RETE) and ablation volumes were measured using phantom and human kidney stones.
  • Experiments involved diode-pumped thulium yttrium aluminum garnet (Tm:YAG) and thulium fiber lasers (TFL) at various standoff distances.
  • Fast camera imaging and optical coherence tomography were used to analyze vapor bubble dynamics and crater volumes.

Main Results:

  • Dual-pulse modulation with Tm:YAG lasers increased RETE by up to 75% at a 1 mm standoff distance compared to single-pulse.
  • Optimal dual-pulse modulation resulted in significantly greater stone volumetric removal for most stone types with Tm:YAG.
  • Thulium Fiber Lasers (TFL) showed similar trends, though with some variability across different stone compositions.

Conclusions:

  • Pulse-modulated Tm:YAG and TFL lasers can enhance photon delivery through saline when the initial pulse is optimized.
  • An optimal pulse modulation profile, synchronized with vapor bubble collapse, achieves the highest RETE.
  • Improved RETE through optimized pulse modulation directly correlates with increased stone volumetric removal in lithotripsy.