Comparison of dusting and fragmentation techniques using an aspiration access sheath: an in vitro study

Area of Science:

• Urology
• Endourology
• Laser Lithotripsy

Background:

• Suction during flexible ureteroscopy enhances stone clearance and reduces complications.
• Aspiration access sheaths are increasingly used in ureteroscopic procedures.

Purpose of the Study:

• To compare dusting and fragmentation techniques for laser lithotripsy in vitro using an aspiration access sheath.
• To evaluate energy consumption, particle size, procedural efficiency, and scope handling for each technique.

Main Methods:

• A bench model simulating the renal calyx was used with an 11-13 Fr aspiration access sheath.
• Thulium Fiber Laser (TFL) lithotripsy was performed by three surgeons using both dusting and fragmentation settings.
• Primary outcomes included energy usage, particle size, efficiency, and scope entry-exit counts.

Main Results:

• Fragmentation resulted in shorter lasing times (31.15 vs 45.15 min) and higher ablation efficacy (29.64 vs 24.55 mm³/J).
• Fragmentation necessitated longer suction durations (14.11 vs 5.77 min) and more scope entries (16 vs 4) due to larger particles.
• Dusting consumed more energy (40.73 vs 33.73 kJ) but yielded finer fragments.

Conclusions:

• Fragmentation with an aspiration sheath improves ablation efficacy and reduces lasing time but increases scope entries and potential for scope damage.
• Dusting produces finer particles, though it requires more energy.
• The optimal lithotripsy technique should be individualized based on patient and surgeon factors.