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

Suction during flexible ureteroscopy improves stone clearance and lowers complications. The aim of this study is to provide one of the first in vitro comparisons of dusting and fragmentation techniques during laser lithotripsy using an aspiration access sheath.

The bench model consisted of a modified 50-cc syringe that served as a calyx model, into which an 11-13 Fr suction access sheath and artificial BegoStone stones were placed. Three trials were performed by 3 surgeons using Thulium Fiber Laser (TFL) for lithotripsy, using both dusting and fragmentation settings and techniques. The primary outcomes were evaluation of energy usage, particle size distribution, procedural efficiency and scope entry-exit count.

Fragmentation showed shorter lasing times (31.15 vs 45.15 min, p < 0.001) and greater ablation efficacy (29.64 vs 24.55 mm³/J, p < 0.001). Nevertheless, it necessitated longer suction durations (14.11 vs 5.77 min, p = 0.001) due to larger particle sizes and the need for more frequent scope entries (16 vs 4, p < 0.001). Dusting consumed more energy (40.73 vs 33.73 kJ, p < 0.001) but produced finer fragments.

Fragmentation using an aspiration sheath shortens the lasing time and improves ablation efficacy, but it also increases the frequency of scope entries and may result in endoscope damage. Dusting produces a finer particle dispersion despite using more energy. The choice of technique should be tailored to the demands of the patient and the surgeon.