The optimal laser fiber core size for endourological performance: a systematic review

Area of Science:

• Endourology
• Laser technology
• Medical device engineering

Background:

• Fiber core size is a critical parameter in laser applications.
• Understanding its impact is essential for optimizing endourological procedures.

Purpose of the Study:

• To review and synthesize evidence on how laser fiber core size affects key performance and safety parameters in endourology.

Main Methods:

• A systematic literature search was conducted on PubMed and Cochrane databases.
• 14 studies were included in the final analysis after rigorous screening and exclusion criteria were applied.

Main Results:

• Smaller fibers (≤300 μm) enhance energy delivery and flexibility, ideal for lithotripsy, but show reduced durability and increased degradation.
• Larger fibers (≥300 μm) offer superior energy efficiency, durability, and fracture resistance, suitable for high-energy procedures like prostate enucleation.
• Thermal safety is dependent on fiber size and irrigation, with smaller fibers requiring adequate irrigation. Retropulsion varies with fiber size, and bubble generation differs between small and large fibers.

Conclusions:

• Laser fiber core size is a crucial determinant of energy delivery, durability, thermal safety, and flexibility.
• Optimizing fiber selection based on core size can significantly improve the efficiency and safety of endourological procedures.