Automated irrigation systems in mitigating laser-induced temperature during simulated ureteroscopy

Area of Science:

• Urology
• Medical Devices
• Laser Surgery

Background:

• Laser lithotripsy generates heat, posing a thermal risk to renal tissue.
• Effective irrigation is crucial for managing intrarenal temperatures during laser lithotripsy.

Purpose of the Study:

• To compare temperature changes during laser activation with irrigation delivered by a pressure bag versus a fluid management system (FMS).

Main Methods:

• Benchtop experiments used a flexible ureteroscope in a kidney model with saline irrigation.
• Systems were pressurized to 200 mmHg; laser activation (20-60W) followed.
• Flow rate, pressures, and calyceal temperature were continuously recorded.

Main Results:

• FMS maintained stable flow (~45 mL/min) vs. pressure bag decline (~38 to ~25 mL/min).
• Temperature rise at 20W was 7.9°C (pressure bag) vs. 6.4°C (FMS) (P=0.02).
• At 60W, temperature rise was 17°C (pressure bag) vs. 12.4°C (FMS) (P=0.02).

Conclusions:

• Consistent irrigation flow rate is critical for managing thermal risk in laser lithotripsy.
• An automated FMS effectively mitigates temperature rise and thermal dose in benchtop models.
• FMS offers a potential advantage in enhancing safety during laser lithotripsy procedures.