Real-Time Laser Fiber-to-Stone Distance Proximity Indicator Improves Ureteroscopic Stone Ablation: In Vitro...

Area of Science:

• Urology
• Biomedical Engineering
• Laser Physics

Background:

• Urinary stone disease is a common condition requiring effective treatment.
• Laser lithotripsy is a standard procedure for stone removal.
• Precise control of the laser fiber tip is crucial for efficient ablation.

Purpose of the Study:

• To evaluate the impact of a real-time fiber-to-stone distance proximity indicator (DPI) on laser stone ablation efficiency.
• To compare stone ablation outcomes with the DPI visible versus covered during in vitro lithotripsy.

Main Methods:

• Timed in vitro lithotripsy trials were conducted using a brushite crystalline aggregate model stone.
• Laser settings, pulse modes, and proximity settings were varied across 12 experiments.
• Stone ablation mass and laser energy were recorded with the DPI alternately covered and visible.

Main Results:

• Significantly greater stone mass was ablated when the DPI was visible compared to covered.
• Increased production of fine stone fragments (<0.5 mm) was observed with the DPI visible.
• Higher laser energy application and improved laser ablation efficiency (mg/J) were achieved with DPI visibility.

Conclusions:

• Visibility of the real-time DPI enhances laser stone ablation during in vitro ureteroscopic lithotripsy.
• The DPI improves fiber tip control, leading to more effective lasing and reduced targeting time.
• The DPI is expected to decrease treatment duration and laser energy requirements in clinical settings.