Optimal Settings for the Noncontact Holmium:YAG Stone Fragmentation Popcorn Technique
Optimal Settings for the Noncontact Holmium:YAG Stone Fragmentation Popcorn Technique
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DOI：
10.1016/j.juro.2017.02.3371
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发表时间：
2017-09-01
影响因子：
6.6
通讯作者：
Traxer, Olivier
中科院分区：
文献类型：
--
作者：
Emiliani, Esteban;Talso, Michele;Traxer, Olivier
目的：本研究的目的是评估爆米花技术，使用范围广泛的钬激光设置和光纤尺寸在一个系统的体外assessment.Materials和方法：评估进行了4个人工结石的收集管。通过输尿管入路鞘插入固定的输尿管镜，以提供恒定的冲洗流量，并将激光器放置在距离底部1 mm处。测试0.5至1.5 J、10至20和40 Hz以及长脉冲和短脉冲的组合2分钟和4分钟。我们使用273和365 TM激光光纤。所有试验重复3次。在实验之前和之后对石头进行称重以评估凝固效率。一个高效的technology. Results的显着预测进行了assessed.Results：共进行了144测试。结石的平均起始重量为0.23 gm，这在各组之间是一致的。实验后，中位体重差异为0.07 gm（范围为0.01 - 0.24）。当指定结石体积减少50%作为高效率的阈值时，有效爆米花技术的重要预测因素是长脉冲（OR 2.7，95% CI 1.05-7.15），持续时间较长（OR 11.4，95% CI 3.88-33.29），小（273 μ m）激光光纤（OR 0.23，95% CI 0.08-0.70）和更高功率（W）结论：较高能量、较长脉冲、高于10 Hz的频率、较长持续时间和较小激光纤维预示爆米花技术在减少结石体积方面更有效。
Purpose: The purpose of this study was to evaluate the popcorn technique using a wide range of holmium laser settings and fiber sizes in a systematic in vitro assessment.Materials and Methods: Evaluations were done with 4 artificial stones in a collection tube. A fixed ureteroscope was inserted through a ureteral access sheath to provide constant irrigation flow and the laser was placed 1 mm from the bottom. Combinations of 0.5 to 1.5 J, 10 to 20 and 40 Hz, and long and short pulses were tested for 2 and 4 minutes. We used 273 and 365 tm laser fibers. All tests were repeated 3 times. The stones were weighed before and after the experiments to evaluate the setting efficiency. Significant predictors of a highly efficient technique were assessed.Results: A total of 144 tests were performed. Mean starting weight of the stones was 0.23 gm, which was consistent among the groups. After the experiment the median weight difference was 0.07 gm (range 0.01 to 0.24). When designating a 50% reduction in stone volume as the threshold indicating high efficiency, the significant predictors of an efficient popcorn technique were a long pulse (OR 2.7, 95% CI 1.05-7.15), a longer duration (OR 11.4, 95% CI 3.88-33.29), a small (273 mu m) laser fiber (OR 0.23, 95% CI 0.08-0.70) and higher power (W) (OR 1.14, 95% CI 1.09-1.20).Conclusions: Higher energy, a longer pulse, frequencies higher than 10 Hz, a longer duration and a smaller laser fiber predict a popcorn technique that is more efficient at reducing stone volume.