Stone dusting with laser pdf

Yag laser systems which are able to operate at pulse frequencies of more than 40 hz. To provide clarity, we investigated the impact of pulse energy, width, and repetition rates on the dusting efficacy of phantom stones in vitro using the 120 w ho. Laser fiber diameter, method of cleaving and laser technology also play a part in dusting and popdusting, and future studies also. The brilliant high resolution 7 widescreen colour display is highly visible even from a less favourable viewing angle. Defocusing the laser will produce smaller fragments i. Laser lithotripsy is associated with lower stone migration and easier retrieval of the smaller fragments it. Listing a study does not mean it has been evaluated by the u. Laser fiber diameter, method of cleaving and laser technology also play a part in dusting and pop dusting, and future studies also need to evaluate this aspect 16,17,18.

The quanta system litho 100 holmium laser emits at a wavelength of 2100nm at frequencies up to 80hz which is critical for effective stone dusting. Data show high stonefree rates with urs ll in all locations of the urinary tract and with all stone types and sizes. Dusting is the utilization of high fr and low pe settings to break stones into submillimeter fragments for spontaneous passage without the need for. The fragmentation efficiency on bego artificial stones during lithotripsy and the propulsive effect via video tracking was investigated for a variety of laser settings. On activation of pulsed laser energy, the surrounding fluid evaporates and expands, leading to the formation of a vapor bubble. Two groups prospectively randomized for different laser settings during ureteroscopy one aimed for stone dusting, the other. In the caliceal model, stone fragmentation and vaporization rates at settings of. If you need help or would like to learn more about olympus products or solutions, get in touch. Predictors of clinical outcomes of flexible ureterorenoscopy. Controversies in endourologickidney stone management. Patient and stone characteristics, perioperative outcomes and. Yag laser in dust quantity and quality, producing much finer particles. Stones to dust maximum power through innovative technology.

Pdf modern day holmium laser systems for ureteroscopy urs provide users with a range of settings, namely pulse energy pe, pulse. How to perform the dusting technique for calcium oxalate stone. Clinical evidence suggests that stone dusting may reduce the need for basket extraction thereby decreasing possible complications associated with the. The irrigation pressure was set to 40 cmh 2o from the phantom stones. Holmium laser lithotripsy machine moses pulse 120h lumenis.

Prospective comparison between different laser settings for. Lithotripsy systems urology olympus medical systems. Both concepts for laser lithotripsy demonstrated efficacy. Dr ghani and his colleagues presented findings of a study of 71 patients who underwent 83 laser dusting procedures with a 120w holmium laser. Pdf how to perform the dusting technique for calcium.

The aim was to determine the most efficacious laser setting for stone dusting. Msha rock dusting information msha rock dusting information. Flexible ureteroscopy and laser dusting of 8 mm kidney stone duration. The brilliant high resolution 7 widescreen colour display is. An allinone holmium laser urology platform providing more energy, features and capabilities than any other holmium system on the market. Which is the best way to treat a stone on a flexible ureterorrenoscopy. Currently, the term stone dusting stands for laser settings with low energy per pulse and a high pulse repetition rate. To evaluate the clinical outcome of flexible ureterorenoscopy furs with holmium laser in managing renal stone greater than 2 cm. However, by definition, dusting cannot achieve an immediate stone free status thus close followup is mandatory. Calcium oxalate monohydrate stone samples with a sample size of n 5 were used for each group, with average initial stone mass ranging from 216 to 297 mg among groups.

Nov, 2018 however, there is no consensus of the optimal laser setting for stone dusting. This enables users to carry out stone dusting and coarse fragmentation. A usability comparison of laser suction handpieces for. Fried, thulium fiber laser stone dusting using an automated, vibrating optical fiber, proc. After a laser pulse, in vitro stone displacement experiments showed a signi. Oct 31, 2014 prospective comparison between different laser settings for ureteral \ kidney stones treatment during ureteroscopy the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Olympus empower h65 laser brochure pdf, 770 kb olympus empower h100 laser brochure pdf, 747 kb. The new stonelight 30 laser system is the next step in. Highfrequency dusting versus conventional holmium laser. Yag laser portfolio offers 35w and 65w systems with a fullrange line of laser fibers to meet the diverse lithotripsy challenges physicians face each day.

Stonelight 30 laser system enhancements unique graphic user interface gui with 5 touch screen options to provide a. Pdf highfrequency dusting versus conventional holmium. Yag laser is used to treat stones, there are two parameters that can be adjusted. Extractable fragment versus dusting during ureteroscopic. Instead of trying multiple settings, it starts with preferred settings then provides 7 levels of pulse width. We therefore recommend dusting settings for patients with large stone mass or when direct extraction seems difficult due to anatomic factors. Mar 26, 2019 a part of the material presented in this paper has been previously published as an spie conference proceedings paper l. Ureteroscopy and laser stone fragmentation ursl has had recent advancements with the more powerful laser systems with the ability to dust and. As minimally invasive surgical techniques become the way of the future, vaaahs is ahead of the curve poised to become a center of excellence for endoscopic laser stone surgery vaaahs is the only va in the nation with an advanced kidney stone.

Userfriendly and no noise the innovative operating concept enables intuitive operation of the sphinx jr. Laser settings are on the touch screen at your finger tip. Yag lasermediated stone fragmentation is better with increased energy per pulse and reduced pulse width, but not consistently with pulse repetition rates with a power output of 1020 w 810. Frontiers a users guide to holmium laser lithotripsy. Prospective randomized controlled trial comparing laser. Accounting for respiratory renal movement is also important. Aug 21, 2018 the initial followup after stone dusting is also debatable and it is unclear how long it takes for the dust to completely clear out. Calcium oxalate monohydrate stones were fragmented using a 200lm laser fiber. The other principle involved in dusting is to keep the laser fiber slightly off of the stone to defocus it and minimize the mechanical acoustic effect of the laser energy. The stone location was in the kidney n 65, 78%, in the ureter n 19, 22% and 5 patients had bilateral renal stones. Dusting versus basketing treatment of intrarenal stones. Use of the moses technology to improve holmium laser.

The stones were present in the kidney in 73% of patients and in the ureters in 27%. The purpose of this study is to evaluate outcomes of fragmentation into extractable pieces and stone dusting during ureteroscopic laser lithotripsy in children. Olympus stone management having a long history in supporting physicians needs in stone management through the provision of rigid and flexible ureteroscopes and the related video equipment, olympus is well aware of the additional procedural requirements in terms of singleuse instruments as well as holmium lasers and lithotriptors. Dusting versus basketing during ureteroscopywhich technique. Dusting utilizing suction technique dust for percutaneous nephrolithotomy. Having a long history in supporting physicians needs in stone management through the provision of rigid and flexible ureteroscopes and the related video equipment, olympus is well aware of the additional procedural requirements resulting from the use of singleuse instruments as well as holmium lasers and lithotriptors. Stonedusting lithotripsy at highfrequency of above 50hz is efficient at pulverizing stones. However, there is no consensus of the optimal laser setting for stone dusting. Jan 16, 2019 an experimental setup consisting of 1. To compare stone dusting and spontaneous passage vs fragmentation and active fragment retrieval during flexible ureteroscopy furs for renal calculi patients and methods. To determine the most efficacious setting of holmium. May 18, 2017 stone dusting using a holmium laser maestro.

Approaches such as flexible ureteroscopy or percutaneous surgery require a wide range of equipment. Conclusion both concepts for laser lithotripsy demonstrated efficacy. Altering the pulse width of the laser can change the effects of laser fragmentation. A users guide to holmium laser lithotripsy settings in. More effective stone breaking higher efficiencies saving hospitals time and money ability to work on types of stones laser can be used in any operating room at full power on 110 volts, improving or efficiency stone dusting setting, removing the need for baskets and reducing operating room costs. Our preliminary study investigates an automated, vibrating fiber optic tip for dusting of kidney stones during thulium fiber laser tfl lithotripsy. Using high repetition rates 50 hertz at lower energy pulses 0. Having a long history in supporting clinicians needs in stone management with the provision of rigid and flexible ureteroscopes and related video equipment, olympus is well aware of the additional procedural requirements resulting from the use of singleuse instruments as well as holmium lasers and lithotriptors. Comprehensive information about the character of the laser emission is easily collected from this real time graph. Role of dusting and popdusting using a highpowered. How to perform the dusting technique for calcium oxalate stone phantoms during ho. Stone management is a complex and wideranging application field. Dusting versus fragmentation for renal stones during.

Haim epshtein, idan sthzeglowski and arkady khachaturov. Dusting versus fragmentation for renal stones during flexible. Yag laser in both dusting mode threefold for com stones and 2. Although such scopes now enable modern surgical stone treatment, they have only been routinely utilized for the past several decades. The versapulse laser enables a wide range of settings from stone fragmentation to stone dusting.

While this treatment is a wellestablished option for treatment of these stones, there are several different techniques used to help eliminate them from the kidney. Pdf holmium laser lithotripsy in the new stone age. Stone breaking was performed using energy settings of 5 j joules and 20 hz hertz while stone dusting settings were 0. Ureteroscopy for treatment of ureteral stones was not performed routinely until. Dusting was performed with continuous firing of the laser until the stones became a dust with aparticlesize laser firing to the formation of this dust. The efficient system design of the empower h35 and h65 enables higher frequency settings compared to competitive systems at similar power offerings. In the renal calix, the lowenergy highfrequency setting performed similarly to the highenergy lowfrequency setting. Which is the best way to treat a stone on a flexible.

Meanwhile, stone dusting with low pulse energy and high pulse repetition rates reduces the size of fragmented stones until. Pdf advances in lasers for the treatment of stonesa. On activation of pulsed laser energy, the surrounding fluid evaporates and expands, leading to. Intra and postoperative complications were comparable. A variation of the laser settings pulse energy, pulse duration, repetition rate altered the total application time required for stone fragmentation, the stone break up time, and the propulsion. The use of the lumenis pulse and versapulse powersuite high power laser systems enables a novel stone management technique called stonedusting. Masterpulse this is an intuitive feature that assists in modifying tissue cutting. This can theoretically decrease operative times and lower the risk of ureteral trauma by minimizing the repetitive introduction and removal of the ureteroscope. Dusting was done using low energy and high frequency 0. Highfrequency dusting versus conventional holmium laser lithotripsy for intrarenal and ureteric calculi article pdf available in journal of endourology 3 december 2016 with 410 reads. A recent study demonstrated a stonefree rate similar to that in our dusting group when using the new 120 w lumenis ho. Then, the stone is broken into tiny fragments using a small laser called a holmium laser.

The laser fiber portfolio of the empower system offers a balltip fiber, that allows the physician to insert the fiber through a deflected scope, while maintaining visualization of the stone. Prospective comparison between different laser settings for ureteral \ kidney stones treatment during ureteroscopy. Yag laser with a maximum power output of 120 w with in vitro phantomstone dusting technique. The new stonelight 30 laser system is the next step in holmium laser technology delivering 30 watts of power. Aug 14, 2019 in our practice we start dusting settings at 0. Records of 120 patients 123 renal units with renal stone greater than 2 cm who underwent furs with holmium laser iwere evaluated. Use of a dedicated laser handpiece to treat a staghorn stone. Minimally invasive kidney stone treatment began in the mid1980s with shock wave lithotripsy and percutaneous nephrolithotomy.

The effect on stone comminution, fiber tip degradation, and retropulsion in a dusting model. The initial followup after stone dusting is also debatable and it is unclear how long it takes for the dust to completely clear out. Sep 07, 2015 stone dusting technique to prevent retropulsion. How to perform the dusting technique for calcium oxalate. The study included patients who underwent furs and holmium laser lithotripsy for renal calculi from january 2015 to march 2017.

This is an intuitive feature that assists in modifying tissue cutting. Today, this treatment approach is mainly the domain of multicavity highpower ho. During noncontact laser lithotripsy, stone fragments are rapidly pulverized in a calyx in laser bursts that result in stones breaking into fine fragments. Both laser lithotripsy and pneumatic lithotripsy are equally safe and ef. According to the pulse width short 500, middle 750, long pulse. Lithotripsy systems all medical specialities olympus.

Influence of high energy holmium laser parameters and applied fiber diameter on calculi phantom ablation. Choosing a backup generator plus 3 legal house connection options transfer switch and more duration. Wide adjustment range of variation in power and pulse duration different user modes and individual presets green pilot beam with stored long and short single pulses intuitive user navigation, very. Power settings in fragmentation, dusting and propulsion and. Rock dusting definition of rock dust pulverized limestone, dolomite, gypsum, anhydrite, shale, adobe, or other inert material, preferably light colored, 100 percent of which will pass through a sieve having 20 meshes per linear inch and 70 percent or more of which will pass through a sieve having 200 meshes per linear inch. Holmium laser lithotripsy clinmed international library. Prospective comparison between different laser settings. Role of dusting and popdusting using a highpowered 100 w.

Stone dusting the future is now, at vaaahs va ann arbor. Laser lithotripsy of calcium oxalate monohydrate stones in the ureter should be performed using the lowenergy, moderatefrequency dusting setting to minimize retropulsion and maximize efficiency. Jan 01, 2018 the other principle involved in dusting is to keep the laser fiber slightly off of the stone to defocus it and minimize the mechanical acoustic effect of the laser energy. These preliminary studies demonstrate that the tfl is a promising alternative laser for lithotripsy when operated in dusting mode, producing higher stone ablation rates and smaller stone fragments than the holmium laser. It is an ideal solution for stone dusting and vaporization or enucleation of the prostate in benign prostatic hyperplasia bph procedures. Factors that influence the selection of pe include stone density, location. The desktop and minitower are holmium yag lasers with a robust 30 watts or 4. Kidney stones are a growing problem the va ann arbor healthcare system vaaahs offers a revolutionary solution new laser technology. Thulium fiber laser ablation of kidney stones using an.