Experimental ex-vivo performance study comparing a novel, pulsed thulium solid-state laser, chopped thulium fibre laser, low and high-power holmium:YAG laser for endoscopic enucleation of the prostate.

ABSTRACT

PURPOSE: The aim of this study was to compare the enucleation performances of four different types of laser devices in an ex-vivo experiment a novel, pulsed TmYAG solid-state laser evaluation model (p-TmYAG), chopped thulium fibre laser (TFL), low-power HoYAG laser (LP-HoYAG), and a high-power HoYAG laser (HP-HoYAG). METHODS: Our primary aim was to endoscopically separate the fascial layers of a porcine belly using laser fibres within a time period of 60 s. The size of a "tissue pocket" was assessed numerically. The enucleation characteristics reflecting the surgeon's experience were evaluated via the NASA Task Load Index (TLX) questionnaire and a questionnaire based on Likert scale. RESULTS: HP-HoYAG achieved with the available laser settings the largest overall "tissue pocket" (31.5 cm2) followed by p-TmYAG (15 cm2), TFL (12 cm2), and LP-HoYAG (6 cm2). The coagulation performances of p-TmYAG and TFL were rated the best. In the performance evaluation by the Likert questionnaire, HP-HoYAG (average score of 4.06) was rated highest, followed by p-TmYAG (3.94), TFL (3.38), and LP-HoYAG (3.25). The evaluation of the NASA-TLX performance questionnaire revealed average scores for HP-HoYAG, LP-HoYAG, TFL and p-TmYAG of 4.38, 4.09, 3.92 and 3.90, respectively. CONCLUSION: We are the first to compare different laser devices and settings in an ex-vivo study. We found that the surgeons were most satisfied with the HP-HoYAG laser device, followed by the p-TmYAG. These findings could be highly relevant for future research and for the practical utilisation of laser systems in endourology.