Safety Parameters for the Use of Holmium:YAG Laser in the Treatment of Biliary Calculi: The Ex-Vivo Model.
Medicina (Kaunas)
; 60(2)2024 Feb 19.
Article
en En
| MEDLINE
| ID: mdl-38399633
ABSTRACT
Background and Objectives:
While studies have demonstrated the efficacy of cholangioscopy-guided Holmium-Yttrium aluminum garnet (HoYAG) laser lithotripsy for the treatment of refractory bile duct stones, data regarding the safety of the operating parameters for laser lithotripsy are lacking. The aim of this study was to determine safe, yet effective, energy settings for HoYAG laser in the ex-vivo model. Materials andMethods:
This ex vivo experimental study utilized the HoYAG laser on porcine bile duct epithelium and human gallstones. HoYAG laser lithotripsy was applied in different power settings from 8 to 15 Watts (W) to six explanted porcine bile ducts. Settings that appeared safe were then utilized to fragment seventy-three human gallstones.Results:
The median bile duct perforation times with the HoYAG laser between 8-15 W were >60 s (8 W); 23 s (9 W); 29 s (10 W); 27 s (12 W); 12 s (14 W); and 8 s (15 W). Statistically significant differences in the median perforation times were noted between 8 W vs. 15 W, 9 W vs. 15 W, 10 W vs. 15 W, and 12 W vs. 15 W (p < 0.05). When using a 365 µm HoYAG laser probe at 8-12 W, the fragmentation rates on various size stones were 100% (<1.5 cm); 80-100% (1.6-2.0 cm) and 0-32% (>2.0 cm). Optimal fragmentation was seen utilizing 12 W with high energy (2.4 J) and low frequency (5 Hz) settings. Using a larger 550 µm probe at these settings resulted in 100% fragmentation of stones larger than 2 cm.Conclusions:
The HoYAG laser appears to be safe and effective in the treatment of large bile duct stones when used between 8-12 W in 5 s bursts in an ex vivo model utilizing porcine bile ducts and human gallstones.Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Litotricia
/
Cálculos Biliares
/
Litotripsia por Láser
/
Láseres de Estado Sólido
Límite:
Animals
/
Humans
Idioma:
En
Revista:
Medicina (Kaunas)
Asunto de la revista:
MEDICINA
Año:
2024
Tipo del documento:
Article
País de afiliación:
Estados Unidos