Laser lithotripsy fundamentals: from the physics to optimal fragmentation

Purpose: Laser Lithotripsy has remained the cornerstone for the management of urolithiasis for more than thirty years. Miniaturization of endoscopic equipment, digital vision, improvement of laser lithotripters, laser fibers has made endourology a field of growing interest, immersed in a technologic revolution. The aim of this article is to do an extense review on laser lithotripsy starting from the physics of the lasers, to translational science apply to lithotripsy fundamentals in order to make lithotripsy safer and more efficient. Methods: We performed a review of the literature in four different databases (PubMed, Embase, Ovid® , and Scopus® ) on any information concerning laser lithotripsy in February 2020 independently by three authors, a total of 186 articles were reviewed and 38 of the most influential articles were selected and a detailed reviewed on this topic is presented. Results: We aim to make a reference paper for all urologists and health personal involved in laser lithotripsy, starting from the physics to answer practical questions as how to set the parameters in my laser system, how to improve lithotripsy efficiency, should we dust or bust? and finally discussing new technologies such as the Holmium: YtriumAluminium-Garnet (Ho:YAG) Moses technology, the revolutionary Thulium Laser Fiber (TLF) and discussing the future of laser lithotripsy. Conclusions: Laser lithotripsy must offer. Higher ablative efficiency, wider range of laser parameters and comprehensive combinations, reduce retropulsion and fiber burnback, scope miniaturization capabilities, smaller fiber sizes, increased safety, lower environmental impact, reduced maintenance costs Ho:YAG has remained the unquestioned gold standard for laser lithotripsy, but the recently launched Thulium fiber laser has all the above mentioned features and outruns without no doubt the current gold standard and is set to gradually replace it.

• Autores: Lopez Ramos, Hugo Enrique; Chavarriaga, Julian; Fakih, Nayib
• Tipo de recurso: Article of journal
• Fecha de publicación: 2021
• Institución: Pontificia Universidad Javeriana
• Repositorio: Repositorio Universidad Javeriana
• Idioma: eng
• OAI Identifier: oai:repository.javeriana.edu.co:10554/63657
• Acceso en línea: https://meddocsonline.org/international-journal-of-innovative-surgery/laser-lithotripsy-fundamentals-from-the-physics-to-optimal-fragmentation.pdf; http://hdl.handle.net/10554/63657
• License: Atribución-NoComercial 4.0 Internacional