尿路上皮
钬
离体
医学
激光器
铥
上尿路
输尿管
软组织
烧蚀
输尿管镜检查
生物医学工程
核医学
泌尿科
泌尿系统
外科
体内
解剖
光学
内科学
物理
生物技术
生物
作者
Silvia Proietti,Moisés Rodríguez-Socarrás,Brian H. Eisner,Roberta Lucianò,Mario José Basulto Martinez,Yuyi Yeow,Ilenia Rapallo,Giuseppe Saitta,Federico Scarfò,Franco Gaboardi,Guido Giusti
出处
期刊:Journal of Endourology
[Mary Ann Liebert]
日期:2021-04-01
卷期号:35 (4): 544-551
被引量:25
标识
DOI:10.1089/end.2020.0222
摘要
Introduction: There are limited data regarding the effect of thulium laser (Tm:YAG) and holmium laser (Ho:YAG) on upper urinary tract. The aim of this study was to compare soft tissue effects of these two lasers at various settings, with a focus on incision depth (ID) and coagulation area (CA). Materials and Methods: An ex vivo experimental study was performed in a porcine model. The kidneys were dissected to expose the upper urinary tract and the block samples containing urothelium and renal parenchyma were prepared. The laser fiber, fixed on a robotic arm, perpendicular to the target tissue was used with a 100 W Ho:YAG and a 200 W Tm:YAG. Incisions were made with the laser tip in contact with the urothelium and in continuous movement at a constant speed of 2 mm/s over a length of 1.5 cm. Total energy varied from 5 to 30 W. Incision shape was classified as follows: saccular, triangular, tubular, and irregular. ID, vaporization area (VA), CA, and total laser area (TLA = VA + CA) were evaluated. Statistical analysis was performed using the SPSS V23 package, p-values <0.05 were considered statistically significant. Results: A total of 216 experiments were performed. Incision shapes were saccular (46%), triangular (38%), and irregular (16%) with the Ho:YAG, while they were tubular (89%) and irregular (11%) with the Tm:YAG. ID was significantly deeper with the Ho:YAG (p = 0.024), while CA and TLA were larger with the Tm:YAG (p < 0.001 and p < 0.005). Conclusion: ID was deeper with Ho:YAG, whereas CA and TLA were larger with the Tm:YAG. Considering surgical principles for endoscopic ablation of upper tract urothelial carcinoma, these results suggest that Tm:YAG may have a lower risk profile (less depth of incision) while also being more efficient at tissue destruction. Future in vivo studies are necessary to corroborate these findings.
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