Ureteroscopy with Holmium: YAG Laser—A Initial Study in the Urology Department of the Pr Bocar Sidy Sall University Hospital of Kati

Introduction: Ureteroscopy is a minimally invasive endoscopic surgery which provides access to the ureter, pyelon and calyceal cavities via the urethra and the bladder. Laser ureteroscopy uses the laser as an energy source to treat the stone and eliminate it naturally. Minimally invasive endoscopic methods are struggling to become popular in sub-Saharan African countries, especially for the upper urinary tract. The objective of our work was to report the results of our first laser ureteroscopy experience in the department. Materials and Methods: This was a prospective and descriptive study running from December 1, 2023 to February 19, 2024. Included in our study was any case of upper urinary tract stone operated by Laser ureteroscopy. The characteristics of the lithiasis were determined by CT scan. Sterilization of urine was verified by carrying out a cytobacteriological examination of urine. Ureteral lithiasis was approached by semi-rigid ureteroscopy. Renal lithiasis was immediately addressed by flexible ureteroscopy. Ureteroscopy was coupled with a Holmium YAG laser. A double J ureteral catheter was placed after the operation. A 230 µm laser fiber was used in each case with a generator with a power of 35 watts (Storz Calculase III type). An access sheath was used in all cases of flexible ureteroscopy. The parameters studied were: sociodemographic characteristics, lithiasis (site, size, number, density, topography), type of anesthesia, duration of laser use, duration of intervention, postoperative outcomes. Data entry and analysis were carried out using the software (Word 2016 and SPSS). Result: We collected 30 cases of laser ureteroscopy. The average age was 37 years with extremes of 9 and 79 years. The male gender was more represented. The most common age group was 24-39 years old. Renal colic was the most frequent reason for admission, 12 patients (40%). On physical examination, lumbar tenderness was present in 47% (14 patients). ECBU was positive in 4 patients (13%). CT scan was performed in all our patients before the intervention. The average stone size was 12 mm and the largest was 23 mm. The majority of stones, i.e. 59% (18 patients), had a density greater than 1000 HU. The stone was unique in 19 patients (63%). The location of the stone was pyelic in 8 patients or 27%. An impact on the upper urinary tract was found in 16 of our patients or 53%. General anesthesia was used in 25 patients (83%). A digital flexible ureteroscopy was used in 24 patients and a semi-rigid ureteroscopy (URS) in 6 patients. Full-course fragmentation was the most used therapeutic method, 9 patients or 32%. The average duration of interventions was 61 minutes. Drainage by double J catheter at the end of the procedure was performed in all our patients. The length of hospitalization was 24 hours. Only one case of failure in the USSR was recorded, and one case of failure was in the semi-rigid URS. Conclusion: Laser ureteroscopy is an effective minimally invasive surgery in the management of lithiasis of the upper urinary tract. It significantly reduces the length of hospitalization. Mastery of this technique and the acquisition of the equipment necessary for its implementation is an undeniable asset in the management of renal and ureteral lithiasis.

Role of Removing Stasis and Reducing Heat Formula in Clearance of Proximal Ureteral Calculi after Ureteroscopic Ho:YAG Laser Lithotripsy: A Prospective Randomized Study

Objective To prospectively evaluate the efficacy of Removing Stasis and Reducing Heat Formula in accelerating calculus clearance and improving lower urinary tract symptoms of patients with proximal ureteral calculi after ureteroscopic Ho:YAG laser lithotripsy. Methods A total of 138 patients with proximal ureteral calculi underwent ureteroscopic Ho:YAG laser lithotripsy by a single endocrinologist. Stone size varied from 10 to 15 mm. After operation, the patients were randomly divided into three groups: the control group(group A), tamsulosin group(group B), and Removing Stasis and Reducing Heat Formula group(group C). The treatment lasted for 4 weeks or until stone clearance. The primary and secondary outcomes of the three groups at follow-up were assessed. Results Of the 131 patients available for follow-up, 44 cases were in the group A, 45 in the group B, and 42 in the group C, respectively. The stone free rate at 2 weeks in the groups B and C were significantly higher than that in the group A(95.56%, 97.62% vs. 79.55%; all P<0.05). The ureteral colic rate and mean time of fragment expulsion were significantly reduced in the groups B(4.44% and 7.86±4.99 days) and C(2.43% and 6.76±4.37 days) compared with the group A(22.73% and 11.54±9.89 days, all P<0.05). On the day of double-J ureteric stent removal, the group C differed significantly from the group A in the total International Prostate Symptom Score, irritative subscore, obstructive subscore, and quality of life score(all P<0.05). Conclusion Removing Stasis and Reducing Heat Formula in the medical expulsive therapy might be an effective modality for patients with calculus in the proximal uretera after ureteroscopic Ho:YAG laser lithotripsy.

Comparison of laser iridotomy using short duration532-nm Nd: YAG laser (PASCAL) vs conventional laser in dark irides

AIM: To evaluate the outcome of laser iridotomy using532-nm Nd: YAG laser(PASCAL) with short pulse duration and Nd: YAG laser compared to conventional combined laser iridotomy.METHODS: Retrospective, nonrandomized, comparative case series. Forty-five eyes of 34 patients underwent laser iridotomy. Twenty-two eyes underwent iridotomy using short duration PASCAL and Nd: YAG laser, and 23 eyes underwent iridotomy using conventional combined laser method. The average settings of PASCAL were60 μm and 700-900 m W with a short duration of 0.01 s to reduce the total applied energy. The conventional laser was 50 μm and 700-900 m W for 0.1s. After photocoagulation with these laser, the Nd: YAG laser was added in each group. Endothelial cell counts of preiridotomy and 2mo after iridotomy were measured and compared.RESULTS: All eyes completed iridotomy successfully.The total energy used in the PASCAL group was 1.85 ±1.17 J. Compared to conventional laser 13.25 ±1.67 J, the energy used was very small due to the short exposure time of PASCAL. Endothelial cell counts were reduced by0.88% in the PASCAL group and 6.72% in the conventional laser group(P =0.044). The change in corneal endothelial cell counts before and after iridotomy was significant in conventional combined laser iridotomy group(P =0.004).CONCLUSION: Combined PASCAL and Nd:YAG laseriridotomy is an effective and safe technique in the dark brown irides of Asians. Furthermore, the short duration of exposure in PASCAL offers the advantages of reducing the total energy used and minimizing the corneal damage.

A Stable Wavelength Operation Ho:YAG Laser with Orthogonally Polarized Pump

A stable wavelength operation Ho:YAG laser dual-pumped by two orthogonally polarized Tm:YLF lasers is reported. Under the cw operation mode, a laser output power of 24 W is measured. The corresponding opticaloptical conversion efficiency is 44.75% and the slope efficiency is 50.12%. Under the Q-switched operation mode,the output maximum average power is 22.8 W at the re-frequency of 6 kHz. The corresponding optical-optical conversion efficiency and slope efficiency are 42.64% and 48.01%, respectively. The output central wavelength is 2090.73 nm, the linewidth is 0.40 nm, and the beam quality is M^2< 1.6. Moreover, the shift of the output central wavelength is less than 0.01 nm, and the linewidth shift is also less than 0.01 nm.

Treatment of Special Renal Colic with Ureteroscope and Holmium YAG Laser

Objective To investigate the method of emergent relief of special renal colic and treatment of ureter diseases causing renal colic. Methods By analyzing 63 cases of special renal colic treated with ureteroscope and Holmium YAG laser. Results 61 cases of renal colic were relieved in a short period of time and the original ureter diseases causing renal colic were cured. Conclusion Special renal colic could be treated with ureteroscope and Holmium YAG laser in a quick and effective manner.

An Actively Mode-Locked Ho:YAG Solid-Laser Pumped by a Tm-Doped Fiber Laser

An actively mode-locked Ho： YAG laser pumped by a diode-pumped Tin-doped fiber laser is reported. For the cw operation, we obtain the maximum output power of 3.43 W with a central wavelength 2022.2nm at the maximum incident pump power of 11.4 W, corresponding to a slope efficiency of 34.5%. The beam quality factor M2 is 1.16, and the output beam is close to fundamental TEMoo. In the case of the CWML operation, a stable pulse train is generated with an average output power up to 3.41 W with a slope efficiency of 34.3% at the incident pump power of 11.4 W and a pulse duration of 294ps at a repetition rate of 81.92MHz. In addition, the maximum single pulse energy is 41.6nJ.

Ureteroscopic Holmium:YAG Laser Lithotripsy for Managing Ureteral Calculi (A Report of 168 Cases)

Summary: The effectiveness and safety of ureteroscopic holmium:YAG laser lithotripsy for managing ureteral calculi was evaluated. Ureteroscopic holmium:YAG laser lithotripsy was performed in 168 ureteral calculi (upper 27 cases, middle 33 cases and lower 108 cases). The results showed that the stone-free rate was 92.6 % in the upper ureteral calculi, 93.9 % in the middle ureteral calculi and 94.4 % in the lower ureteral calculi, respectively. The complication rate was 4.8 % (8 cases). It was suggested that ureteroscopic holmium:YAG laser lithotripsy is a highly effective and safe treatment modality for managing ureteral calculi.

Nd:YAG water mist laser treatment for giant gestational gingival tumor: A case report

BACKGROUND This case of gestational gingival tumor is huge and extremely rare in clinical practice.As the growth location of this gingival tumor is in the upper anterior tooth area,it seriously affects the pregnant woman's speech and food,causing great pain to the patient.The use of Nd:YGA water mist laser to remove the gingival tumor resulted in minimal intraoperative bleeding,minimal adverse reactions,and good postoperative healing,which is worthy of clinical promotion and application.CASE SUMMARY The patient,a pregnant woman,reported a large lump in her mouth on the first day of postpartum treatment.Based on medical history and clinical examination,the diagnosis was diagnosed as gestational gingival tumor.Postoperative pathological biopsy also confirmed this diagnosis.The use of Nd:YAG water mist laser to remove the tumor resulted in minimal intraoperative bleeding,clear surgical field of view,short surgical time,and good postoperative healing.CONCLUSION In comparison to traditional surgery,Nd:YAG water mist laser surgery is minimally invasive,minimizes cell damage,reduces bleeding,ensures a clear field of vision,and virtually eliminates postoperative edema,carbonization,and the risk of cross infection.It has unique advantages in oral soft tissue surgery for pregnant patients.Therefore,the clinical application of Nd:YAG water mist laser for the treatment of gestational gingival tumors is an ideal choice.

First Intraluminal Temperature Measurement during Ho:YAG-Laser Exposure at an <i>In-Vitro</i>URS

Introduction: The laser is a high energy instrument which can melt metals like nitinol. So it is very important to know under which conditions it is dangerous to perform an endourologic lithotripsy. We measure the temperature increase during laser exposure in an underwater in-vitro ureter model. For comparison, temperatures with and without irrigation and with different distances from the laser fiber to the thermometer are measured. Materials and Methods: We used the Ho:YAG-laser (Vera PulseTM, Coherent) with a 365 μm laser fiber. The settings of the laser were 0.6 J with a frequency of 5 Hz which is the minimum setting for that type of laser. The experimental setup was closely aligned with the clinical situation. A metal container was filled with 0.9% sodium chloride (NaCl) solution (Temp. 36.8°) and a catheter with an inner diameter of 4 mm was attached to the rim of the container. The tip of the thermometer was attached inside the catheter through a waterproof hole. The laser fiber was guided by means of a rigid URS video device (11.5 F). We had four different settings during the measurement: 1) Distance of 0.5 cm between the laser and the thermometer;without irrigation, 2) Distance of 0.5 cm between the laser and the thermometer;with irrigation, 3) Distance of 1 cm between the laser and the thermometer;without irrigation, 4) Distance of 1 cm between the laser and the thermometer;with irrigation. Results: The maximum overall temperature was recorded in the 1) and 3) setting, both featuring no irrigation. The maximum temperature was ~50°C in both settings, with the 1) setting reaching the maximum temperature after 50 seconds and hence approximately twice as fast as the 3) setting. During measurements with a NaCl solution flow we couldn’t detect any noticeable increase in temperature, neither at short nor at long distance between the laser fiber and the thermometer. Conclusion: There is a relevant heating in the ureter beside an endourologic lithotripsy. In our model we could reproduce a maximum heating until ~50°C without irrigation and no heating with irrigation. Without irrigation there is a relevant bubble formation which should be an indicator for the surgeon to stop lithotripsy due to a temperature increase which could harm surrounding tissue.

Development of a Single-Longitudinal-Mode Ho:YAG Laser Based on Corner Cube

We present a Tm-doped fiber laser pumped Fabry-Perot etalons Ho：YAG laser based on a corner cube. A maximum single-longitudinal-mode and fundamental transverse mode output power of 478 m W at the wavelength of 2091.06 nm is achieved with a pump power of 16.3 W, corresponding to an optical-to-optical efficiency of 2.9% and a slope efficiency of 7.9%. The single-longitudinal-mode and fundamental transverse mode are less sensitive to the rotating of the corner cube. The results indicate the potential impact of a single-longitudinal-mode Ho： YA G laser with corner cube geometry to improve the anti-maladjustment stability.

A Linearly Polarized Ho:YAG Laser at 2.09 μm with Corner Cube Cavity Pumped by Tm:YLF Laser

A linearly polarized operation Ho： YAG laser at 2090.5 nm with a corner cube cavity is demonstrated. A polarizer with high reflectivity for the s-polarized light at the laser wavelength is employed to achieve a linearly polarized laser. In the same case of resonator length, the corner cube can be used to cut the volume of the Ho：YAG laser and to enhance the stability of the system. The maximum linearly polarized output power of 5.8 W is achieved at the absorbed pump power of 23.3 W, corresponding to a slope efficiency of 29.7%, and the optical-optical conversion efficiency is around 24.9%. The M2 factors of the 2.09μm laser are 2.4 and 1.2 along the horizontal and vertical directions, respectively.

A Mid-IR Optical Parametric Oscillator Pumped by an Actively Q-Switched Ho:YAG Ceramic Laser

We demonstrate a mid-IR ZnGeP2 （ZGP） optical parametric oscillator （OPO） pumped by a dual-end-pumped actively aeoasto-optie Q-switched Ho：YAG ceramic laser. The maximum average output power of 35 W is obtained at a pulse repetition frequency of 20 kHz from the Ho：YAG ceramic laser. Under the maximum incident pump power of Ho：YAG ceramic laser, the maximum output power of 14 W is obtained from the ZGP OPO, corresponding to the slope efficiency of 49.6% with respect to the incident pump power. The wavelength can be tuned from 3.5 μm to 4.2μm （signal）, corresponding to 5.24.1 μm （idler）. The beam quality M2 is less than 2.3 from the ZGP OPO.

High-Power Dual-End-Pumped Actively Q-Switched Ho:YAG Ceramic Laser

We present a high-power Ho：YAG ceramic laser pumped at 1908nm. Using a dual-end-pumped structure, the maximum continuous-wave output power of 48 W is obtained, corresponding to a slope efficiency of 70.4% with respect to the absorbed pump power. At actively Q-switched mode, the maximum average output power of 46 W and the minimum pulse width of 21 ns are achieved at a pulse repetition frequency of 20 kHz, corresponding to a peak power of approximately 109.5kW. In addition, the beam-quality M2 factor is found to be 1.4 at the maximum output power.

COMPARATIVE EXPERIMENTAL STUDY OF HO-YAG LASER AND TRUE- CUT BIOPSY NEEDLE IN MYOCARDIAL REVASCULARIZATION

Objective.To study the mechanism and effects of blood perfusion on acute ischemic region of myocardium through channel created by Ho- Yag laser and True- cut biopsy needles with myocardial contrast echocardiography. Methods. We partially ligated the left anterior descending coronary artery of canine hearts between the lst and 2nd diagonal branches to produce two groups of acute myocardial ischemia models and then performed tran- smyocardial revascularization (TMR) on this region with Ho- Yag laser and True- cut biopsy needles. Myocardial contrast echocardiography was performed with a new generation of ultrasound contrast agent and second harmonic imaging of this region before, during ischemia and after revascularization. Pictures were taken with“ R” wave trigger skill. Results. Acoustic density (dB) in the ischemic region (anterior wall) with myocardial contrast echocardiography decreased obviously after the left anterior descending artery was ligated (Laser group: 5.40± 1.81, Needle group: 7.11± 2.51) compared with that before (Laser group: 11.69± 1.61, Needle group: 12.96± 2.88, P< 0.01). dB increased remarkably after TMR by either laser or True cut biopsy needle (Laser group: 11.02± 2.01, Needle group: 10.01± 4.45. P< 0.01) compared to that during ischemia and approximated to that before ischemia (P >0.05). We found that the acoustic density of the contrast developed one picture (one cardiac cycle) ahead in the transmyocardial revascularization region than that in the lateral and other region of the left ventricle wall in the scan of both groups. Conclusions. Acute ischemic myocardium can be perfused immediately by oxygenated blood from the left ventricle through channels created with both Ho- Yag laser and True- cut biopsy needles. Evidence of blood perfusion through these channels mainly during systolic phase was detected, and myocardial contrast ultrasound using intravenous perfluorocarbon- exposed sonicated dextrose albumin was regarded as a reliable method in the study of transmyocardial revascularization.

TREATMENT OF LUNG CANCER AT LATE STAGE BY HOLMIUM: YAG LASER-A CLINICAL SURVEY OF 4 CASES

Objective In order to investigate the effect and leasibility of Holmium: YAG laser in the treatment of lung cancer at late stage. Methods 4 cases of lung cancer at late stage were treated with Holmium: YAG laser through liber brochoscopie. ResuIts The patients received the palliative treatment for 3~7 times. Alter the treatment, the tumor tissues decreased in size, and the tracts were unobstructed. The symptoms due to tract- obstruction were improved. Conclusion Holmium: YAG laser treatment has some practical value by improving the tract obstruction of lung cancer at late stage, improving the lung function and also the lofe quality.

Multipulse Nd:YAG Laser Thomson Scattering Diagnostics on HT-7 Tokamak

A multipulse Nd：YAG （Neodym-yttrium aluminium garnet） laser Thomson scattering diagnostic system developed was recently applied on HT-7 tokamak to obtain more accurate electron temperatures. A CAMAC-based real-time computer system for laser control, data acquisition, analysis and calibration was investigated in detail. Furthermore, the reliability and accuracy of this diagnostic system were demonstrated by comparing the results with those of a soft-X ray diagnostic system.

Use of Holmium:Yag laser in early stage oropharyngeal squamous cell cancer

AIM: To evaluate the efficacy of Holmium:Yag laser resection for oropharyngeal squamous cell cancer.METHODS: A prospectively collected case series of all patients with oropharyngeal squamous cell carcinoma undergoing laser resection using the Holmium:Yag laser technique only over a 15 year period at a tertiary referral centre. All patients underwent long term follow up with regular clinical and radiological surveillance, when indicated. All patients were operated on under general anaesthetic with a laser-safe endotracheal tube. Typically laser resection was performed first using an operating microscope, followed by neck dissection. The tumour was held with a Luc's forceps or Allis clamp. The Holmium:Yag laser was implemented via a fibre delivery system. The Holmium:Yag laser fibre, of 550 micron diameter, was inserted through a Zoellner sucker and attached via steri-strips to a second Zoellner suction to provide smoke evacuation. The settings were 1J/pulse, 15 Hz, 15 W in a continuous delivery modality via a foot pedal control. The procedure is simple, bloodless, effective and quick. All surgeries were performed as day cases. RESULTS: Twenty-seven oropharyngeal squamous cell cancer patients were identified, at the following subsites:23 lateral pharyngeal wall/tonsil, 2 anterior faucal and 2 tongue base. Of the 23 tonsil tumours,19 required no further treatment(83% therefore had negative histopathological margins) and 4 required chemoradiotherapy(17% were incompletely excised or had aggressive histopathological features such as discohesive, perineural spread, vascular invasion). The 2 patients with anterior faucal pillar neoplasia needed no further treatment. Both tongue base cancer cases required further treatment in the form of chemoradiotherapy(due to positive histopathological margins). Postoperatively, patients complained of pain locally, which resolved with regular analgesia. There were no postoperative haemorrhages. Swallowing and speech were normal after healing(10-14 d). There was one case of fistula when neck dissection was carried out simultaneously; this resolved with conservative management. All patients were followed up with serial imaging and clinical examination for a minimum of five years. Median follow up was 84 mo.CONCLUSION: Holmium:Yag lasers are a safe and effective treatment for Stage 1 and 2 squamous cell carcinoma of the oropharynx, excluding the tongue base.

Factors Which Influence Intraluminal Temperature during Ho:YAG-Laser Exposure at an In-Vitro URS

Introduction: The Ho:YAG-Laser is categorized as a potentially dangerous lithotripsy device (DIN: Class 4) for perforation which is mainly caused by the photonic energy the laser emits. Long time complications like ureteral strictures seem to be directed by thermal and mechanical injury. In this study different energy settings a) are being investigated, a DJ (double J stent) is placed beside the laser to simulate a therapy of a forgotten stent with reduction of the lumen b) due to the volume exploitation of the DJ, and direct contact between the laser fiber and the DJ in the ureter c) is simulated during laser exposure. Materials and Methods: We used the Ho:YAG-laser (Vera PulseTM, Coherent, Santa Clara USA) with a 365 μm diameter laser fiber. The settings of the laser were 0.6 J and 1 J pulse energy with a frequency of 5 Hz. The experimental setup was closely aligned with the clinical situation. The tip of the thermometer was attached inside the catheter through a puncture. The laser fiber was guided by means of a rigid URS video device (11.5 Ch). We had four different settings for a), b) and c) during the measurement: 1) Distance of 0.5 cm between the laser and the thermometer;without irrigation, 2) Distance of 0.5 cm between the laser and the thermometer;with irrigation, 3) Distance of 1 cm between the laser and the thermometer;without irrigation, 4) Distance of 1 cm between the laser and the thermometer;with irrigation. Results: The temperature in an empty ureter rises approximately by 5°C, when the laser energy is increased from 0.6 J to 1 J. When a DJ is inserted in the artificial ureter there is surprisingly almost no difference in the maximum temperature between the lower energy level (0.6 J) and the high energy level (1 J). However the time needed to reach the maximum temperature is noticibly less when using high energy levels. The reduction involume based on the placement of the DJ leads to a higher maximum temperature for the low energy setting. The third setting with direct laser fiber contact with the DJ produces the highest temperatures of up to 55°C. We think there must be a melting or burning of the DJ which leads to a temperature rise. Bubble formation was a sign of heating in the ureter in every setting without irrigation. A temperature fall off with increasing distance between the laser fiber and the thermometer is noticable when measuring without irrigation. Conclusion: There is no relevant heating with irrigation. Direct contact between the laser fiber and the DJ seems to evoke additional heating because of melting or underwater burning of the DJ. The maximum temperatures reached without irrigation are limited to a relatively small volume since the is a noticable temperature fall of when increasing the distance between the laser fiber and the thermometer.

Cr,Tm,Ho∶YAG激光器的理论模拟

为了使CTH∶YAG激光器的设计得到更好的优化,从晶体光谱吸收特性、离子间能量转移过程及准三能级运转方式对CTH∶YAG激光器的工作特性进行了理论分析;依据速率方程理论建立了CTH∶YAG激光器运转的理论模型.模拟能量输出与试验结果较好的吻合,验证了此理论模型描述CTH∶YAG激光器运转规律的合理性.模拟结果表明:CTH∶YAG激光器的激光脉冲输出与泵浦有较长的时间延迟且伴随较强的驰豫振荡,冷却温度对激光输出产生较大的影响.

脉冲Ho∶YAG激光对犬多种器官的生物效应

目的 为研究平均功率、照射时间、脉冲能量、脉冲频率等激光参数对Ho∶YAG激光生物效应的影响。方法 我们以犬作为实验对象 ,以不同平均功率、不同照射时间及对相同平均功率的又分为高脉冲能量低脉冲频率 (H)组和低脉冲能量高脉冲频率 (L)组照射皮肤、食管、支气管、胃、膀胱粘膜、卵巢、子宫 ,进行配对研究。结果 肉眼、光镜、电镜观察不同激光参数消融、热凝固作用结果的差异 ,各器官Ho∶YAG激光治疗的安全、有效治疗剂量。结论 脉冲式Ho∶YAG激光的组织表面热凝固作用与平均功率、照射时间成正相关 ;照射时间、脉冲频率恒定时 ,脉冲式Ho∶YAG激光的消融作用与脉冲能量成正比 ;在相同平均功率 ,高脉冲能量低脉冲频率 (H)组的消融作用大于低脉冲能量高脉冲频率 (L)组 ,而热凝固损伤作用小于L组。