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Generated temperatures and thermal laser damage during upper tract endourological procedures using the holmium: yttrium–aluminum-garnet (Ho:YAG) laser: a systematic review of experimental studies

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Abstract

Purpose

To perform a review on the latest evidence related to generated temperatures during Ho:YAG laser use, and present different tools to maintain decreased values, and minimize complication rates during endourological procedures.

Methods

We performed a literature search using PubMed, Scopus, EMBASE, and Cochrane Central Register of Controlled Trials-CENTRAL, restricted to original English-written articles, including animal, artificial model, and human studies. Different keywords were URS, RIRS, ureteroscopy, percutaneous, PCNL, and laser.

Results

Thermal dose (t43) is an acceptable tool to assess possible thermal damage using the generated temperature and the time of laser exposure. A t43 value of more than 120 min leads to a high risk of thermal tissue injury and at temperatures higher than 43 °C Ho:YAG laser use becomes hazardous due to an exponentially increased cytotoxic effect. Using open continuous flow, or chilled irrigation, temperatures remain lower than 45 °C. By utilizing high-power (> 40 W) or shorter laser pulse, temperatures rise above the accepted threshold, but adding a ureteral access sheath (UAS) helps to maintain acceptable values.

Conclusions

Open irrigation systems, chilled irrigation, UASs, laser power < 40 W, and shorter on/off laser activation intervals help to keep intrarenal temperatures at accepted values during URS and PCNL.

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Authors and Affiliations

  1. Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK

    Patrick Rice & Bhaskar Kumar Somani

  2. Department of Urology and Andrology, General Hospital Hall i.T., Milser Str. 10, 6060, Hall in Tirol, Austria

    Udo Nagele & Theodoros Tokas

  3. Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria

    Udo Nagele, Thomas R. W. Herrmann & Theodoros Tokas

  4. Department of Urology, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland

    Thomas R. W. Herrmann

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  1. Patrick Rice
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Contributions

PR: data management, data analysis, manuscript writing. BKS: interpreting data, manuscript editing. UN: interpreting data. TRWH: interpreting data. TT: protocol/project development, data management, data analysis, manuscript writing.

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Correspondence to Theodoros Tokas.

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Rice, P., Somani, B.K., Nagele, U. et al. Generated temperatures and thermal laser damage during upper tract endourological procedures using the holmium: yttrium–aluminum-garnet (Ho:YAG) laser: a systematic review of experimental studies. World J Urol 40, 1981–1992 (2022). https://doi.org/10.1007/s00345-022-03992-7

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