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Effect of Ho:YAG laser on kidney tissue with Virtual Basket™ and Bubble Blast™ pulse modulation: an experimental ex vivo study

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Abstract

Purpose

There is a lack of studies in the literature on effects of Virtual Basket™ (VB) and Bubble Blast™ (BB) laser pulse modulations of the Ho:YAG laser on tissue. We aimed to compare the effects of standard modulation (SM), VB, and BB pulse modulations of Ho:YAG laser on kidney tissue.

Methods

An ex vivo experiment was conducted using veal kidneys. The Quanta System Cyber Ho 100W laser generator with a broad setting spectrum at 15–80 W, 10–40 Hz, 1.5–2 J, and medium pulse duration were tested. Incision depth (ID), vaporization area (VA), coagulation area (CA), and total laser area (TLA = VA + CA) were evaluated. Histopathological measurement outcomes were grouped as a low-power group (15, 20, and 30 W) and a high-power group (40, 60, and 80 W) according to the power outputs used.

Results

A total of 108 experiments were performed. In saline and high-power output (40, 60, 80 W), mean VA, TLA, and ID, histopathological measurements were higher in BB pulse modulation than VB and SM pulse modulations (p: 0.03, p: 0.001, and p: 0.003, respectively). In contrast, mean CA and LE measurements were higher in SM than in VB and BB pulse modulations (p < 0.001 and p < 0.001, respectively). There was no statistically significant difference in mean histopathological measurements of VA, CA, TLA, and ID, among SM, VB, and BB pulse modulations in the low-power output group in saline (p > 0.05).

Conclusion

VB can allow controlled dissection, as it does not create a large VA during surgical procedures. BB should be used in a controlled manner in soft tissue surgery due to its strong effect on tissues.

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The raw data are with the corresponding author and can be provided on request.

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Acknowledgements

We would like to thank Atıl Emre COSGUN for his contributions to the design, engineering and production of mini robots.

Funding

The study was internally funded.

Author information

Authors and Affiliations

  1. Department of Urology, Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences, Ankara, Turkey

    Mehmet Emin Şirin

  2. Clinic of Urology, Bingol State Hospital, Bingol, Turkey

    Mustafa Karaaslan

  3. Faculty of Medicine, Department of Medical Pathology, Aksaray University, Aksaray, Turkey

    Melike Ordu

  4. Urology, Asklepios Klinik Triberg, Triberg, Germany

    Mehmet Yilmaz

Authors
  1. Mehmet Emin Şirin
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  2. Mustafa Karaaslan
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  3. Melike Ordu
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  4. Mehmet Yilmaz
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Contributions

MES and MY conceived the study concept and design. MES and MK carried out the experiment. MES performed the laser procedure. MES and MO analyzed the data. MES, MK, MO and MY interpreted the data and wrote the manuscript. MK and MY provided critical feedback and helped shape the research, analysis and manuscript. MES and MY supervised the project. All authors discussed the results and commented on the manuscript.

Corresponding author

Correspondence to Mehmet Yilmaz.

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Conflict of interest

The authors have no conflicts of interest to declare.

Ethical approval

Not applicable for this section. The manuscript does not contain clinical studies or patient data. This article does not contain any studies with human subjects performed by the any of the authors. The authors did not perform any procedures on living humans or animals. Only fresh ex-vivo veal kidneys were utilized in this study.

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Supplementary Information

Below is the link to the electronic supplementary material.

345_2023_4555_MOESM1_ESM.pdf

Fig.1: A) 100 W Ho:YAG (Cyber Ho, Quanta System, Samarate, Italy) laser device. B) veal kidney from a fresh cadaver. C) a mini laser plotter robot system with laser holder that can automatically move linearly on one axis (X-Y). Supplementary file1 (PDF 3235 KB)

345_2023_4555_MOESM2_ESM.pdf

Fig.2: A) experimental setup. B and C) kidney tissues with 20 mm fissure created by laser. Supplementary file2 (PDF 253 KB)

345_2023_4555_MOESM3_ESM.pdf

Fig.3: A) lateral effect (LE) (which is defined as the longest horizontal radius from the midpoint of the evaporation gap to normal tissue, including the coagulation zone), incision depth (ID), vaporization area (VA), coagulation area (CA), and total laser area (TLA=VA+CA). B) Surface section (SS) (which is defined as a thin horizontal section of the superficial part of the tissue affected by the laser). Supplementary file3 (PDF 4303 KB)

Supplementary file4 (PDF 372 KB)

Supplementary file5 (PDF 83 KB)

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Şirin, M.E., Karaaslan, M., Ordu, M. et al. Effect of Ho:YAG laser on kidney tissue with Virtual Basket™ and Bubble Blast™ pulse modulation: an experimental ex vivo study. World J Urol 41, 3091–3095 (2023). https://doi.org/10.1007/s00345-023-04555-0

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