Abstract
Purpose
To evaluate coagulation necrosis depth (CND) of Holmium (HL), Moses (ML), and Thulium fiber laser (TFL) in ex vivo human prostate tissue at various energy settings.
Methods
After endoscopic HL enucleation, small prostate tissue fragments were removed from the bladder with graspers and used for study. Immediately after surgery, a single incision was made on the surface of the tissue kept under normal saline at room temperature using a hand-held 550-µm laser fiber. Variable energy settings were tested for all three lasers. Two pathologists measured the CND with light microscopy using ocular micrometer. Impact of various laser settings on CND was analyzed. The differences in CND of all three lasers at similar laser power were compared.
Results
Mean CND was 0.56 ± 0.53 mm for long-pulse HL, 0.54 ± 0.53 mm for ML, 0.67 ± 0.67 mm for low-pulse TFL, and 0.81 ± 0.78 mm for high-pulse TFL. There was no significant difference between mean CND of HL and ML at various laser settings ranging from 10 to 120 W and CND with long- and short-pulse settings of TFL at settings from 10 to 60 W. There was a trend of increasing CND in HL and ML with increasing laser power; however, it was not statistically significant. TFL had similar tissue effects as HL and ML.
Conclusion
There is no significant difference in CND of HL, ML, and TFL in ex vivo human prostate tissue. Other factors besides laser type and settings need to be studied to explain clinical differences among various lasers used for prostate enucleation.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Data availability
The original data would be made available upon request after getting necessary permission from institutional IRB.
References
Parsons RL, Campbell JL, Thomley MW (1968) Carcinoma of the penis treated by the ruby laser. J Urol 100(1):38–39. https://doi.org/10.1016/s0022-5347(17)62468-6
Taratkin M et al (2022) Ex vivo study of Ho:YAG and Thulium fiber lasers for soft tissue surgery: which laser for which case? Lasers Med Sci 37(1):149–154. https://doi.org/10.1007/s10103-020-03189-7
Fried NM (2006) Therapeutic applications of lasers in urology: an update. Expert Rev Med Devices 3(1):81–94. https://doi.org/10.1586/17434440.3.1.81
Hartung FO et al (2022) Holmium versus Thulium laser enucleation of the prostate: a systematic review and meta-analysis of randomized controlled trials. Eur Urol Focus 8(2):545–554. https://doi.org/10.1016/j.euf.2021.03.024
Nevo A et al (2021) Holmium laser enucleation of the prostate using Moses 2.0 vs non-Moses: a randomised controlled trial. BJU Int 127(5):553–559. https://doi.org/10.1111/bju.15265
Fried NM, Murray KE (2005) High-power Thulium fiber laser ablation of urinary tissues at 1.94 microm. J Endourol 19(1):25–31. https://doi.org/10.1089/end.2005.19.25
Emiliani E et al (2018) The true ablation effect of Holmium YAG laser on soft tissue. J Endourol 32(3):230–235. https://doi.org/10.1089/end.2017.0835
Nishioka NS, Domankevitz Y, Flotte TJ, Anderson RR (1989) Ablation of rabbit liver, stomach, and colon with a pulsed Holmium laser. Gastroenterology 96(3):831–837
Kabalin JN (1996) Holmium: YAG laser prostatectomy canine feasibility study. Lasers Surg Med 18(3):221–224. https://doi.org/10.1002/(SICI)1096-9101(1996)18:3%3c221::AID-LSM1%3e3.0.CO;2-U
Janeczek M et al (2018) Preliminary evaluation of Thulium doped fiber laser in pig model of liver surgery. Biomed Res Int 2018:e3275284. https://doi.org/10.1155/2018/3275284
Taratkin M et al (2021) The impact of the laser fiber-tissue distance on histological parameters in a porcine kidney model. World J Urol 39(5):1607–1612. https://doi.org/10.1007/s00345-020-03326-5
Yilmaz M et al (2022) Experimental ex-vivo performance study comparing a novel, pulsed Thulium solid-state laser, chopped Thulium fibre laser, low and high-power Holmium: YAG laser for endoscopic enucleation of the prostate. World J Urol 40(2):601–606. https://doi.org/10.1007/s00345-021-03825-z
Becker B et al (2020) Comparative analysis of vaporization and coagulation properties of a hybrid laser (combination of a Thulium and blue diode laser) vs Thulium and Ho: YAG lasers: potential applications in endoscopic enucleation of the prostate. J Endourol 34(8):862–867. https://doi.org/10.1089/end.2020.0009
Doizi S, Germain T, Panthier F, Compérat E, Traxer O, Berthe L (2022) Comparison of Holmium:YAG and Thulium fiber lasers on soft tissue: an ex vivo study. J Endourol 36(2):251–258. https://doi.org/10.1089/end.2021.0263
Proietti S et al (2021) Thulium: YAG versus Holmium: YAG laser effect on upper urinary tract soft tissue: evidence from an ex vivo experimental study. J Endourol 35(4):544–551. https://doi.org/10.1089/end.2020.0222
Minagawa S, Okada S, Morikawa H (2017) Safety and effectiveness of Holmium laser enucleation of the prostate using a low-power laser. Urology 110:51–55. https://doi.org/10.1016/j.urology.2017.08.034
Kumar V, Abbas AK, Aster JC, Fausto N (2020) Robbins & Cotran pathologic basis of disease, 10th edn. Elsevier
Large T, Nottingham C, Stoughton C, Williams J, Krambeck A (2020) Comparative study of Holmium laser enucleation of the prostate with MOSES enabled pulsed laser modulation. Urology 136:196–201. https://doi.org/10.1016/j.urology.2019.11.029
Nottingham CU, Large T, Agarwal DK, Rivera ME, Krambeck AE (2021) Comparison of newly optimized Moses technology vs standard Holmium: YAG for endoscopic laser enucleation of the prostate. J Endourol 35(9):1393–1399. https://doi.org/10.1089/end.2020.0996
Gauhar V et al (2022) Does MOSES technology enhance the efficiency and outcomes of standard Holmium laser enucleation of the prostate? Results of a systematic review and meta-analysis of comparative studies. Eur Urol Focus. https://doi.org/10.1016/j.euf.2022.01.013
Enikeev D et al (2022) Randomized prospective trial of the severity of irritative symptoms after HoLEP vs ThuFLEP. World J Urol 40(8):2047–2053. https://doi.org/10.1007/s00345-022-04046-8
Author information
Authors and Affiliations
Contributions
HNS had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Protocol/project development: HNS, MCSA, OAI, and ONK. Data collection or management: KS, MH, JP, DKC, RB-B, OAI, and ONK. Data analysis: RB-B and KS. Manuscript writing/editing: HNS, MCSA, JP, OAI, ONK, MH, DKC, RB-B, and KS.
Corresponding author
Ethics declarations
Conflict of interest
Dr Hemendra Shah received $1000 from Lumenis for mentoring urologists for HoLEP in 2019. He also received research grants for Boston Scientific and Karl Storz. All other authors have nothing to disclose.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Shah, H.N., Arbelaez, M.C.S., Shah, K. et al. Histopathological assessment of depth of coagulation necrosis with Holmium, Moses, and Thulium fiber lasers in human prostate tissue. World J Urol 41, 3059–3063 (2023). https://doi.org/10.1007/s00345-023-04617-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00345-023-04617-3