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BACKGROUND AND OBJECTIVE Stone fragmentation is required in ca. 5% of patients with choledocholithiasis to free the patients of stones. Several extra- and intracorporal methods of stone fragmentation (lithotripsy) have been available. We here report our experience with the recently available holmium-YAG laser, used under babyscopic monitoring. PATIENTS AND METHODS Between September 1997 and May 1998 lithotripsy was performed by holmium-YAG laser under monitoring in 20 patients with choledocholithiasis in whom conventional methods had failed to achieve stone fragmentation. RESULTS All stones were cleared in 19 of the 20 patients. A second session was necessary in four patients, three sessions in one. There was no serious complication and no death during a 30-day follow-up. CONCLUSION Holmium-YAG laser lithotripsy under babyscopic monitoring has been shown to be a suitable method in patients with choledocholithiasis in whom previous treatment has failed it is complementary to current methods of stone fragmentation.

For a biomechanical study 10 specimen of the lumbar spine (L1-S1) were scanned with MRI. After that 18 normal motion segments were prepared for the experiments. The paraspinal musculature as well as the posterior elements were removed. Under an axial load of 500 N, in each disc 500 J and 1000 J of energy were applicated with a Holmium-Yag laser (2060 nm, fiber thickness 600 microns) into the nucleus pulposus. In nine of the 18 discs also 1500 J and 2000 J were applicated. At the beginning of every standardized experiment of a motion segment, as well as after every 500 J, the height of the disc, intradiscal pressure, the contour of the disc and the size of the transversal plane of the disc were determined with an axial load on the motion segment of 1000 N. The change in radial bulging of the disc was measured using the computer-assisted recordings of each disc contour. All the data were statistically analyzed using the Friedman-/Wilcoxon-test. After every application of 500 J energy, in the 18 discs as well as in the 9 discs, the height and the intradiscal pressure reduced. The differences per 500 J were for all measurements not significant (p < 0.05). Up till the application of 1500 J the radial bulge and the size of the transversal plane of the disc increased, although the differences per 500 J were not significant. From 1500 J to 2000 J the radial bulge and size of transversal plane of the disc decreased.(ABSTRACT TRUNCATED AT 250 WORDS)

We prospectively compared the results of the Swiss LithoClast System with the holmium: yttrium-aluminum-garnet (Ho:YAG) laser for ureteral lithotripsy for management of upper ureteral stones.Fifty patients were randomized to two groups: LithoClast classic 2 (n = 25) and Ho:YAG laser (n = 25) between January 2005 and January 2007. Procedure selection was decided by random chit allotment. All patients who successfully had ureteral dilatation (up to 10F) were included in the study. An 8/9.8F semirigid ureteroscope was used in all procedures with LithoClast 2, and either an 8F or 7F was used in patients who underwent laser lithotripsy. Patients were analyzed for fragmentation time, stone-free rate, stone up-migration, intraoperative complications, and auxiliary procedures.Average stone size was 9.63 +/- 2.46 mm2 and 10.17 +/- 2.28 mm2 with overall stone-free rates of 84% and 88% (P = 0.41), respectively, for laser and LithoClast 2 groups. Stone up-migration was 24% and 16% (P = 0.82), mean stone fragmentation time was 9.82 +/- 7.58 and 7.86 +/- 3.25 minutes (P = 0.12), and stone fragments requiring ancillary procedures were 16% and 12% (P = 0.99), respectively, in laser and LithoClast 2 groups. Postoperative hematuria (up to 72 hours) was significantly (P = 0.04) prolonged in the laser group (36%) compared with the LithoClast 2 group (8%). Three patients in the LithoClast 2 group had instrument breakage.Both Ho:YAG laser and LithoClast 2 were equally efficient in managing ureteral stones with effective stone clearance, minimum morbidity, and reduced stone up-migration.

Summary Introduction Shock wave lithotripsy (SWL) is the treatment of choice for most cases of renal lithiasis in children. Some cases, however, are refractory to SWL and may be associated with anatomic and metabolic changes or a large stone burden. In these circumstances, mini-percutaneous nephrolithotomy (mini-PCNL) is an option. Objective The aim was to assess the safety and efficacy of high-power holmium YAG (Ho:YAG) laser in mini-PCNL for staghorn calculi. Patients and methods The clinical records relating to 35 mini-PCNLs ( Table ) performed between January 2008 and December 2012 in 33 patients (27 boys and 6 girls; mean age 7 years, range 2–18 years) were retrospectively reviewed. Twenty-two (66.7%) of the patients had undergone a previous SWL (28.6% three sessions). The mini-PCNL puncture technique used involved fluoroscopic guidance with the C arm at 0–90° in the supine position. An 18F tract was used. Stone fragmentation was performed with a high-power Ho:YAG laser (Lumenis 100 W). Results Ten of the mini-PCNLs (28.6%) were right sided, and 25 were left sided (71.4%). Stones were located in the lower calyceal group in 64% of patients and in the renal pelvis in 50%. The mean stone size was 4.46 cm 2 (range 3–13.20 cm 2 ). The number of stones varied between one and 20, and 83.3% were radiopaque. The laser was set at 70 W (range 50–100 W) (3.5 J/pulse with a frequency of 20 pulses/s). The mean surgical time was 150 min. In 78% of patients, complete stone clearance was achieved, and the overall stone-free rate rose to 85% when residual stones were treated with either SWL or retrograde intrarenal surgery. No perioperative complications were seen. Discussion There are few reports in the literature concerning the use of a high-power laser for treatment of complex stones and the few that do exist relate to adults have similar results, showing it to be highly effective and safe, with low morbidity. Some limitations of the present study must be acknowledged. It was retrospective and a relatively small number of patients were included. However, randomized prospective studies are required to confirm our findings and conclusions. Conclusion In the pediatric population, mini-PCNL with high-power Ho:YAG laser is feasible and safe and represents the technique of choice for complex renal stones. Table . Stone composition in the 35 mini-PCNL procedures. Composition No. of procedures % Whewellite + apatite 6 17 Hyperoxaluria 4 11 Struvite 4 12 Cystine 21 60

The impact and outcome of holmium:YAG-laser (Ho:YAG) ureterolithotripsy in treating proximal and distal ureteral stones was investigated.A total of 543 patients harbouring proximal (n=194) or distal (n=349) ureteral stones underwent semirigid Ho:YAG ureterolithotripsy. The degree of hydronephrosis; stone size, location, impaction, and composition; and complication and stone-free rates were recorded.Mean stone size for proximal and distal stones was 7.1+/-3.6 mm and 6.2+/-2.5 mm, respectively. The stone-free rate on the first postoperative day was 79.4% for proximal and 96.8% for distal stones (p0.0001). For proximal stones10mm andor =10mm, respectively, the stone-free rate was 80.5% and 74.3% (p=0.4) and for distal stones 97.3% and 94.3% (p=0.2). Stone-free rates for radio-opaque versus radiolucent stones in proximal stones were 79.6% versus 77.9% (p=0.8) and 97.6% versus 96.2% in distal stones (p=0.5). Impaction correlated significantly with stone-free rates (p0.0001). Stone-free rates for nonimpacted versus impacted proximal stones were 85.8% versus 67.2% (p=0.003) and for distal stones 99.2% versus 91.4% (p0.003), respectively. The presence or degree of hydronephrosis did not correlate with treatment success (p=0.4, p=0.8). The presence of intraoperative complications correlated significantly with proximal compared to distal ureteral stone location (p=0.004). Auxiliary measures in proximal versus distal stones were performed in 20.6% versus 2.9% (p0.0001).In this series, stone-free rates in Ho:YAG ureterolithotripsy were significantly higher in distal and nonimpacted stones but were independent of stone size and composition and the degree of hydronephrosis. Ureterolithotripsy in proximal stones was associated with higher intraoperative complication and retreatment rates compared to distal stones.

Few Western studies have focused on percutaneous techniques using percutaneous transhepatic choledochoscopy (PTHC) and holmium:yttrium-aluminum-garnet (YAG) laser to ablate biliary calculi in patients unable or unwilling to undergo endoscopic or surgical removal of the calculi. The authors report the efficacy of the holmium:YAG laser in clearing complex biliary calculi using percutaneous access techniques.This study retrospectively reviewed 13 non-Asian patients with complex secondary biliary calculi treated percutaneously using holmium:YAG laser. Percutaneous access was accomplished via left, right, or bilateral hepatic ducts and upsized for passage of a 7-Fr video choledochoscope. Lithotripsy was performed under choledochoscopic vision using a holmium:YAG laser with 200- or 365-microm fibers generating 0.6 to 1.0 joules at 8 to 15 Hz. Patients underwent treatment until stone clearance was confirmed by PTHC. Downsizing and subsequent removal of percutaneous catheters completed the treatment course.Seven men and six women with an average age of 69 years underwent treatment. All the patients had their biliary tract stones cleared successfully. Of the 13 patients, 3 were treated solely as outpatients. The average length of percutaneous access was 108 days. At this writing, one patient still has a catheter in place. The average number of holmium:YAG laser treatments required for stone clearance was 1.6, with no patients requiring more than 3 treatments. Of the 13 patients, 8 underwent a single holmium:YAG laser treatment to clear their calculi. Prior unsuccessful attempts at endoscopic removal of the calculi had been experienced by 7 of the 13 patients. Five patients underwent percutaneous access and subsequent stone removal as their sole therapy for biliary stones. Five patients were cleared of their calculi after percutaneous laser ablation of large stones and percutaneous basket retrieval of the remaining stone fragments. There was one complication of pain requiring admission, and no deaths.The use of PTHC with holmium:YAG laser ablation is safe and efficacious, but requires prolonged biliary access and often multiple procedures to ensure clearance of all calculi.

We sought to evaluate the effect of holmium:yttrium-aluminum-garnet (Ho:YAG) laser exposure on ex vivo pig eyes and to test the protective action of different glasses in preventing eye lesions in case of accident.We pointed the tip of a Ho:YAG laser fiber from different distances (0, 3, 5, 8, 10, and 20 cm, respectively) toward the center of the pupil of the pig eye. The Ho:YAG laser was activated for 1 or 5 seconds at three different settings (0.5 J-20 Hz, 1 J-10 Hz, and 2 J-10 Hz, respectively). The experiment was repeated using laser safety glasses and eyeglasses. A total of 78 pig eyes were used. The effects of the Ho:YAG laser on pig eyes were assessed by histopathology. Comparable laser emission experiments were performed on thermal paper at different distances using different pulse energies.Ho:YAG laser-induced corneal lesions were observed in unprotected eyes, ranging from superficial burning lesions to full-thickness necrotic areas, and were directly related to pulse energy and time of exposure and inversely related to the distance from the eye. When the laser was placed 5 cm or more, no corneal damage was observed regardless of the laser setting and the time of exposure. Similar distance/energy level relationships were observed on thermal paper. No damage was observed to the lens or the retina in any of the Ho-YAG laser-treated eyes or in any of the eyes protected by laser safety and eyeglasses.Ho:YAG lasers can cause damage when set to high energy, but only to the cornea, from close distances (0-5 cm) and in the absence of eye protection. Eyeglasses are equally effective in preventing laser damage as laser safety glasses.

The aim of this in vivo study was report the long-term results of arthroscopic laser surgery for treatment of TMJ internal drangements (Wilkes class II-III). This report included 45 patients (42 women and 03 men) with an average age of 36.7 years old (14 to 66 years). There were 69 joints involved. The criteria for inclusion were patients who had complained of TMJ pain and dysfunction and had remained refractory to nonsurgical treatment for at least 3 months without resolution of the problem. All patients filled out a questionnaire preoperatively and postoperativelly for assessment of their signs and symptoms. The range of interincisal opening was measured preoperatively and at 1, 7, 30, and 60 days after the surgery. The postoperative questionnaire, radiographic evaluation, and the last measure of range of motion were performed with one year or more after the surgical procedures. The preoperatively and postoperativelly scores were compared and tested for statistically significant differences by the paired t-test (P>0.05). Forty-five patients (69 joints) have been followed postoperativelly for an average of 28.6 months. Maximal interincisal opening improved from a mean of 25.95mm to 35.91mm (+9.96mm) in seven days after the surgery; to 39.86mm (+3.95mm) after thirty day and; to 40.92mm (+1.06mm) after 60 days. The last measurement of maximal interincisal opening made after one year or more showed a mean of 42.15mm. All postoperative VAS pain scores showed a statistical significant improvement (p

Over the last two decades there has been an increase in the incidence of kidney stone disease with a simultaneous rise in the use of ureteroscopy for its management [1]. Flexible ureteroscopy training is variable and still largely dependent on high fidelity models and virtual reality (VR) simulation, both of which are expensive and not readily available in many parts of the world. There is also a lack of good quality bench trainers. In a recent survey of endourologists worldwide, flexible ureteroscopy was considered as a first line treatment for stones

Lacrimal bypass surgery is the preferred surgical procedure in cases with epiphora, where the canalicular and lacrimal sacral injury is not repairable either by canaliculodacryocystorhinostomy or by conjunctivodacryocystorhinostomy. Accidental and/or surgical trauma being the most common etiology distorts the normal anatomy of the lacrimal drainage system and replaces the normal soft tissue with highly vascularized granulation tissue and eventually fibrosis. Surrounding bony structures may be repaired by callus formation as well, if there is a fracture. These healing changes render the conventional lacrimal bypass surgery difficult to perform. Additional extensive surgical trauma results with additional scar tissue and limited successful outcome. This article describes Holmium:YAG (Ho:YAG) LASER-assisted lacrimal bypass surgery. By means of the hemostatic and less traumatic disruptive properties of Ho:YAG LASER, the surgeon performs an easier, fast, and effective procedure with minimum early and late complications.

Transmyocardial revascularization, using the US FDA-approved holmium: yttrium-aluminum-garnet (Ho:YAG) laser system, is a surgical option for patients with debilitating angina caused by diffuse coronary artery disease in areas of the heart not amenable to complete revascularization using conventional treatments. Increased utilization of this therapy is warranted, in parallel with continuing research into therapeutic or cell-based methods for enhancing the clinically relevant, positive outcomes. This article will review the clinical science surrounding Ho:YAG transmyocardial revascularization with an emphasis on the randomized controlled trials performed in these patient groups.

The frequency doubled, double pulse Nd:YAG (FREDDY) laser (World of Medicine, Berlin, Germany) functions through the generation of a plasma bubble. Upon bubble collapse a mechanical shock wave is generated, causing stone fragmentation. This mechanism of action is in contrast to the holmium laser, which cause stone destruction by vaporization. Observed clinical stone retropulsion and fragmentation with the FREDDY and holmium lasers has prompted a series of in vitro experiments designed to compare laser induced retropulsion and fragmentation with those of a holmium laser and pneumatic lithotrite.For retropulsion a hands-off underwater laboratory setup, including a horizontally oriented silicone tube 1.3 cm in diameter and a holder to keep the stone phantom in contact with the quartz laser fiber or pneumatic probe, was used. Previously weighed, cylindrical Bego stone phantoms (Bego USA, Smithfield, Rhode Island) were placed in the apparatus. Stone fragmentation was performed with the FREDDY or holmium laser, or the pneumatic lithotripter. The FREDDY and holmium lasers were tested at similar pulse energy and frequency settings. As a standard for comparison, a pneumatic lithotrite was tested with a semirigid probe and single pulse settings of 100, 200 and 300 kPa. Stone phantoms underwent 30 shocks per setting. Mean net retropulsion, defined as the final resting point of the stone, as determined by direct measurement, was recorded for each setting. For fragmentation plaster of Paris stone phantoms of known weights were used to compare the fragmentation ability of each laser. Stones phantoms were placed in a hands-off underwater setup, consisting of an inverted silicon syringe and holder immersed in tap water. The laser fiber (365 microm for the holmium and 280 microm for the FREDDY) was placed through the tip of the syringe in contact with the stone phantom. A total of 24 stones were divided into 4 groups of 6 per group. Two groups were fragmented with the FREDDY laser at 300 and 400 J total energy. The other 2 groups were fragmented using the holmium laser at 300 and 480 J total energy. Fragmentation efficiency was determined as percent weight loss.For retropulsion at 160 mJ the FREDDY laser caused stone retropulsion to a mean distance of 7.6, 8.1 and 6.8 cm at settings of 5, 10 and 15 Hz, respectively. At 0.8 J the holmium laser retropulsed the stone to a mean distance of 3.3 and 4.9 cm at settings of 5 and 10 Hz, respectively. The pneumatic device caused stone retropulsion a mean distance of 8.5, 9.9 and 13.8 cm at pressure settings of 100, 200 and 300 kPa, respectively. The FREDDY laser generally caused less retropulsion than the pneumatic device, although this difference was only significant at the highest pneumatic lithoclast setting (p0.05). At clinically relevant settings the FREDDY laser caused significantly more retropulsion than the holmium laser (p0.05). For fragmentation at total energy settings of 300 and 400 J the FREDDY laser resulted in 44.9% and 86.8% weight loss, respectively (p0.05). At settings of 300 and 480 J the holmium:YAG laser resulted in 3.3% and 7.1% weight loss, respectively (p0.05).At lower frequency settings stone retropulsion was significantly greater with the FREDDY laser compared with the holmium laser. However, retropulsion was significantly less than that caused by the pneumatic lithotripter at all settings. Therefore, we recommend the use of an occlusive device, such as the Stone Cone (Boston Scientific, Natick, Massachusetts) proximal to the calculus during intracorporeal ureteral lithotripsy and in the ureteropelvic junction during percutaneous laser nephrostolithotomy. In vitro stone fragmentation was significantly greater with the FREDDY laser than with the holmium:YAG laser, suggesting that the FREDDY may offer a low cost alternative to the holmium:YAG laser lithotrite in select patients.

Introduction: There has been a steady increase in the number of ureteroscopic laser lithotripsy. In addition to its soft tissue applications Holmium:YAG laser has also been found an excellent intracorporeal lithotripter for all kinds of stones. We here present the results of patients treated with Holmium: YAG laser lithotripsy in our clinic. Methods: Between June 1997 and December 2002, 205 patients with a diagnosis of ureteric calculi were treated with ureteroscopy using Holmium:YAG laser as an intracorporeal lithotriptor. The stones were localized in the distal ureter in 158 patients (77), middle and proximal ureter in 47 patients (23). Stones ranged in size from 5 × 5 mm to 20 × 10 mm and the operation time was about 35 minutes (ranged 25–65 minutes). Follow-up evaluations have done at first and third months. Results: The ureteral stone could not be reached in 10 patients (4.8). Stone fragmentation or removal was accomplished in all other patients. Four patients (1.9) had proximal migration of the fragments and later treated with extra corporeal shock wave lithotripsy, and three patients (1.5) had ureteral perforation. They were managed by double J stent placement. Two of the patients had ureteral obstruction on the third month of procedure. One of the patients was treated with open surgery. For the other one, ureteroscopic balloon dilatation was performed and catheterized by double J stent and there wasn’t any complication after the removal of stent. Conclusions: Ureteroscopic Holmium:YAG laser lithotripsy is a safe, technically feasible and efficacious treatment for ureteral stones.

Adoption of holmium laser enucleation of the prostate has been limited by its difficult learning curve. To enhance training, digital video clips from four procedures were captured in MPEG-2 format and compiled into a PowerPoint file with professional narration. The two surgical techniques used--the two-lobe and three-lobe methods--are described with a focus on the technical details and common mistakes.

Millimeter-wave therapy (MWT) is based on the systemic biological effects resulting from local exposure of skin to low-power electromagnetic waves of millimeter wavelength. The aims of the present study are to quantitatively evaluate hypoalgesic effects of MWT in murine experimental models of acute and chronic neuropathic pain, and to compare them with the previously determined MWT-induced hypoalgesia in an experimental model of chronic nonneuropathic pain, and also to assess the ability of local heating with a Holmium YAG laser to produce hypoalgesia in mice. The cold and hot water tail-flick tests and the unilateral chronic constriction injury (CCI) to the sciatic nerve were used as pain models. The MWT characteristics were: frequency =61.22 GHz; average power density =13.3 mW/cm/sup 2/; duration of exposure =15 min; and area of exposure-nose. This study demonstrated that a single MWT most effectively suppressed chronic nonneuropathic pain. Less effectively, a single MWT reduced pain sensitivity in the murine model of acute pain, and was ineffective in the model of chronic neuropathic pain. However, multiple MWT reduced the symptoms that developed following CCI. The local heating of the exposed area did not produce hypoalgesia. The findings support the use of MWT in chronic pain states.

The aim of this study was to investigate the clinical results and efficacy of arthroscopic anterolateral capsular release achieved through the use of a holmium:YAG laser or electrocautery for the management of patients with internal derangements of the temporomandibular joint (TMJ).We studied internal derangement (106 joints) and osteoarthritis (46 joints) of the TMJ in 129 patients. Preoperatively, the mean mouth-opening degree was 31 mm and 129 TMJs exhibited moderate to severe arthralgia. All patients underwent arthroscopic anterolateral capsular release achieved with a holmium:YAG laser (84 TMJs) or through electrocautery (68 TMJs).At the end of each patient's respective follow-up period, which ranged from 2 to 72 months (mean, 19 months), the mean mouth-opening degree was 43 mm (P.0001). Also during that time, 105 joints were discovered to exhibit no arthralgia and 36 had mild arthralgia. The total success rates with 2 sets of criteria were 92.8% and 95.6%.Arthroscopic anterolateral capsular release is a minimally invasive and effective surgical method for the treatment of patients with TMJ intracapsular disorders.

Upper urinary tract transitional (UUTT) cell carcinoma is a relatively uncommon urologic tumor. The traditional treatment approach for them is radical nephroureterectomy. However, in recent years, less-invasive treatments, including different nephron-sparing procedures, have become increasingly popular. We report a case of laser ablation of UUTT cell carcinoma using new Olympus digital flexible ureteroscope (URF-V).

Neurosurgery has long required a method for dissecting brain tissue without damaging principal vessels and adjacent tissue, so as to prevent neurological complications after operation. In this study we constructed a prototype of such a device and used it in an attempt to resect beagle brain cortex.The prototype device consisted of an optical fibre, a Y adaptor, and a nozzle whose internal exit diameter was 100 microm. Cold physiological saline (4 degrees C) was supplied to it at a rate of 40 ml/h. Pulsed liquid jets were ejected from the nozzle by a pulsed Holmium:YAG) (Ho:YAG) laser at an irradiation energy of 300 mJ/pulse. The profile of the liquid jet was observed with a high-speed camera while changing the distance between the optical fibre end and nozzle exit (equivalent to the standoff distance). With this device (3 Hz operation), brain dissection of anaesthetized beagles was attempted while measuring the local temperature of the target. A histological study of the incised parts was also performed.When the standoff distance was 24 mm, the liquid jet was emitted straight from the nozzle at a maximum initial velocity of 50 m/s. The brain parenchyma was cut with this device while preserving vessels larger than 200 microm in diameter and keeping the operative field clear. The local temperature rose to no more than 41 degrees C, below the functional heat damage threshold of brain tissue. Histological findings showed no signs of thermal tissue damage around the dissected margin.The Ho:YAG laser-induced liquid jet dissector can be applied to neurosurgery after incorporating some minor improvements.

As the renal stone size increases, the stone clearance rate using extracorporeal shock wave lithotripsy (ESWL) for renal calculi decreases. For stone sizes >2 cm in diameter, the stone clearance rate of ESWL is unsatisfactory. Thereafter, percutaneous nephrolithotomy (PCNL) is the preferred treatment of choice because of a better stone-free rate. However, increased complications and a longer convalescence period with PCNL became more important issues in certain cases. Previous literature reviews reported that ureteroscopic lithotripsy (URSL) can be used as adjunct therapy in combination with PCNL. Some authors even reported an excellent stone-free rate with minimal complications by performing URSL for large renal calculi. Because of the availability of technologically advanced ureteroscope and improved ancillary equipment, such as the holmium laser and ureteral access sheath, this procedure has become more feasible and effective for treating renal calculi. In addition to reviewing stone-free and complication rates, the literature was also reviewed for the total number of procedures carried out, and medical expenses were compared although only a few reports are available on this subject. The contemporary literature supports URSL as a safer, more-efficient, and more cost-effective alternative to PCNL in selected patients.

To report on the technique and utility of the holmium: YAG laser in performing laparoscopic partial nephrectomy (LPN).Three patients with indications for LPN (complex cyst, nonfunctioning lower pole, renal mass) underwent parenchymal-sparing procedures with the Ho:YAG laser. The kidney was identified using a transperitoneal laparoscopic technique. Gerota's fascia was opened, and the renal mass/nonfunctioning lower pole was resected using the laser. Settings of 0.2 J/pulse at 60 pulses/sec and 0.8 J/pulse at 40 pulses/sec were used.All three procedures were performed successfully with minimal blood loss and without the need for hilar occlusion. Although the laser alone was hemostatic, fibrin glue was applied in two cases and oxidized cellulose in one case to reinforce the tissue against delayed bleeding. There were no perioperative complications, and all patients left the hospital within 3 days.At high power settings, the Ho:YAG laser is an effective tool for LPN. It results in good hemostasis without the need for hilar occlusion. This technique promises to facilitate the laparoscopic management of renal tumors and nonfunctioning moieties of duplicated systems.

Purpose: We compared the safety and efficacy of ureteroscopy with intracorporeal holmium:YAG laser lithotripsy and extracorporeal shock wave lithotripsy (ESWL) (Dornier Medical Systems, Inc., Marietta, Georgia) for proximal ureteral calculi.Materials and Methods: A total of 67 patients underwent 81 primary procedures, including in situ ESWL with a DoLi 50 lithotriptor (Dornier Medical Systems, Inc.) or ureteroscopy combined with holmium:YAG laser lithotripsy for proximal ureteral calculi.Results: Of the primary procedures 81 involved proximal ureteral calculi, including 35 done for calculi 1 cm. or greater. The initial stone-free rate in patients with calculi 1 cm. or greater was 93% for ureteroscopy combined with holmium:YAG laser lithotripsy and 50% for in situ ESWL. The efficiency quotient for treating proximal ureteral calculi 1 cm. or greater was calculated as 0.76 for ureteroscopic lithotripsy and 0.43 for ESWL. For proximal ureteral calculi less than 1 cm. the initial stone-free rate was 100% and 8...

Burch colposuspension remains one of the successful operations performed for stress incontinence. Accidental suturing of the bladder wall during the procedure or subsequent erosion may lead to lower urinary tract symptoms. Diagnosis and management of these sutures indicate precise evaluation for which a 70 degree cystoscope is used. In selected cases, Holmium-YAG laser may enable us to manage long-standing, encrustated neglected sutures. Here we would like to report successful removal of intravesical sutures using the Holmium-YAG laser.Burch kolposüspansiyonu stres inkontinans tedavisinde kullanılan en başarılı tedavilerden biri olmaya devam etmektedir. İşlem esnasında sütürün yanlışlıkla mesane duvarından geçmesi yada daha sonra gelişen erozyon nedeniyle sütürün mesane içinde kalması alt üriner sistem semptomlarına yol açmaktadır. Bu sütürlerin belirlenmesi ve ortadan kaldırılmasında ayrıntılı inceleme ve bunun için daha çok 70 derecelik sistoskopun kullanılması gerekmektedir. Seçilmiş vakalarda, uzun süre içeride kalmış ve katılaşmış sütürün çıkarılmasında Holmium-YAG lazer özellikle yardımcı olabilir. Bu vakada, intravesikal sütürlerin Holmium-YAG lazer ile başarılı şekilde çıkarılması anlatılmaktadır.

Two patients with acquired posterior urethral diverticulum that is a complication of laparoscopic assisted anorectoplasty underwent urethroscopic holmium: YAG laser ablation. After the ablation therapies, the size of the diverticulum markedly decreased in both patients. Holmium: YAG laser is safe and easy to handle in the small pediatric urethra.

We aimed to compare the effectiveness of holmium YAG laser and pneumatic lithotripsy in the treatment of ureteral stones.A total of 216 patients who had established indications of ureteroscopy between November 2011 and June 2012 were included in this study. Patients' files were retrospectively reviewed by dividing cases as groups that underwent pneumatic (PL) or laser lithotripsy (LL) procedures. Age, sex, stone burden and localization, duration of follow-up, operative times were evaluated. Stone-free rates were evaluated by ureteroscopical examination, postoperative scout films and ultrasonography.Group PL consisted of 109 and group LL of 107 patients. Median age was 43.93±15.94 years in Group PL and 46.15±14.54 years in Group LL. Male to female ratio, stone burden and localization were similar for both groups. Overall success rate was 89.9% in Group PL and 87.9% in Group LL, respectively (p0.791). With the aid of additional procedures, success rate was 100% for both groups at the end of the first month. Groups were not different as for operative time, rate of insertion of an ureteral catheter and its removal time. Hospitalization period was apparently somewhat shorter in Group LL (p=0.00).Pneumatic lithotripsy can be as efficacious as laser lithotripsy and be used safely in the endoscopic management of ureteral stone. In comparison of both methods, we detected no differences as to operative time, success of operation and the time to removal of the catheter, however, hospitalization period was shorter in Group LL.

Our prospective study compare 40 holmium yag laser meniscectomies with 40 mechanical meniscectomies. Mean duration of laser meniscectomy was 12 minutes againts 10 minutes with the mechanical instruments. In only one case, laser meniscectomy was impossible due to air abuble phenomenon and two superficial cartilaginous thermal changes were observed. In the laser group the effusion was less frequent and less important. Pain difference was not statistically significant. Return to range of motion was very fast in the laser group. Helmium Yag laser is safe and effective and results are a little bit better than mechanical instruments. Unfortunately, the cost remains very high and limits its use. However, meniscectomy is not the only advantage of laser system. it is effective for synovectomy, lateral release, cartilaginous shaving, and even bone abrasion., Biz 40 holmium yağ lazer menisektomisiyle 40 mekanik menisektomiyi karşılaştırdık. Lazer menisektominin ortalama süresi 10 dakikalık mekanik menisektomiye göre 12 dakika idi. Sadece bir vakada, baloncuk fenomeni nedeniyle lazer menisektomi imkamsız idi. 2 vakada da kartilaj'da yüzeysel termal değişiklikler oldu. Lazer grubunda effüzyon daha nadir ve daha az önemliydi. Ağrı farkı istatistiksel olarak anlamlı değildi. Lazer grubunda normal eklem hareketlerine dönüş çok hızlıydı. Holmium Yag lazer güvenli ve etkilidir ve sonuçlar mekanik enstrümanlardan biraz daha iyidir. Maalesef maaliyeti çok yüksektir ve kullanımı sınırlamaktadır. Mamafih menisektomi lazer sistemi tek avantaj değildir. Sinovektomi, lateral release, kartilaj tıraşlaması ve hafta kemik abrazyonuna da lazer etkilidir.

KORKUSUZ, FEZA/0000-0001-9486-3541 WOS: 000172158300004 PubMed: 11710619 Objective: The authors performed an experimental and a prospective clinical study to evaluate the histological and magnetic resonance imaging (MRI) alterations after irradiation of meniscus using holmium:YAG (Ho:YAG) laser VersaPulse Select 60 watts and InfraTome Delivery Systems 30 degrees Handpiece (spot size at fiber tip 0.4 mm; Coherent Medical, Palo Alto, CA). Background Data: Recently, some authors reported a few cases with articular cartilage damage or paraarticular osteonecrosis following arthroscopic knee surgery in which the laser was used to assist in the treatment of meniscal pathology. Methods: Meniscus specimens in saline immersion were exposed to Ho:YAG laser irradiation. The laser wavelength was 2.1 mum and pulse duration was 250 mu sec. Power settings were 1-1.5 joules per pulse and 10-15 Hz. Total laser energy used in these procedures was 2, 3.5, and 6 K joules. Eight patients with meniscal problems underwent arthroscopic partial meniscectomy using Ho:YAG laser. Total laser energy used for these surgeries was 1.5-2.5 K joules. MRI was performed preoperatively and at 6 months postoperatively. Results: At higher energy levels (more than 3 K joules), separation of the gap between the collagen fibers, and a three-dimensional dispersion in the striation were observed on electron microscopic evaluation of meniscus specimens. No patient had abnormal signals in MRI (a sign of articular cartilage damage or osteonecrosis) following arthroscopic laser surgery. Conclusion: When higher energy level is required, conventional instruments should be preferred in the treatment of meniscal lesions. Laser should be reserved for the posteriorly located and smaller meniscal lesions.

Maggi Boult, Malcolm Wicks, David I. Watson, Graeme Macdougal, Andrew Shimmin and Guy J. Maddern

Background and Objective We have widely used a Ho:YAG laser to treat bullae thoracoscopically. Study Design/Materials and Methods Bullae with broad necks were treated with a Ho:YAG laser thoracoscopically. Because one patient relapsed after application of fibrin glue in the early period, a DEXON™ (polyglycolic acid) mesh patch soaked in fibrin glue was used through a 2-cm opening in the subsequent cases. Lastly, gelatin-resorcinol formaldehyde-glutaraldehyde (GRFG) glue was applied through a 5-mm opening instead of a DEXON™ mesh after coagulation. Results In the 38 patients patched with DEXON™ mesh soaked in fibrin glue and 56 patched with GRFG glue after coagulation, none relapsed. Conclusion Combined uses of fibrin glue plus DEXON™ mesh or GRFG glue were effective when bullae were treated with the Ho:YAG laser. However, the wound was smaller and more cosmetic in the GRFG glue group than in the DEXON™ mesh plus fibrin glue group. Lasers Surg. Med. 28:255–258, 2001. © 2001 Wiley-Liss, Inc.

Purpose: We defined the safety and efficacy of retrograde ureteroscopic endopyelotomy using the holmium:YAG laser.Methods and Materials: Between July 1996 and December 1999 a total of 28 renal units in 21 women and 6 men 7 to 75 years old (mean age 43.5) with ureteropelvic junction obstruction were treated at our institution with retrograde ureteroscopic endopyelotomy. Ureteropelvic junction obstruction was bilateral in 1 case, primary in 20 and secondary in 8. Endoluminal ultrasound was done before endopyelotomy in all cases. Patients with renal calculi underwent antegrade percutaneous nephrostolithotomy and traditional cold knife endopyelotomy. Endoluminal ultrasound revealed posterior and lateral crossing vessels in 5 patients, who did not undergo the endoscopic approach. Retrograde endopyelotomy was performed using the holmium:YAG laser in 23 cases and electrode incision with pure cutting current in 5. Postoperatively a ureteral stent remained indwelling for an average of 6 weeks. Thereafter patients ...

Hypopharynx hemangioma is a rare disease. We reported a case of a 63-year-old woman who complained of laryngeal discomfort of nine months. Fiberscopy demonstrated a tumor with dark red, regular smooth surface that was located at the left piriform sinus.The tumor was completely excised by Holmium YAG laser. Histological examination revealed that it was a cavernous hemangioma.Recurrence of the tumor has not been observed in the three months since the surgery. The authors considered the effectiveness of the Holmium YAG laser in this case.

Objective: Various modalities ranging from acucise balloon to endoincision with electrocautery, cold knife, and lasers have been used to treat ureteropelvic junction obstruction (UP

We report here on the efficacy and safety of three arthroscopic procedures using a Holmium: Yag laser in two high-responder haemophiliacs. The two patients were treated with an activated prothrombin complex concentrate (FEIBA; Immuno, Vienna, Austria). Treatment was started just before surgery and continued for 4-8 days. On one occasion antifibrinolytics were concomitantly used without thromboembolic complication. Post-operative blood loss was slight, joint mobility was rapidly acceptable and full weight bearing without pain was possible on day 4. Such a procedure would appear to be superior to conventional arthroscopic synovectomy utilizing mechanical devices in haemophiliacs, because it might improve the quality of local haemostasis and the rapidity of post-operative recovery. In addition, it is also the technical procedure of choice in haemophilic patients with inhibitors who need synovectomy.

The holmium laser is a relatively new multipurpose medical laser that recently became available for use in urology. There has been considerable interest in this device, as it seems to combine the cutting properties of the carbon dioxide laser with the coagulating properties of the neodymium:YAG laser, making it particularly appealing for many surgical applications. The last decade has seen enthusiasm for the use of laser energy for the treatment of benign prostatic hyperplasia. In this article, we review the technique of Ho:YAG laser resection of the prostate, including the essential equipment and perioperative patient care.

To evaluate the safety and efficacy of holmium:YAG laser vaporization v transurethral electroresection (TURP) for benign prostatic hyperplasia.Thirty-six patients were randomized. Two laser procedures (60 to 80 W) were performed for one TURP. Symptom Score, peak flow rate, potency, and ejaculation status were measured at baseline and at 1, 3, 6, and 12 months.The mean operative time was 75 minutes for laser and 56 minutes for TURP (P = 0.0407). With a mean laser energy delivered of 103.6 kJ, hemostasis was satisfactory during vaporization. The mean catheterization time was 1.7 and 2.1 days in the laser and TURP group, respectively. For the laser and TURP groups, the mean AUA Score improved from 20 preoperatively to 7 and from 24.1 to 5, respectively, at 12 months. The mean peak flow increased from 8.4 to 19.5 mL/sec and from 7.6 to 16.8 ml/sec, respectively, at 12 months. These results are not statistically different. No significant initial dysuria occurred. No significant difference between the groups appeared in potency or ejaculatory status during the follow-up. One patient in the laser group (Day 5) and two in the TURP group (2nd and 6th month) had to undergo a second procedure to relieve obstruction.Although taking slightly longer to accomplish, holmium:YAG laser vaporization of BPH provides early results very similar to those of TURP with a shorter catheterization time and no initial dysuria or pain.

The purpose of this study was to evaluate the histological effects of holmium:YAG laser partial meniscectomy in an in vivo rabbit model and compare it with scalpel partial meniscectomy at selected time intervals. Twenty-four adult male New Zealand rabbits underwent bilateral partial medial meniscectomies through the avascular zone. In the right knee, partial medial meniscectomy was performed using a standard surgical blade; in the left knee, an anatomically similar partial medial meniscectomy was performed using a Ho:YAG laser (Coherent, Santa Clara, CA). All animals were randomized and three animals were killed at postoperative days I and 3, and postoperative weeks 1, 2, 3, 4, 6, and 10. Samples of all medial and lateral menisci, with attached synovium and vascular rim, from both knees were harvested and submitted for histological and/or ultrastructural examination. The results indicate that (1) at all time periods, laser cut menisci had more cell loss and matrix degradation; (2) synovial necrosis was more common in laser-treated knees; (3) the Ho:YAG laser creates three zones of damage in the meniscal fibrocartilage: a zone of fibrin and debris at the incision site, a zone of necrosis characterized by degeneration of the collagen and loss of viable cells, and a zone of thermal change characterized by collagen degeneration. The zone of thermal change, with its histological injury was thought at the time of surgery to be the viable border. The zone of thermal change may act as a barrier to delay healing, and the scalpel produced a consistently straighter cut.

To report on the experience obtained in the treatment of a series of 150 cases of ureteral stone disease by means of the holmium:yttrium-aluminum-garnet (Ho:YAG) laser.One hundred and fifty consecutive cases treated by means of Ho:YAG laser ureterolithotripsy have been reviewed in order to assess the results. In 81 cases the stones were located in the lower third, in 47 in the medium third, and in 22 cases in the upper third of the ureter. The laser was set at a power of 8-10 W and at a frequency of between 6 and 10 Hz. Thin ureteroscopes were selected, such as the 7-Fr Gautier or the new ultrathin 4.8-Fr Wolf instrument. In some cases other ureteroscopes were chosen.Lasertripsy was effective in every kind of stone, allowing fragmentation into portions measuring at most 4 mm (largest diameter) or disintegration. The clearance rate of the stones was 92.6% during the 30-day follow-up period. Calcium dihydrate stones were of course more easily broken than monohydrate ones. No damage to the ureter was observed following the vaporization which is produced by this kind of laser, since particular attention was paid to avoid any contact between the laser beam and the ureteral mucosa. In some instances ureteroscopic maneuvering provoked some slight lacerations. In a few cases accidental contact of the laser beam with the ureteral mucosa produced extremely small coagulations of no immediate or postoperative relevance.The Ho:YAG laser constitutes an effective instrument for the fragmentation of any kind of ureteral stone; it allows the use of thin or ultrathin instruments and, if manipulated with care, does not damage the ureteral mucosa or the ureteral wall.

Nine patients with hemangioma of the oral cavity, pharynx and larynx treated in our clinic from 1995 to 1998 were reviewed with attention to diagnostic imaging and choice of treatment. Pathological diagnosis was cavernous hemangioma in 8 patients and venous hemangioma in 1 patient. As diagnostic imaging, MRI was useful to clearly demonstrate hemangiomas of these regions and color Dopper ultrasonography was also useful to evaluate the hemodynamics such as flow rate and flow direction within the tumor. Most of them showed low to iso signal intensity on T1 and high intensity on STIR and T2. They were enhanced by Gd-DTPA. The flow rate within the cavernous hemangioma was very slow measured by color Doppler ultrasonography. As the treatment for hemangioma of these regions, surgical resection was performed in 6 patients. Photocoagulation using holmium YAG laser was performed in 3 patients. Our results indicate that photocoagulation is a very effective treatment of mucosal hemangiomas with a low flow rate, which should be confirmed by color Doppler ultrasonography.

Superficial hypopharynx hemangioma is generally treated by KTP laser, however, we used Holmium YAG laser in this case. Hemangioma was located at the pirif orm sinus. We have performed laser treatment on the surrounding normal tissue of the hemangioma and completely excised it without tracheotomy and with less bleeding. In comparison to Holmium YAG laser and other types (KTP or NdYAG) of laser, Holmium YAG laser is reported to be less damage to neighbor tissues. This case appeared to get good course and laryngeal edema was not observed through the admission. The indication of using Holmium YAG laser treatment is considered to depend on the size of tumor, diameter smaller than 2cm, and to be situated superficial The authors considered the effectiveness of Holmium YAG laser.

To evaluate the results of Holmium:YAG (Ho:YAG) laser lithotripsy in the treatment of urinary stones.Between 1993 and 1997, 59 patients with 85 urinary stones were treated with the Ho:YAG laser lithotripsy. Retrospective evaluation was done on the 64 procedures available, comprising 53 ureteric, 8 bladder, and 2 renal calculi, and one stone in a ureterocele.The Ho:YAG laser fragmented all types of calculi. Of 38 patients, 29 (76%) with ureteric stones were stone-free and 7 (18%) had stone fragments smaller than 2 mm left 1-3 months after the lithotripsy, resulting in a total clinical success rate of 95%. The procedure caused four ureteric perforations. One ureteric stricture, after repeated treatments for a Steinstrasse formation, led to nephrectomy.The Ho:YAG laser was reliable and effective for most of the urinary stones. The largest stones in any location, and stones of hard composition, however, were treated with combined disintegration methods. Four minor ureteric perforations and one ureteric stricture were related to laser use.

The authors review the current knowledge regarding the application of the Holmium: YAG laser for prostatectomy.Conventional surgical therapies for benign prostatic hyperplasia (BPH) are effective but associated with relatively high morbidity. Laser prostatectomy, using either Neodymium:YAG or potassium-titanyl-phosphate lasers, has emerged as a new and much safer operative approach to relieve symptoms of benign prostatic hyperplasia. However, these laser wavelengths possess key disadvantages that have limited their acceptability and dissemination in everyday urologic practice.THE authors review their own extensive experience in the development of clinical application of Holmium: YAG laser technology for prostatectomy, as well as the published reports in the current medical literature now dealing with this subject.In multiple clinical trials, Holmium:YAG laser resection of the prostate has proven efficacious in relieving symptomatic BPH. Both objective urodynamic measures of voiding outcomes and symptomatic improvement have been shown to be equivalent to standard electrocautery resection of the prostate. At the same time, these studies have demonstrated the superior safety and hemostasis of Holmium:YAG laser prostatectomy compared to electrocautery resection, similar to prior laser prostatectomy procedure. Unlike prior forms of laser prostatectomy, Holmium:YAG laser resection of the prostate acutely removes all obstructing prostate tissue, so that the postoperative catheterization requirement is typically only overnight and improvement in voiding is immediate. Current operative techniques and the latest technological developments to facilitate Holmium:YAG laser prostatectomy are described.Holmium: YAG laser prostatectomy combines the best features of prior laser prostatectomy technologies, including minimal complications and morbidity, with the efficacy and immediacy of voiding outcomes associated with conventional electrocautery resection of the prostate.

To determine the feasibility of holmium laser enucleation of the prostate (HoLEP) combined with mechanical morcellation to surgically treat bladder outflow obstruction due to the larger prostate.The first 14 patients treated with this new combination technique are described. Standard preoperative investigations were performed and all patients were assessed at 1 month postoperatively with an AUA symptom score and peak urinary flow rate (Qmax). Both transurethral (8 patients) and suprapubic (6 patients) morcellation was utilised.The mean ultrasound volume of the prostate was 98.6 ml (55-200). The mean total operating room time was 98 min (64-190). No patient required blood transfusion but 2 patients required postoperative bladder irrigation. Twelve of the patients were discharged catheter-free the following day. The only significant complication was extraperitoneal extravasation from the suprapubic site in 2 patients. At 1 month the mean Qmax was 25.2 ml/s and the mean AUA score was 7.2.This combination of techniques offers a minimally morbid method of treating the larger prostate gland.

We evaluated the usefulness of operative arthroscopy with a Holmium: YAG laser for the treatment of internal derangement of the temporomandibular joint (TMJ) as compared with electric cautery. Thirty-four patients (43 joints) with deranged TMJ were treated with a Holmium: YAG laser and 55 (68 joints) were treated with electric cautery. After 9.5 months of follow-up, the surgical success rate with Holmium: YAG laser was 95.3%, which was similar to the success rate with electric cautery 9.7 months after operation. There was no significant difference between the two groups with respect to the size of the postoperative interincisal opening or arthralgia. Almost all patients recovered more rapidly and returned more promptly to normal daily activities by using a Holmium: YAG laser as well as by electric cautery. We conclude that TMJ arthroscopic surgery with a Holmium: YAG laser is useful for the treatment of internal derangement of the TMJ.

Today, the holmium:YAG laser is the gold standard in endourologic stone treatment because of its high efficacy. However, guidewires and stone-extraction tools often are close to the fiber and may be damaged accidentally by the laser. The aim of our study was to evaluate the duration of laser application required to disrupt wires at different energy settings.Two standard wires (0.035-inch guidewire and 0.025-inch hydrophilic Terumo wire) and two baskets (1.9F Nitinol tipless and 3F stone extraction) were investigated. We used a holmium:YAG laser (Auriga; Wavelight Laser Technologie AG, Erlangen, Germany) and two fibers (230 and 365 microm) at 800 and 2000 mJ and a 5-Hz pulse rate. The laser was brought into direct contact with the wires.The average time required for transection was 55 to 103 seconds for a safety wire. The Terumo wire broke after 20 to 40 seconds of direct laser application; 15 to 34 seconds was required for a Dormia basket. Thin Nitinol basket wires were disrupted after only 1 to 4 seconds. One- and two-factorial variance analysis showed a high degree of significance (P0.0001) of the energy level and type of wire.The disruption of stone-extraction tools occurs in a remarkably short time with laser exposure, especially in case of Nitinol baskets, whereas guidewires are more resistant. Attention should be paid to avoiding contact of laser energy with wires and baskets during stone fragmentation.

Objectives Endourologic techniques ranging from balloon dilation to endoincision with electrocautery, cold knife, and lasers have been increasingly used in recent years for the treatment of ureteral strictures. While the long-term results may not be as reliable or as durable as traditional reconstructive surgical techniques, they can be accomplished with much less morbidity. Recently, the holmium:yttrium-aluminum-garnet (YAG) laser, which possesses both cutting and coagulating properties, has been demonstrated to have many applications in urology. We report our experience with this laser in the endoscopic treatment of ureteral strictures. Methods We reviewed the charts and follow-up history of 22 patients in whom the holmium:YAG laser was used to treat ureteral strictures from a variety of causes and including those in ureteroenteric anastomoses. Strictures were either approached in a retrograde fashion with a 6.9F ureteroscope or antegrade with flexible instruments in the cases involving ureteroenteric strictures. The only energy source employed was the laser, followed by balloon dilation. Indwelling stents were left in place for at least 4 weeks postoperatively and follow-up was obtained with radiographic imaging. Results A minimum 9-month follow-up was available for 18 patients. There were 5 patients who had developed recurrent strictures and were therefore considered treatment failures. Each of these patients failed in less than 3 months and all had either lengthy or complex strictures noted at the time of surgery. One patient was lost to follow-up and three recent patients have follow-up of 3 to 6 months showing no evidence of recurrent stricture formation. Overall, 16 of 21 (76%) patients are clinically well with no evidence of stricture recurrence. Conclusions Endoureterotomy for ureteral stricture disease is a minimally invasive, less morbid, but ultimately less successful, alternative to open surgical reconstruction. Stricture length and etiology remain the most important determinants of success. The holmium:YAG laser, with its ability to precisely cut tissue and provide hemostasis and its multiuse potential and compatibility with small rigid and flexible endoscopic instruments, is an ideal tool for performing endoureterotomy.