Exploring optimal settings for safe and effective thulium fibre laser lithotripsy in a kidney model.
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2024-02
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Abstract
Objectives
To explore the optimal laser settings and treatment strategies for thulium fibre laser (TFL) lithotripsy, namely, those with the highest treatment efficiency, lowest thermal injury risk, and shortest procedure time.Materials and methods
An in vitro kidney model was used to assess the efficacy of TFL lithotripsy in the upper calyx. Stone ablation experiments were performed on BegoStone phantoms at different combinations of pulse energy (EP ) and frequency (F) to determine the optimal settings. Temperature changes and thermal injury risks were monitored using embedded thermocouples. Experiments were also performed on calcium oxalate monohydrate (COM) stones to validate the optimal settings.Results
High EP /low F settings demonstrated superior treatment efficiency compared to low EP /high F settings using the same power. Specifically, 0.8 J/12 Hz was the optimal setting, resulting in a twofold increase in treatment efficiency, a 39% reduction in energy expenditure per unit of ablated stone mass, a 35% reduction in residual fragments, and a 36% reduction in total procedure time compared to the 0.2 J/50 Hz setting for COM stones. Thermal injury risk assessment indicated that 10 W power settings with high EP /low F combinations remained below the threshold for tissue injury, while higher power settings (>10 W) consistently exceeded the safety threshold.Conclusions
Our findings suggest that high EP /low F settings, such as 0.8 J/12 Hz, are optimal for TFL lithotripsy in the treatment of COM stones. These settings demonstrated significantly improved treatment efficiency with reduced residual fragments compared to conventional settings while keeping the thermal dose below the injury threshold. This study highlights the importance of using the high EP /low F combination with low power settings, which maximizes treatment efficiency and minimizes potential thermal injury. Further studies are warranted to determine the optimal settings for TFL for treating kidney stones with different compositions.Type
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Mishra, Arpit, Robert Medairos, Junqin Chen, Francois Soto-Palou, Yuan Wu, Jodi Antonelli, Glenn M Preminger, Michael E Lipkin, et al. (2024). Exploring optimal settings for safe and effective thulium fibre laser lithotripsy in a kidney model. BJU international, 133(2). pp. 223–230. 10.1111/bju.16218 Retrieved from https://hdl.handle.net/10161/31500.
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Scholars@Duke
Arpit Mishra
Dr. Arpit Mishra is a Postdoctoral Associate in the Department of Mechanical Engineering and Materials Science at Duke University, USA. His research focuses on laser lithotripsy for urolithiasis treatment, combining both experimental and simulation approaches to investigate laser interactions with fluids, bubbles, and solid surfaces. He earned his PhD and M.S. in Mechanical Engineering from the Indian Institute of Technology, Kharagpur, where his dissertation centred on the dynamics of interacting cavitation bubbles. His international research experience includes fellowships as an ETH4D Visiting Researcher at ETH Zurich and a Raman Charpak Fellow at CEA/UGA Grenoble. Dr. Mishra's expertise extends to cryogenic engineering, hydrodynamic cavitation, and laser thermal safety. He has been recognized with several prestigious awards, including the Milton Van Dyke Award from the APS Division of Fluid Dynamics, the T.H.K. Frederking Space Cryogenic Workshop Student Scholarship, and the ETH4D Visiting Student Grant. His work has been featured in the 1st Traveling Gallery of Fluid Motion by the Cultural Programs of the National Academy of Sciences (CPNAS).
Robert Medairos
Junqin Chen
Glenn Michael Preminger
- Minimally invasive management of urologic diseases
2. Minimally invasive management of renal and ureteral stones
3. Medical management of nephrolithiasis
4. Bioeffects of shock wave lithotripsy
5. Basic physics of shock wave lithotripsy
6. Intracorporeal lithotripsy for stone fragmentation
7. Minimally invasive management of urinary tract obstruction, including ureteropelvic junction obstruction and ureteral strictures
8. Enhanced imaging modalities for minimally invasive surgery
9. Digital video imaging during endoscopic surgery
10. 3-D imaging modalities for minimally invasive surgery
11. Holmium laser applications in urology
Michael Eric Lipkin
Pei Zhong
My research focuses on engineering and technology development with applications in the non-invasive or minimally invasive treatment of kidney stone disease via shock wave and laser lithotripsy, high-intensity focused ultrasound (HIFU) and immunotherapy for cancer treatment, acoustic and optical cavitation, and ultrasound neuromodulation via sonogenetics.
We are taking an integrated and translational approach that combines fundamental research with engineering and applied technology development to devise novel and enabling ultrasonic, optical, and mechanical tools for a variety of clinical applications. We are interested in shock wave/laser-fluid-bubble-solid interaction, and resultant mechanical and thermal fields that lead to material damage and removal. We also investigate the stress response of biological cell and tissue induced by cavitation and ultrasound exposure, mediated through mechanosensitive ion channels, such as Piezo 1. Our research activities are primarily supported by NIH and through collaborations with the medical device industry.
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