Laser lithotripsy uses a flexible laser fiber inserted into an endoscope through the urethra to the stone located in the bladder, ureter or kidney. When the laser is activated, the laser beam vaporizes the stone. This high-tech approach has become a standard of care and is revolutionizing the treatment of urinary stones. This minimally invasive therapy is increasingly replacing the traditional extracorporeal shock wave lithotripsy (ESWL) technique where the stone is bombarded by shock waves generated outside the body.

Peer-reviewed articles appearing in well-respected urology and laser journals continue to document the many advantages of laser lithotripsy over ESWL including:

• Better treatment for more complex stones
• Higher success rate with a single treatment
• Fewer treatments for stone-free result
• No risk of generating potential seeds for future stone formation

The holmium laser advantages over other endoscopic techniques include:

• Greater reach due to fiber flexibility and small diameters
• Less stone movement during treatment
• More effective on all stone compositions
• More efficient in removing embedded stones
• Less bleeding during treatment

Lumenis offers holmium / Nd:YAG lasers that are uniquely suited to treat all urinary calculi safely and effectively. The following journal excerpt summarizes the value of holmium laser technology for urologists.

"The Ho:YAG laser is a multipurpose, multispecialty surgical laser that has recently become available for use in urology. In addition to its excellent stone-fragmenting qualities, the holmium laser possesses ablative and hemostatic properties for soft tissue applications...when one considers the many potential uses for this laser in urology and its expanding list of applications in other specialties, the device may in fact become as cost-effective, if not more so, than many other surgical instruments and tools that we now employ."

Bukala, Bernard, MD and Denstedt, John D., MD. Techniques in Endourology: Holmium:YAG Laser Resection of the Prostate, Journal of Endourology, Volume 13, Number 3, April 1999.

Products

The VersaPulse PowerSuite system provides unparalleled performance, procedure after procedure. Available in several state-of-the-art configurations, it offers the highest power and widest range of treatment settings available. The laser's speed and precision can be tailored to meet specific surgical needs. Although it is a commonly held belief that low-power holmium lasers are sufficient to treat most urinary stones, many surgeons and hospitals choose to invest in higher powered configurations. It is believed that they choose high power to enable overall faster, more efficient treatments, reduce operating and anesthesia time and to acquire the power for use by other specialties and for future applications. And the combination of high-power holmium and Nd:YAG laser wavelengths in one system enables surgeons to choose holmium for cutting and ablating or Nd:YAG for deeper coagulation for added versatility.

Designed for operation with an extensive selection of reusable and disposable delivery systems, the VersaPulse PowerSuite gives surgeons the edge for virtually every laser procedure.

Accessories

SlimLine and DuoTome fibers are designed to deliver either holmium or Nd:YAG wavelengths with the touch of a pedal. Both are compatible with flexible, semi-rigid and rigid endoscopes except the 1000 micron SlimLine fiber, which is used with a cytoscope or resectoscope. Their rugged, reusable design lowers costs per case and their blue-colored jacket enhances visibility during surgery. They can be used for multiple endoscopic applications.

SlimLine reusable end-firing fibers are available in 200, 365, 550 and 1000 micron diameter sizes.

DuoTome single use side-firing fibers direct laser energy at a 70° angle and are used in a fluid environment, making them ideal for endoscopic urology.

Lithotripsy Doctor FAQs

(Answers from "Endourologic use of the Holmium Laser" by Dr. Akhil Das and Dr. Demetrius H. Bagley.)

Q: What do you do if the holmium laser does not fragment the stone?
A: Be sure to place the fiber in direct contact with the stone. Increase the energy per pulse if necessary to improve fragmentation. There has not been a stone that the holmium laser cannot fragment.

Q: What fragmentation pattern breaks stones most effectively?
A: Think of the fragmentation technique as "sculpting with the laser." Use the geometry of the stone to determine where to place the fiber to maximize fragmentation.

Q: How can the holmium laser ablate tissue but also break stones without damaging the ureter?
A: The minimal penetration of the laser energy into water or tissue (<0.5 mm) limits its effect. Careful visual positioning of the fiber with appropriate selection of the energy level gives extremely accurate control of the laser.

Q: What is the minimum size of fragments obtained with the holmium laser during lithotripsy?
A: Very tiny pieces of stone can be removed during holmium laser lithotripsy. The debris in the irrigant giving the snowstorm effect with lithotripsy consists of stone "dust." By maximizing this effect, a large volume of stone can be removed without having major fragments to retrieve or to pass.

Q: When treating tumors do you use coagulation or ablation with the holmium laser?
A: Both the coagulative and ablative effects of the laser are used to treat tumors in the urinary tract.

Q: How is the holmium laser different from other surgical lasers?
A: Holmium is very effective for several endoscopic applications. The holmium laser can break any urinary calculus. It can also coagulate or ablate tissue and cut tissue to make an incision. It can treat stones, tumors, strictures and the enlarged prostate effectively with great precision and minimal bleeding.