Multifunctional Use Of "Holmium: Yag Laser" in Urology By

Multifunctional Use Of "Holmium:Yag Laser" in Urology

• By

• Sunil Shroff, Graham Watson 

• Institute of Urology & Nephrology in association with

• St. Peter's Hospital, London, UK

•  

• Sri Ramachandra Medical College & Research Institution

• Sri Ramachandra Hospital, Porur, Madras.

Technical Specifications of Holmium: Yag Laser

• Laser type Pulse Holmium:YAG

• Wavelength 2.1 micron

• Pulse duration 350 microsecs

• Power to tissue Variable 1 - 20 Watts

• Energy/Pulse 1 J - 1.8 J

• Aiming beam 3 milliwatts (red)

• Beam delivery Low water quartz fibre (400m)

• Dimensions 79 cm H x 36 cmW x 53 cm D

• Weight 64 Kg

• Cost 20W £70000

Advantages of Holmium: Yag Laser

• Combines cutting superiority of Co2 laser haemostatic superiority of Neodymium: YAG Laser

• Can be used in contact and non-contact mode

• Can be used for cutting and for stone work

• Easy to maintain

• Holmium Laser for ureteric

• Lithotripsy - 114 (79%)

•  

• Other Procedures With

• Holmium Laser - 30 (21%)

Other Procedures With Holmium Laser

• Endoureterotomy - Ureteric Strictures 8

• PUJ Obstruction Retrograde Endopyelotomy 6

• PUJ Obstruction Antegrade Endopyelotomy 1

• Ablation of Tumours - Bladder & Kidney 5

• Ablation of Calyceal Diverticulum 4

• Fragmentation of Lower Calyceal Calculi 2

• Bladder Neck Incision 2

• Fragmentation of Very hard calculi Calculi 1

• Excision of Uretheral Caruncle 1

• Total 30

Holmium:YAG For Stone Disease

Site & Size of Stones in the Ureter

• Left Right Total

• Upper 1/3 rd 24 28 52

•  

• Middle 1/3 rd 4 12 16

•  

• Lower 1/3 rd 13 33 46

• Total 41 73 114

Success with Stones Clearance using Holmium Laser

• Left (N=41) Right (N=73)

• Upper 1/3 rd 19/24 (79%) 21/28 (75%)

• Middle1/3rd 4/4 (100%) 11/12 (92%)

• Lower 1/3rd 12/13 (92%) 32/33 (97%)

• Total 35/41 (85%) 64/73 (88%)

Results - Holmium To Cut & Coag.

• Sustained Improv.

• PUJ Obstruction 5/7 (6 To 12 Months F/U)

• Ureteric Stricture 7/8 (1 Year F/u)

• (2 On DJ Stent)

• Calyceal Divert. 2/4 (However Only Partial Ablation)

• BNI 2/2 ( 6/12 F/U)

• Early

• Perforation of ureter 3

• Double J Stent for Obstruction 3

• Nephrostomy for Obstruction 2

• Deep venous thrombosis 1

•  Late

• Ureteric Stricture 3

• Total 12

• Early

• Hemorrhage (PUJ obst.) 1

• Hydropneumothorax (Calyc. Divert.) 1

• Late

• Nephrectomy (Stricture) 1

• Total 3

Conclusion - Holmium for Stones

• 1. Can be used through the smallest semirigid ureteroscopes (6.9F).

• 2. Can be used through flexible ureteroscopes.

• 3. Effective for very hard stones

• (Disadvantage - not as safe as pulsed dye laser for ureteric wall).

Conclusion - Holmium To Cut & Coag.

• 1. Excellent haemostatic properties

• 2. Use via small calibre ureteroscope

• 3. End on cutting action of laser under vision - an advantage

• 4. Control & precision greater with laser

• 5. Depth of penetration 0.5cm - safe for deeper tissues like intestines

• 6. Multi-Speciality Laser - hence economical