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



Yüklə 502 b.
tarix02.03.2018
ölçüsü502 b.


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





Dostları ilə paylaş:


Verilənlər bazası müəlliflik hüququ ilə müdafiə olunur ©genderi.org 2019
rəhbərliyinə müraciət

    Ana səhifə