Temperature changes during laser lithotripsy with Ho:YAG laser and novel Tm-fiber laser: a comparative in-vitro study

Aim The aim of this study was to compare the thermal effects of Ho:YAG and Tm-fiber lasers during lithotripsy in an in-vitro model via real-time temperature measurement. Methods We compared a Ho:YAG laser (p(av) up to 100 W, Lumenis, Yokneam, Israel) and a superpulse Tm-fiber laser (SP TFL, p(av) up to 40 W, NTO IRE-Polus, Fryazino, Russia), both equipped with 200 mu m bare-ended fibers. The following settings were used: 0.2 J, 40 Hz (nominal p(av) 8 W). Power meter FieldMaxII-TO (Coherent, Santa Clara, CA, USA) was used to verify output laser power (p(av)). Each laser was fired for 60 s in two setups: (1) thermos-insulated (quasi-adiabatic) cuvette; (2) actively irrigated setup with precise flow control (irrigation rates 0, 10, 35 mL/min). Results Power measurements performed before the test revealed a 10% power drop in Ho:YAG (up to 7.2 +/- 0.1 W) and 6.25% power drop in SP TFL (up to 7.5 +/- 0.1). At the second step of our experiment, irrigation reduced the respective temperatures in the same manner for both lasers (e.g., at 35 mL/s SP TFL - 1.9 degrees C; for Ho:YAG laser - 2.8 degrees C at 60 s). Conclusion SP TFL and Ho:YAG lasers are not different in terms of volume-averaged temperature increase when the same settings are used in both lasers. Local temperature rises may fluctuate to some degree and differ for the two lasers due to varying jet streaming caused by non-uniform heating of the aqueous medium by laser light.