KEYWORDS: Tissues, In vivo imaging, Laser lithotripsy, Temperature metrology, Prototyping, Temperature sensors, Injuries, Infrared sensors, In vitro testing, High power lasers
High fluid temperatures have occurred in studies with laser lithotripsy, yet temperature within the renal parenchyma has not been well characterized. Our objective was to measure renal tissue temperatures during laser activation in a calyx. Ureteroscopy was performed in porcine subjects with a prototype ureteroscope containing a temperature sensor at its tip. A needle with thermocouples was introduced percutaneously to allow temperature measurement in the renal medulla and cortex. Trials of 60 second laser activation (40 W) were conducted with irrigation of 8 ml/min. Substantial temperature elevation was observed in the renal medulla with thermal dose in two of nine trials exceeding threshold for tissue injury. In conclusion, high-power laser settings (40 W) can induce potentially injurious tissue temperatures in the in-vivo porcine model, particularly in the region adjacent to the collecting system.
We devised a method to continuously measure the distance from fiber tip to stone surface based on the reflectance of an aiming beam back into the fiber during a popcorning scenario to determine how often the stone is close to the laser fiber when firing. Continuous light was coupled into a 200 µm fiber taped immediately next to the holmium fiber. Fibers were placed into a test tube with 5 BegoStones. Reflected light back into the fiber passed through the coupler to a biased photodiode. The fraction of time a stone was within 0.5 mm varied from 5%-18%.
KEYWORDS: In vitro testing, Laser lithotripsy, Thermal modeling, Laser safety, Safety, Laser therapeutics, Injuries, High power lasers, In vivo imaging, Tissues
The objective of this study was to map parameter boundaries for thermally safe laser and irrigation settings. The experimental system consisted of models simulating ureter, renal calyx, and renal pelvis placed in a water bath maintained at 37°C. Thermal dose for each trial was calculated based on Dewey and Sapareto t43 methodology. A parameter safety boundary was established by plotting the maximal safe power level for each irrigation rate. The boundary was found to be linear for each scenario with the renal pelvis able to tolerate the highest laser power and renal calyx the least power without injury.
Introduction: The Moses technology for the Ho:YAG laser introduces a pulse-shape modulation that optimizes energy delivery through water. The aim of this study was to assess fiber tip to stone working distance on fragmentation incorporating a variety of pulse modes.
Methods: Experiments were conducted with a 3D positioner, a 30 mm flat BegoStone, and a 230 µm fiber utilizing short pulse (SP), long pulse (LP), Moses Contact (MC), and Moses Distance (MD) modes. Ablation crater volume was measured by 3D confocal microscopy, after a single pulse (1.0J) with the fiber tip positioned at 0, 0.5, 1, 2, and 3 mm from the stone. Fragmentation efficiency (1Jx10Hz) was assessed with the fiber tip at 0 and 1 mm distance, programmed to fragment the stone over 3 minutes. Fragmentation was defined as difference in stone mass before and after each experiment.
Results: For all tested pulse modes, ablation crater volume and fragmentation were greatest when the fiber tip was in contact with the stone. Ablation declined as the working distance increased with no ablation occurring at 3 mm. At 1 mm distance, ablation volume using MD mode was significantly higher when compared to SP, LP and MC (p<0.05). Compared to all modes tested, MD resulted in 28% and 39% greater fragmentation at both 0 and 1 mm working distance, respectively (p<0.05).
Conclusion: Holmium laser lithotripsy is significantly affected by fiber working distance. At 0 and 1 mm distance, MD had the greatest fragmentation efficiency suggesting this mode may have advantages during ureteroscopy.
We explored the potential of an emerging laser-based technology, photoacoustic imaging (PAI), for bladder cancer
diagnosis through high resolution imaging of microvasculature in the interior bladder tissues. Images of ex vivo canine
bladders demonstrated the excellent ability of PAI to map three-dimensional microvasculature in optically scattering
bladder tissues. By comparing the results from human bladder specimens affected by cancer to those from the normal
control, the feasibility of PAI in differentiating malignant from benign bladder tissues was explored. The reported
distinctive morphometric characteristics of tumor microvasculature can be seen in the images from cancer samples,
suggesting that PAI may allow in vivo assessment of neoangiogenesis that is closely associated with bladder cancer
generation and progression. By presenting subsurface morphological and physiological information in bladder tissues,
PAI, when performed in a similar way to that in conventional endoscopy, provides an opportunity for improved
diagnosis, staging and treatment guidance of bladder cancer.
Histotripsy is an extracorporeal ablative technology that utilizes microsecond pulses of intense ultrasound (< 1% duty
cycle) to produce nonthermal, mechanical fractionation of targeted tissue. We have previously demonstrated the
feasibility of histotripsy prostate ablation. In this study we sought to assess the chronic tissue response, tolerability and
safety of histotripsy in a chronic in vivo canine model. Five acute and thirteen chronic canine subjects were anesthetized
and treated with histotripsy targeting the prostate. Pulses consisted of 3 cycle bursts of 750 kHz ultrasound at a repetition
rate of 300 Hz delivered transabdominally from a highly focused 15 cm aperture array. Transrectal ultrasound imaging
provided accurate targeting and real-time monitoring of histotripsy treatment. Prostates were harvested at 0, 7, 28, or 56
days after treatment. Consistent mechanical tissue fractionation and debulking of prostate tissue was seen acutely and at
delayed time points without collateral injury. Urothelialization of the treatment cavity was apparent 28 days after
treatment. Canine subjects tolerated histotripsy with minimal hematuria or discomfort. Only mild transient lab
abnormalities were noted. Histotripsy is a promising non-invasive therapy for prostate tissue fractionation and
debulking that appears safe and well tolerated without systemic side effects in the canine model.
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