Holmium laser lithotripsy is a standard and effective method for treating kidney stones during flexible ureteroscopy. However, the efficiency of laser surgery can be influenced by various factors, including patient and operator characteristics and perioperative management. A recent study examined intraoperative data to identify the surgical and demographic factors associated with high lasing efficiency during kidney stone treatment.
This study was published in Journal Of Endourology by Gelikman DG and colleagues. The study analyzed 82 intraoperative reports from an ongoing clinical trial that assessed the use of the Lumenis Pulse™ 120H holmium laser for treating renal stones up to 20mm in diameter, both with and without Moses 2.0 technology. The researchers measured lasing efficiency by calculating the total pause time between lasing activations, corrected for lengthy pauses, and divided by the total lasing time. They then compared this efficiency with various patient demographics, anesthesia administration methods, stone burden, postoperative complications, and stone-free rates using both univariate and multivariate analyses.
Anesthesia Method: Patients who received endotracheal intubation (ETT) had significantly higher lasing efficiency (78.7%) compared to those who had a laryngeal mask airway (LMA) (73.3%). This difference was observed in both univariate and multivariate analyses, even after adjusting for stone size, stone number, stone density, and patient BMI.
Complications: Patients with higher lasing efficiency also experienced significantly lower rates of postoperative complications. Those with no postoperative complications had a mean lasing efficiency of 76.3%, while those with any grade (I-V) Clavien-Dindo complication within 30 days after surgery had a mean efficiency of 70.0%.
The study suggests that flexible ureteroscopy and laser lithotripsy cases with higher lasing efficiency are associated with lower rates of postoperative complications. Additionally, the data indicates that using endotracheal intubation (ETT) for anesthesia may improve overall lasing efficiency, although the choice of anesthesia administration remains one of several factors to consider.
These findings contribute to a better understanding of the factors influencing the success of kidney stone treatments using holmium laser lithotripsy. They underscore the importance of optimizing surgical techniques and anesthesia methods to enhance patient outcomes and minimize complications during these procedures.
Reference:
Gelikman, D. G., Ibanez, K. R., Reed, A. M., Hsi, R., Nimmagadda, N., & Miller, N. Factors affecting holmium laser efficiency: Comparison of laryngeal mask airway and endotracheal intubation during ureteroscopy for renal stones. Journal of Endourology,2023. https://doi.org/10.1089/end.2023.0294