Abstract：
OBJECTIVE: The risk of thermal damage increases with the introduction of high-power lasers during holmium laser lithotripsy. This study aimed to quantitatively evaluate the temperature change of renal calyx in the human body and the 3D printed model during high-power flexible ureteroscopic holmium laser lithotripsy and map out the temperature curve.
METHODS: The temperature was continuously measured by a medical temperature sensor secured to a flexible ureteroscope. Between December 2021 and December 2022, willing patients with kidney stones undergoing flexible ureteroscopic holmium laser lithotripsy were enrolled. High frequency and high-power settings (24 W, 80 Hz/0.3 J and 32 W, 80 Hz/0.4 J) were performed for each patient with room temperature (25 °C) irrigation. In the 3D printed model, we studied more holmium laser settings (24 W, 80 Hz/0.3 J, 32 W, 80 Hz/0.4 J and 40 W, 80 Hz/0.4 J) with warmed (37 °C) and room temperature (25 °C) irrigation.
RESULTS: Twenty-two patients were enrolled in our study. With 30 ml/min or 60 ml/min irrigation, the local temperature of the renal calyx did not reach 43 °C in any patient under 25 °C irrigation after 60 s laser activation. There were similar temperature changes in the 3D printed model with the human body under the irrigation of 25 °C. Under the irrigation of 37 °C, the temperature rise slowed down, but the temperature in the renal calyces was close to or even exceeded the 43 °C at the setting of 32 W, 30 ml/min and 40 W, 30 ml/min after continuing laser activation.
CONCLUSIONS: In the irrigation of 60 ml/min, the temperature in the renal calyces can still be maintained within a safe range after continuous activation of a holmium laser up to 40 W. However, continuous activation of 32 W or higher power holmium laser in the renal calyces for more than 60 s in the limited irrigation of 30 ml/min can cause excessive local temperature, in such situation room temperature perfusion at 25 ℃ may be a relatively safer option.
METHODS: The temperature was continuously measured by a medical temperature sensor secured to a flexible ureteroscope. Between December 2021 and December 2022, willing patients with kidney stones undergoing flexible ureteroscopic holmium laser lithotripsy were enrolled. High frequency and high-power settings (24 W, 80 Hz/0.3 J and 32 W, 80 Hz/0.4 J) were performed for each patient with room temperature (25 °C) irrigation. In the 3D printed model, we studied more holmium laser settings (24 W, 80 Hz/0.3 J, 32 W, 80 Hz/0.4 J and 40 W, 80 Hz/0.4 J) with warmed (37 °C) and room temperature (25 °C) irrigation.
RESULTS: Twenty-two patients were enrolled in our study. With 30 ml/min or 60 ml/min irrigation, the local temperature of the renal calyx did not reach 43 °C in any patient under 25 °C irrigation after 60 s laser activation. There were similar temperature changes in the 3D printed model with the human body under the irrigation of 25 °C. Under the irrigation of 37 °C, the temperature rise slowed down, but the temperature in the renal calyces was close to or even exceeded the 43 °C at the setting of 32 W, 30 ml/min and 40 W, 30 ml/min after continuing laser activation.
CONCLUSIONS: In the irrigation of 60 ml/min, the temperature in the renal calyces can still be maintained within a safe range after continuous activation of a holmium laser up to 40 W. However, continuous activation of 32 W or higher power holmium laser in the renal calyces for more than 60 s in the limited irrigation of 30 ml/min can cause excessive local temperature, in such situation room temperature perfusion at 25 ℃ may be a relatively safer option.
摘要：
目的：在钬激光碎石术中，随着引入高功率激光，热损伤的风险增加。本研究旨在定量评估高功率输尿管软镜钬激光碎石术中人体和3D打印模型中肾萼的温度变化，并绘制温度曲线。
方法：通过固定在输尿管软镜上的医用温度传感器连续测量温度。在2021年12月至2022年12月之间，自愿接受输尿管软镜钬激光碎石术的肾结石患者被招募。高频和高功率设置(24W,80Hz/0.3J和32W,对每位患者进行80Hz/0.4J）的室温（25°C）冲洗。在3D打印模型中，我们研究了更多的钬激光设置(24W，80Hz/0.3J,32W,80Hz/0.4J和40W,80Hz/0.4J），并进行温热（37°C）和室温（25°C）灌溉。
结果：22例患者纳入本研究。30毫升/分钟或60毫升/分钟冲洗，在60s激光激活后，在25°C冲洗下的任何患者中，肾萼的局部温度均未达到43°C。在25°C的灌溉下，3D打印模型与人体有类似的温度变化。在37°C的灌溉下，气温上升速度减慢,但是在32W的设定下，肾盏的温度接近甚至超过了43°C，30ml/min和40W，30ml/min后继续激光激活。
结论：在60毫升/分钟的冲洗中，在连续激活高达40W的钬激光后，肾盏的温度仍然可以保持在安全范围内。在30ml/min的有限冲洗条件下，在肾盏中连续激活32W或更高功率的钬激光超过60s会导致局部温度过高，在这种情况下，25℃的室温灌注可能是相对安全的选择。
方法：通过固定在输尿管软镜上的医用温度传感器连续测量温度。在2021年12月至2022年12月之间，自愿接受输尿管软镜钬激光碎石术的肾结石患者被招募。高频和高功率设置(24W,80Hz/0.3J和32W,对每位患者进行80Hz/0.4J）的室温（25°C）冲洗。在3D打印模型中，我们研究了更多的钬激光设置(24W，80Hz/0.3J,32W,80Hz/0.4J和40W,80Hz/0.4J），并进行温热（37°C）和室温（25°C）灌溉。
结果：22例患者纳入本研究。30毫升/分钟或60毫升/分钟冲洗，在60s激光激活后，在25°C冲洗下的任何患者中，肾萼的局部温度均未达到43°C。在25°C的灌溉下，3D打印模型与人体有类似的温度变化。在37°C的灌溉下，气温上升速度减慢,但是在32W的设定下，肾盏的温度接近甚至超过了43°C，30ml/min和40W，30ml/min后继续激光激活。
结论：在60毫升/分钟的冲洗中，在连续激活高达40W的钬激光后，肾盏的温度仍然可以保持在安全范围内。在30ml/min的有限冲洗条件下，在肾盏中连续激活32W或更高功率的钬激光超过60s会导致局部温度过高，在这种情况下，25℃的室温灌注可能是相对安全的选择。
