Lithium Triborate Laser Vaporization of the Prostate Using the 120 W, High Performance System Laser: High Performance All the Way?

• Published in: The Journal of urology Vol. 185; no. 6; pp. 2241 - 2247
• Main Authors: Hermanns, Thomas, Strebel, Daniel D, Hefermehl, Lukas J, Gross, Oliver, Mortezavi, Ashkan, Müller, Alexander, Eberli, Daniel, Müntener, Michael, Michel, Maurice S, Meier, Alexander H, Sulser, Tullio, Seifert, Hans-Helge
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.06.2011; Elsevier
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Borates; disposable equipment; Equipment Design; Humans; Laser Therapy - instrumentation; Laser Therapy - methods; lasers; Lithium Compounds; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; prostate; Prostatectomy - methods; prostatic hyperplasia; solid-state; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the genital tract and mammary gland; transurethral resection of prostate; Tumors of the urinary system; Urinary tract. Prostate gland; Urology; KTP; lithium-triborate; prostate specific antigen; LV; lasers; transurethral resection of prostate; potassium-titanyl-phosphate; LBO; disposable equipment; prostate; laser vaporization; solid-state; prostatic hyperplasia; PSA; Laser vaporization; Nephrology; Prostate disease; Lithium; Transurethral route; Urology; Triborates; Surgery; Benign prostatic hyperplasia; Bladder neck obstruction; Benign neoplasm; Male genital diseases; Human; Disposable; High performance; Urinary system disease; Surgical resection; Urinary tract disease; Treatment; Surgical approach; Bladder disease; Medical device
• ISSN: 0022-5347; 1527-3792
• DOI: 10.1016/j.juro.2011.02.023

Purpose Technical modifications of the 120 W lithium-triborate laser have been implemented to increase power output, and prevent laser fiber degradation and loss of power output during laser vaporization of the prostate. However, visible alterations at the fiber tip and the subjective impression of decreasing ablative effectiveness during lithium-triborate laser vaporization indicate that delivering constantly high laser power remains a relevant problem. Thus, we evaluated the extent of laser fiber degradation and loss of power output during 120 W lithium-triborate laser vaporization of the prostate. Materials and Methods We investigated 46 laser fibers during routine 120 W lithium-triborate laser vaporization in 35 patients with prostatic bladder outflow obstruction. Laser beam power was measured at baseline and after the application of each 25 kJ during laser vaporization. Fiber tips were microscopically examined after the procedure. Results Mild to moderate degradation at the emission window occurred in all fibers, associated with a loss of power output. A steep decrease to a median power output of 57.3% of baseline was detected after applying the first 25 kJ. Median power output at the end of the defined 275 kJ lifespan of the fibers was 48.8%. Conclusions Despite technical refinements of the 120 W lithium-triborate laser fiber degradation and significantly decreased power output are still detectable during the procedure. Laser fibers are not fully appropriate for the high power delivery of the new system. There is still potential for further improvement in the laser performance.