Laser Heating of Fluid With and Without Stone Ablation: In Vitro Assessment

Introduction: Laser lithotripsy can cause excessive heating of fluid within the collecting system and lead to tissue damage. To better understand this effect, it is important to determine the percentage of applied laser energy that is converted to heat and the percentage used for stone ablation. Our objective was to calculate the percentage of laser energy used for stone ablation based on the difference in fluid temperature measured in an in vitro model when the laser was activated without and with stone ablation.Methods: Flat BegoStone disks (15:5) were submerged in 10 mL of deionized water at the bottom of a vacuum evacuated double-walled glass Dewar. A Moses 200 D/F/L laser fiber was positioned above the surface of the stone at a distance of 3.5 mm for control (no stone ablation) or 0.5 mm for experimental (ablation) trials. The laser was activated and scanned at 3 mm/second across the stone in a preprogrammed pattern for 30 seconds at 2.5 W (0.5 J x 5 Hz) for both short-pulse (SP) and Moses distance (MD) modes. Temperature of the fluid was recorded using two thermocouples once per second.Results: Control trials produced no stone ablation, while experimental trials produced a staccato groove in the stone surface, simulating efficient lithotripsy. The mean temperature increase for SP was 1.08 degrees C +/- 0.04 degrees C for control trials and 0.98 degrees C +/- 0.03 degrees C for experimental trials, yielding a mean temperature difference of 0.10 degrees C +/- 0.06 degrees C (p = 0.0005). With MD, the mean temperature increase for control trials was 1.03 degrees C +/- 0.01 degrees C and for experimental trials 0.99 degrees C +/- 0.06 degrees C, yielding a smaller mean temperature difference of 0.04 degrees C +/- 0.06 degrees C (p = 0.09).Conclusions: Even under conditions of energy-efficient stone ablation, the majority of applied laser energy (91%-96%) was converted to heat.