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Lasers in Medicine: Healing with Light
Published in Suzanne Amador Kane, Boris A. Gelman, Introduction to Physics in Modern Medicine, 2020
Suzanne Amador Kane, Boris A. Gelman
One use of the extremely rapid photovaporization made possible by pulsed lasers is a technique called photodisruption. Photodisruption effectively generates a small-scale explosion at the laser beam, sending forth shock waves that tear tissues apart and break up hard deposits. In laser lithotripsy, this effect is used to break up gallstones and stones in the urinary tract. The small pieces of the shattered stones can then either be passed by the patient or removed laparoscopically.
Non-Malignant Large Bowel Obstruction
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Janet T. Lee, Genevieve B. Melton
Ingested or rectally inserted foreign bodies can lead to large bowel obstruction. Bezoars or large gallstones can sometimes lead to obstruction as well. If clinically stable, endoscopic removal can be attempted but may occasionally necessitate surgical removal. If the cause of obstruction is a large impacted gallstone, intracoporeal laser lithotripsy or endoscopic mechanical lithotripsy can also be performed to break up the stone.65
The urinary bladder
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Ultrasound lithotripsy is extremely safe but appropriate only for small stones. Laser lithotripsy with the holmium laser can deal with most large stones. Once small fragments are produced, the optical lithotrite can be used to finish the job. For evacuation of the fragments, fluid (200 mL) is introduced into the bladder. The evacuator, filled with solution, is fitted on to the sheath. The bulb is compressed slowly and then permitted to expand; the returning solution carries with it fragments of stone.
Donor kidney lithiasis and back-table endoscopy: a successful combination
Published in Acta Chirurgica Belgica, 2023
Michaël M. E. L. Henderickx, Joyce Baard, Pauline C. Wesselman van Helmond, Ilaria Jansen, Guido M. Kamphuis
Literature on the back-table treatment of nephrolithiasis in renal allografts is scarce. A literature search on PubMed (Medline) resulted in eight articles describing this specific procedure, as presented in Table 1. A total of 76 procedures were described in these eight papers [4,6–12]. Semi-rigid, as well as flexible URS, were used to reach the stone. Baskets and forceps in combination with laser lithotripsy were used to retrieve the stone. The overall complication rate was low with 7.5% minor complications and only one major complication. The literature review shows that the post-transplant stone-free rate varied between 89% and 100%. More importantly, Schade et al. did not find a stone in the collecting system in four of the 23 patients (17%) [9]. Olsburgh et al. encountered the same problem in six out of there 17 patients (35%) [11].
Photothermal nanoparticles for ablation of bacteria associated with kidney stones
Published in International Journal of Hyperthermia, 2021
Ilan Klein, Santu Sarkar, Jorge Gutierrez-Aceves, Nicole Levi
When exposed to near-infrared (NIR) light these NPs generate heat, which has been shown to be effective for bacterial ablation in vivo (unpublished data). The goal of the current project was to determine whether these NPs can c-localize with bacteria on artificial and patient-derived kidney stones, and evaluate the effect of heat, generated by NPs stimulated with NIR laser, on inactivating Escherichia coli bacteria. During laser lithotripsy, which is commonly used to break kidney stones and aid in their removal from the patient, intense laser sources of up to 120 W are used [41]. One of the challenges with such a technique is that powerful lasers may be more likely to disperse bacteria rather than apply sufficient heat for long enough to kill them, which may increase the risk of urosepsis. The goal of using NPs is twofold: (1) to develop a precise method of heating the bacteria/biofilm at the stone interface, which harbor pathogens and (2) to deliver the heat rapidly. For future clinical utility, we envision that polymer NPs can be delivered during percutaneous nephrolithotomy (PCNL) for direct interfacing with bacteria that reside in stone crevices. Following their delivery, low powered laser light could be delivered via a fiber optic catheter to stimulate thermal destruction of the bacteria prior to breaking of the kidney stone.
Prevention of stone retropulsion during ureteroscopy: Limitations in resources invites revival of old techniques
Published in Arab Journal of Urology, 2020
Tarek K. Fathelbab, Amr M. Abdelhamid, Ahmed Z.M. Anwar, Ehab M. Galal, Mamdouh M. El-Hawy, Ahmed H. Abdelgawad, Ehab R. Tawfiek
To guard against this problem, many devices have been used, e.g., the Stone Cone, N-Trap, Back stop, and Accordion. All these devices add extra cost to the procedure [4,5]. Laser lithotripsy is associated with the lowest incidence of stone retropulsion. Because of the widespread use of laser lithotripsy, retropulsion prevention using additional devices has dramatically decreased in many centres. Nevertheless, its high cost has limited its use in countries with modest resources. Many hospitals in different parts of the developing world do not have sufficient resources to cover the price of a laser machine and its running costs. For this reason, we suggest the revival of an old technique of disassembly of a Dormia basket to prevent stone retropulsion during ureteroscopic pneumatic lithotripsy.