Ho:YAG laser and temperature: is it safe to use high-power settings?

The study conducted by Peteinaris and colleagues [1] assessed the impact of both Ho:YAG laser settings and intraoperative irrigation conditions on the irrigation fluid temperature (IFT) in a porcine model. IFT was measured in a real-time manner (1 count/s) and the time to reach a critical temperature rise (i.e., ≥ 54 °C) was recorded for each scenario. The authors confirmed the “thermal” safety of low-power settings, and concluded that the safest “thermal” configuration for high-power settings during flexible ureter-oscopy (fURS) is represented by the insertion of a ureteral access sheath (UAS) and the use of forced irrigation. The authors should be commended for completing this animal study, which represents one of the few available in vivo mod-els of IFT assessment during fURS. They measured IFT in a real-time manner in an anatomical system similar to the human one, also simulating the effect of ventilation during the surgical procedure.