Dusting is Efficacious and Safe with a 30-Watt Laser
Eric Jung, MD, Ohad Kott, MD, Osama Al-Alao, MD, Alejandra Balen, MD, Timothy O'Rourke, MD, Meredith Wasserman, MD, Christopher Tucci, RN, Gyan Pareek, MD
Minimally Invasive Urology Institute, The Miriam Hospital; Department of Urology, The Warren Alpert Medical School of Brown University, Providence, RI
It has been reported that 100-Watt lasers may shorten operative and lasing times leading to higher efficiency during ureteroscopic laser lithotripsy (URSL) and costs savings. At our institution, 30-Watt lasers are utilized for ureteroscopic cases. In this study, we sought to compare our institutions experience with 30-Watt lasers in the domains of cost-effectiveness and operating times to reported 100-Watt laser data from literature.
We identified 246 adult patients who underwent URSL at our institution between March 1, 2017 to September 1, 2017. Cases were included if their pre-operative stone burden was measured using standard non-contrast CT imaging and if post-operative imaging for residual stone burden assessment showed complete stone free status. All cases started with a similar stone fragmentation laser setting of 0.8 J and 8 Hz. Dusting cases followed with a 0.4 J and 25 Hz setting. Basketing cases included stone fragment extraction. We compared the operating time in our cohort to recently published data from the EDGE research group that compared dusting vs. basketing using a high-power holmium laser (Humphreys et al. J Urol. 2018 May).
101 patients met the inclusion criteria and were stone free post URSL. 39 cases used basketing with 200 nm laser (30.8%) and 365 nm laser (69.2%). 62 cases dusted the stones using 200 nm laser (27.4%) and 365 nm laser (72.6%). Mean operative time of URSL cases dusting the stones (mean size 52.85 mm2) was 35.4 minutes. Mean operating time of URSL cases using basketing of stones (mean size 50.69 mm2) with 30-Watt was 50.4 minutes.
Data from the EDGE research group depict mean operative time in URSL cases using dusting of stones (mean size 96.1 mm2) with 100 Watt is 35.9 minutes. No significant time difference was found when comparing mean operating times of the EDGE group study and our cohort. In addition, mean operative time of URSL cases using basketing of stones (mean size 63.3 mm2) with 100 Watt is 67.4 minutes.
In this study, ureteroscopic stone treatment using 30-Watt laser was efficacious and did not prolong operating time compared to dusting with a 100-Watt laser. Considering the price difference between the high and low power lasers, we estimate the yearly costs savings in our institution to be around $100,000. Operative time difference may be noticed in cases involving very large stone burden. However, when comparing the potential benefits of an expensive advanced laser, it is important to consider that actual time and cost savings may not be achieved, especially if operating time savings does not allow the addition of another surgical case to the schedule. In addition, basketing of kidney stones was found to prolong the operating time in our institution and therefore should be used in selected cases.
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