<title>Use of the holmium:YAG laser in urology</title>

Abstract

The Holmium:YAG (Ho:YAG) laser operating at a wavelength of 2.1 micrometers with a maximum power of 15 watts (W) and 10 different pulse-energy settings was systematically evaluated on kidney, bladder, prostate, ureteral, and vasal tissue, and was used to perform various urologic surgical procedures (partial nephrectomy, transurethral laser incision of the prostate, and laser-assisted vasovasostomy) in the dog. By using the SurgiTome<SUP>TM</SUP> 3- inch straight delivery system with an energy-pulse setting of 0.5 joules (J) at 20 Hz (10 W), partial nephrectomies required slightly longer operating times (15 minutes) than when similar procedures were performed using the Neodymium:YAG (Nd:YAG) laser and a free GI fiber at 59 to 83 W (4 - 7 minutes); however, the total energy required was considerably less. Hemostasis was excellent and no sutures were required to control bleeding. Transurethral incisions of the prostate using TV monitoring were made at the 4 and 8 o'clock positions extending from the colliculus seminalis through the vesical neck with an energy/pulse setting of 1.0 J at 15 Hz (15 W). Attempts at laser-assisted vasovasostomies were unsuccessful due to excessive thermal affect. The LaparoTome<SUP>TM</SUP> Delivery System proved helpful in performing laparoscopic pelvic lymphadenectomy in the pig. Our investigations showed that the Ho:YAG laser possesses both excellent cutting and adequate hemostatic abilities even in a fluid medium. Although these results are preliminary, we believe that the Ho:YAG laser is well suited for urologic surgery and may well become the 'urologist's laser of the future.'