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TAIPEI, TAIWAN (UroToday.com) - Introduction and Objectives: The LithAssist (Cook Medical, Bloomington IN) is a new disposable handle, which integrates laser fiber use with on- demand suction, attempting to enhance user control and fragment clearance. Our objective was to evaluate LithAssist’s (LA) usability and efficacy using in vitro calyceal and bladder stone models.

wceMethods: Bego stones (1 cm) were used in calyceal models, whereas bladder models used large (2.5–3 cm) rehydrated uric acid stones. LA was inserted through the working channel of a 24Fr nephroscope and connected to suction. The device was tested using 1000lm laser fiber at two settings (L1: 0.8 J/8 Hz, L2: 0.2 J/20 Hz), and the pneumatic StoneBreaker (Cook Medical, SB). The handle was removed and a bare laser fiber (L3: 0.8 J/8 Hz) and Cyberwand (CW) were tested. Three trials (60 s/ trial) were repeated for each.

Results: Calyceal Stone: CW had the greatest residual stone dry weight reduction (CW 8.9%, L1 2.48%, L2 3.57%, SB 0.41%, L3 0.91% p < 0.001). SB produced the greatest number of fragments/stone (SB 12.13, CW 6.01, L1 3.17, L2 0.92, L3 0.94 p = 0.031). Similar findings were observed for the larger soft bladder stones, though dusting was significantly more effective than fragmentation settings with and without the handle (L2 2.1% vs L1 0.4%, L3 0.01% p = 0.021).

Conclusions: During rigid nephroscopy the LithAssist provides straightforward control of the laser fiber and on-demand suction, while eliminating the need for assistance with suction. Dusting settings appear more appropriate with the LA, however the efficacy of laser lithotripsy for larger stones remains limited – with or without the use of this device.

Source of Funding: None

 

 
View an interview with Sri Sivalingam, one of the authors of this study.

 

Presented by Shubha De, Mohamed Omar, Manoj Monga, and Sri Sivalingam at the 32nd World Congress of Endourology & SWL - September 3 - 7, 2014 - Taipei, Taiwan

Cleveland Clinic, Cleveland, OH USA

 

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