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.
Methods: 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