INTEGRATED AND MINIATURIZED ENDOSCOPIC DEVICES FOR USE DURING HIGH POWER INFRARED FIBER LASER SURGERY
Abstract
The Thulium Fiber Laser (TFL) is currently being studied as a potential alternative to the conventional, solid-state Holmium:YAG laser (Ho:YAG) for the treatment of kidney stones. The TFL is an ideal candidate to replace the Ho:YAG for laser lithotripsy due to a higher absorption coefficient in water of the emitted wavelength, an ability to operate at high pulse rates, and a near single mode, Gaussian spatial beam profile. The higher absorption of the TFL wavelength by water translates to a decrease in ablation threshold by a factor of four. High pulse rate operation allows higher ablation rates than the Ho:YAG, thus decreasing operation time necessary to ablate the urinary stone. The Gaussian spatial beam profile allows the TFL to couple higher laser power into smaller optical fibers than those currently being used for Ho:YAG lithotripsy. This decrease in fiber diameter translates into a potential decrease in the size of ureteroscope working channel, higher saline irrigation rates for improved visibility and safety, and may also extend to a decrease in overall ureteroscope diameter. Furthermore, the improved spatial beam profile reduces the risk of damage to the input end of the fiber. Therefore, the trunk fiber, minus the distal fiber tip, may be preserved and re-used, resulting in significant cost savings. This thesis details rapid TFL lithotripsy at high pulse rates up to 500 Hz, both with and without the aid of a stone retrieval basket, in order to demonstrate the TFL’s superior ablation rates over the Ho:YAG. Collateral damage testing of the TFL effect on the ureter wall and Nitinol stone baskets were conducted to ensure patient safety for future clinical use. Proximal fiber end damage testing was conducted to demonstrate fiber preservation, critical for permanent fiber integration. Optical fibers were fitted with fabricated hollow steel tips and integrated with stone retrieval baskets for testing. Ball tipped optical fibers were tested to maintain ablation rates comparable to those of the 100-µm-core traditional fiber used in TFL lithotripsy while providing an additional safety feature for initial fiber insertion through the ureteroscope working channel.Working channel flow rates were explored in regards to diameter and geometry. Illumination sources and configurations were explored in regards to optimized wavelength selection as well as physical geometry of the ureteroscope tip. Ureteroscope designs were devised, modeled, fabricated, and tested, implementing a reduced working channel, and optimized illumination geometry, culminating in an integrated, miniaturized ureteroscope for use in TFL lithotripsy. This final device, coupled with the proven TFL and optimized laser parameters may establish the TFL as a viable replacement to the conventional Ho:YAG laser for treatment of kidney stones.