energy sources in urology
TRANSCRIPT
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Energy Sources in Urology
-Dr. Shubham Lavania
30/06/2017
“HEAT CURES WHEN EVERYTHING ELSE FAILS”- Hippocrates
Tissue Dissection and CauterizationIntracorporeal LithotriptersESWL
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• Electrosurgery ??Classification -Type of Generator Used:A. Simple generator: mono/ Bipolar cauteryB. Advanced Bipolar System:
I. LigasureII. PK systemIII. Enseal
C. UltrasonicD. Integrated US & ABSE. Argon Beam coagulatorF. LasersG. Others: radiofrequency, microwave, Cryo
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Mono polar: •Circuit•100 W of power to the tissue at voltages ranging from 100 to 5000 volts•Cut, Coagulate, blend•Fulgration , dessiccation
Bipolar:Circuit
Safety: 1. Patient pad placement2. Demodulated current (250-2000KHz)3. Direct application4. Direct coupling5. Insulation failure6. Capacitative coupling
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Ligasure:-
• Combines pressure and energy
• Uses higer current & low voltage
• Vs upto 7mm
Gyrus PK tissue management sysytem:-
• Vapour pulse coagulation
Enseal:-
• Patented blade & smart electrode technology
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Physics of US:
2types: Low power: CUSA
High power(55.5 kHz): Harmonic– Working
– Advantage
Integrated US and ABG: Thunderbeat
Argon beam Coagulation: uses radiofrequency electrical energy.
• Properties of Argon
• Non contact, monopolar electrothermalhemostases.
• Use/ drawback
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Radiofrequency ablation: probe+ radiofrequency generator= >100⁰C
Use in tumor ablation
Microwave ablation: ultra high speed (2450MHz) alternating field current.
Cryotherapy: rapid cooling of cell and thawing.
Limited uses
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Lasers• “light amplification by stimulated emission of
electromagnetic radiation.”
• Each wave exists as a bundle of energy
• Properties :– Monochromatic
– Coherent
– Directionality
• Pulsed or continous
• The power of the laser is equal to the energy over time
• Light-Tissue Interaction-
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Types of LasersNeodymium:Yttrium-Aluminum-Garnet:
– wavelength of 1064 nm
– Penetration- 1 cm
Potassium Titanyl Phosphate– wavelength to 532 nm
Holmium:YAG– 2140-nm pulsed laser
– Ts pene-0.5mm
Thulium:YAG– 2000 nm
– Diode laser
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Intracorporeal Lithotripters
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Extracorporeal Shock wave Lithotripsy
Physical Principles
• Shock wave focusing-sufficient strength only at the target (F2)
• Generator type:
1. Electro hydrolic
2. Electro megnetic
3. peizoelectric
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Imaging Systems
1. Fluoroscopy
2. Ultrasound
3. Combined
Anesthesia
• discomfort experienced~energy density & size of F2
• Narcotic, sedative-hypnotics
• EMLA cream
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•shock wave profile•Mechanics of stone fragmentation1. Spall fracture2. Squeezing-splitting or
circumferential compression3. Shear stress4. Superfocusing5. Cavitation6. Dynamic fracture process
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Bioeffects: Clinical Studies• Acute extra renal damage: Liver, spleen pancreas,
cardiac, muscles.• Acute Renal Injury: hematuria, subcapsular
hematoma• Chronic Renal Injury: systemic blood pressure,
↓renal function, ↑ rate of stone recurrence, and the induction of brushite stone disease
Risk Factors for Shock Wave Lithotripsy• Age Obesity• Coagulopathies Thrombocytopenia• Diabetes mellitus Coronary heart disease• Preexisting hypertension
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Aggravating Factors• Number of shocks• Period of shock wave administration: Shorter period
increases damage• Accelerating voltage: Higher voltage increases damage• Type of shock wave generator: First- versus
second/third-generation devices• Kidney size: Juvenile versus adult• Preexisting renal impairmentMitigating Factors• Pretreatment with 100 to 500 shocks at low energy
level to reduce lesion size• Treatment at a slow rate of shock wave delivery (≤60
shocks/min)
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AUA Recommendations• Clinicians should inform patients that SWL is the
procedure with the least morbidity and lowest complication rate. S R; Grade B
• Routine stenting should not be performed in patients undergoing SWL. S R;Grade B
• In symptomatic patients with a total non-lower pole renal stone burden ≤ 20 mm, clinicians may offer SWL or URS. SR grade B
• Clinicians should offer SWL or URS to patients with symptomatic ≤ 10 mm lower pole renal stones
• In pediatric patients with a total renal stone burden ≤20mm, clinicians may offer SWL or URS as first-line therapy. MR; Grade C
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