INTRODUCTION Holmium laser lithotripsy is a standard energy source used for treatment of kidney stones during flexible ureteroscopy. Efficiency of laser surgery may be affected by patient and operator characteristics or perioperative management. Here, we sought to examine intraoperative data from patients undergoing high frequency dusting with high-powered holmium laser lithotripsy to evaluate surgical and demographic factors associated with lasing efficiency. METHODS A total of 82 intraoperative reports were analyzed from an ongoing laser lithotripsy clinical trial evaluating the Lumenis Pulse™ 120H holmium laser with renal stones up to 20mm in diameter with and without Moses 2.0 technology. For each case, the total pause time between lasing activations was corrected to remove lengthy pauses and divided by the total lasing time to calculate an efficiency percentage. This was then compared with patient demographics, anesthesia administration, stone burden, postoperative complications, and stone-free rates using both univariate and multivariate analyses. RESULTS Of the 82 included patients, 36 received endotracheal intubation (ETT) and 46 had a laryngeal mask airway (LMA). Patients with ETT had significantly higher lasing efficiency (78.7%) compared to those with an LMA (73.3%) in our univariate analysis (p < .01) as well as in the multivariate model that adjusted for maximum stone size, number of stones, stone density, and patient BMI (p < .05). There was also significantly higher mean lasing efficiency in patients with no postoperative complications (76.3%) compared to those with any grade (I-V) Clavien-Dindo complication within 30 days after surgery (70.0%) (p < .05). CONCLUSIONS Flexible ureteroscopy and laser lithotripsy (fURSL) cases with higher lasing efficiency are associated with lower rates of postoperative complications. The data also supports the use of ETT over LMA to improve overall lasing efficiency, however, this remains one consideration among many for choosing anesthesia administration.

中文翻译：

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影响钬激光效率的因素：肾结石输尿管镜检查时喉罩气道与气管插管的比较。

简介 钬激光碎石术是输尿管软镜检查期间用于治疗肾结石的标准能源。激光手术的效率可能会受到患者和操作者特征或围手术期管理的影响。在这里，我们试图检查接受高功率钬激光碎石术高频除尘的患者的术中数据，以评估与激光效率相关的手术和人口因素。方法 对正在进行的激光碎石临床试验中总共 82 份术中报告进行了分析，该试验评估了 Lumenis Pulse™ 120H 钬激光在使用和不使用 Moses 2.0 技术的情况下治疗直径达 20mm 的肾结石的效果。对于每种情况，校正激光激活之间的总暂停时间以消除长时间的暂停，并除以总激光时间来计算效率百分比。然后使用单变量和多变量分析将其与患者人口统计数据、麻醉管理、结石负担、术后并发症和无结石率进行比较。结果 在 82 名患者中，36 名接受了气管插管 (ETT)，46 名接受了喉罩气道 (LMA)。在我们的单变量分析 (p < .01) 以及调整最大结石尺寸、结石数量、结石密度和患者 BMI (p < .05)。与术后 30 天内出现任何 IV 级 Clavien-Dindo 并发症的患者 (70.0%) 相比，无术后并发症的患者 (76.3%) 的平均激光效率也显着更高 (p < .05)。结论 具有较高激光效率的输尿管软镜和激光碎石术 (fURSL) 病例与较低的术后并发症发生率相关。数据还支持使用 ETT 而非 LMA 来提高整体激光效率，然而，这仍然是许多选择麻醉管理的考虑因素之一。