INTRODUCTION & OBJECTIVES:
During flexible ureteroscopy each situation requires different laser settings consisting of the right combination of 3 factors: energy, frequency and pulse duration. The aim of our study was to find out how the lasers interfaces are helping the user into fast taking the right decision and how much time it takes to apply these settings.
MATERIALS & METHODS:
12 medical students, residents and young specialists were enrolled in the study. Using images of different types of stones and urothelial tumours they were tought the correct laser settings for each situation and were instructed how to use each laser.We used 6 holmium lasers: Stone Light (AMS), Swiss LaserClast (EMS), Medilas H Solvo (Dornier), Lumenis Pulse 120H, Rocamed* and Calculase II (Storz). Only 3 of these lasers have the possibility of modulating the pulse duration (EMS, Lumenis, Rocamed).
The order of use for each laser was randomized. Videos of 5 different stones and 1 urothelial tumor were presented one by one in a randomized fashion. The participants had to choose the right settings and to activate the laser. On each stone, settings for "dusting" and "fragmentation" techniques were required, while for tumors only the settings for ablation were applied. Time from connecting the laser fiber until the first activation was recorded. Further on, we recorded the time needed for changing the settings in each situation. The correctitude of the setting selection was also evaluated. For each correct choice 1 point was attributed, for the wrong choice O points.
There are no significant differences between the compared lasers regarding the time needed for changing the settings, excepting a longer initialisation time for Lumenis.The fastest to use laser was Rocamed and the slowest AMS.
The time needed for each situation is presented in the table.
The summary for correctitude of choices is presented in the chart.
A carefully designed laser interface (Rocamed) improves the correctitude of choice, helping the urologist to take the right decision about the laser settings according to the type of stone and the applied technique. All the other lasers need to become more user friendly.
*The Rocamed laser is being sold by Cogentix Medical in the United States as the MH01 Holmium Laser.