SPIE Proceeding - 7883B-49 - MoXy Fiber With Active Cooling Cap

Please verify that (1) all pages are present, (2) all figures are acceptable, (3) all
fonts and special characters are correct, and (4) all text and figures fit within the
margin lines shown on this review document. Return to your MySPIE ToDo list and approve or disapprove this submission.
MoXy Fiber with Active Cooling Cap for Bovine Prostate

Vaporization with High Power 200W 532 nm Laser
Steven Yihlih Peng, Hyun Wook Kang, Homa Pirzadeh, and Douglas Stinson
American Medical Systems -- San Jose, CA
ABSTRACT
A novel MoXyTM fiber delivery device with Active Cooling Cap (ACCTM) is designed to
transmit up to 180W of 532 nm laser light to treat benign prostatic hyperplasia (BPH). Under
such high power tissue ablation, effective cooling is key to maintaining fiber power transmission
and ensuring the reliability of the fiber delivery device To handle high power and reduce fiber
degradation, the MoXy fiber features a larger core size (750 micrometer) and an internal fluid
channel to ensure better cooling of the fiber tip to prevent the cap from burning, detaching, or
shattering during the BPH treatment. The internal cooling channel was created with a metal cap
and tubing that surrounds the optical fiber. In this study MoXy fibers were used to investigate
the effect of power levels of 120 and 200 W on in-vitro bovine prostate ablation using a 532 nm
XPSTM laser system. For procedures requiring more than 100 kJ, the MoXy fiber at 200W
removed tissue at twice the rate of the current HPS fiber at 120W. The fiber maintained a
constant tissue vaporization rate during the entire tissue ablation process. The coagulation at
200W was about 20% thicker than at 120W. In conclusion, the new fibers at 200W doubled the
tissue removal rate, maintained vaporization efficiency throughout delivery of 400kJ energy, and
induced similar coagulation to the existing HPS fiber at 120W.
Key words: MoXy fiber, active cooling cap, 532 nm Laser, vaporization, in-vitro, bovine
prostate
7883B - 49 V. 1 (p.1 of 10) / Color: No / Format: Letter / Date: 2010-12-16 01:44:05 PM
SPIE USE: ____ DB Check, ____ Prod Check, Notes:

Please verify that (1) all pages are present, (2) all figures are acceptable, (3) all fonts and special characters are correct, and (4) all text and figures fit within the
1. INTRODUCTION
Benign prostate hyperplasia (BPH) is a condition in which excessive growth of stromal tissue in
the prostate obstructs urine passage, causing various urological symptoms such as decreased
stream, incomplete urination, nocturia, and urgency [1]. The condition affects more than 50% of
men at age 60 or older, and approximately 400,000 identified BPH patients are treated surgically
each year in US [2]. Numerous surgical therapies have been implemented to treat obstructive
BPH, and the application of laser light has gained a wide acceptance as a minimally invasive
therapeutic modality providing low peri-operative morbidity and good hemostasis [3-4]. Among
various wavelengths tested, 532 nm with its strong absorption of oxyhemoglobin and blood
vessels in prostate has demonstrated favorable and durable clinical outcomes [5]. Due to its
selective light absorption, laser prostatectomy with 532 nm became known as photoselective
vaporization of the prostate (PVP) [6].
To expedite PVP procedures, a laser with a high power of 120W was introduced in 2006,
and used in several studies that presented desirable outcomes [7-9]. However, even at this power
level, PVP for large prostates remains time consuming [9]. Although higher power can shorten
PVP time for large prostate glands, one of the major technical challenges is an optical fiber that
can deliver such high power laser light efficiently and safely. A recent long-term clinical study
demonstrated that due to geometrical limitations in large prostates, fiber degradation resulting
from tissue contact often occurred, eventually protracting PVP procedures [10]. In addition,
Hermmans et al. presented quantitative data showing laser fiber degradation during 120-W PVP
[11,12]. They utilized 25 fibers clinically and took measurements of output power through each
fiber every 25 kJ. It was reported that optical transmission dropped by around 40% after the
initial application of 50 kJ. There was further, slow reduction in transmission through the
remainder of the procedure [12]. Devitrification of fiber glass initiated by frequent tissue contact
and debris attachment could account for the reduction of output power, leading to decreasing
efficiency of tissue ablation.

XyTM fiber was

In order to overcome these issues, a novel internally-cooled MoX
developed. Addition of an interrnal flow channel along the fiber can provide cooling as well as
self-cleaning functions, which aare expected to minimize fiber degradation. Therefore,
T in this
study, the MoXy and HPS fibeers were compared by emulating PVP procedu
ures in vitro, and
measuring transmission and the ccorresponding ablation rate in vitro.
2. MOXY FIBER
R and TISSUE ABLAION EXPERIME
ENTS
Figure 1 shows the design conceppt of MoXy fiber. In order to handle high poweer and reduce
fiber degradation, MoXy featuress a) large fiber core diameter of 750 µm, compaared to the
existing 600 µm of HPS fiber, b)) an internal cooling channel to expel tissue debrris and prevent
fiber degradation. The MoXy fiiber is designed for insertion through a cystoscop
pe such that the
fiber tip can be positioned proxim
mate to a treatment location. A saline bag is con
nnected with a
luer lock connector to the fiber ffluid channel to provide saline for cooling the fib
ber. This is in
addition to the saline bag that proovides irrigation through the cystoscope in the saame manner as
practiced previously.
Figure 1. MoXy fiber design conncept
Bovine prostatic tissue w

was used in our study due to its structural sim
milarity to human
prostate. Entire lower urinary ttracts were obtained from a local slaughterhousse. For the light

source, an experimental Q-switched 532-nm laser was employed for the current in vitro study.
Two different side-firing fibers were used to transmit laser light: a conventional 600 µm-core
HPSTM fiber (American Medical Systems, Inc., MN, USA) and the newly developed 750 µm-
core MoXyTM fiber. The HPS fiber delivered 120W, which is the maximum power setting
available from the HPS laser. In the case of the MoXy fiber, 120 and 200W were used to
evaluate its performance in comparison with the HPS fiber.
Experiments consisted of two parts: optical transmission measurement and ablation

volume assessment. For optical transmission, the entire bovine urinary tract was situated in a
long cylindrical tube in order to emulate a clinical PVP setting. A 23-French cystoscope,
attached to an endoscopic camera, was introduced through the urethra, and each fiber was
inserted through the cystoscope. The fiber tip, positioned at around 2 mm distance from the
prostatic tissue surface, was swept within sequential 30º to 40º arcs to ablate the tissue under
visual guidance. Under saline irrigation, tissue ablation started distal to bladder neck, carried out
systematically throughout the cavity, simulating PVP technique in man, and ended at the level of
the verumontanum. The entire procedure continued until the total energy delivered was 400 kJ.
Fiber optical transmission through the fiber tip was measured with a power meter (Ophir Optical
Power Meter Head, Model L30A) when the total energy reached 0 (reference), 50, 100, 200, 300,
and 400 kJ.
Immediately after the transmission measurement at each energy level, the same fiber was
used to ablate tissue for volume assessment. 2.5×2.5 cm specimens were prepared from fresh
bovine prostatic tissue and kept for 4 hours in saline at 4ºC to minimize dehydration and
structural changes. Prior to light irradiation, each specimen was placed with its exposed
epithelial side up in a custom-made metal tissue holder. A metal plate with two square apertures
of 1.5×0.5 cm, was superimposed over the specimen with slight compression to secure it in
position and to obtain a flat epithelial surface for the two portions of the tissue that were
visualized through the apertures. During ablation experiments, the tissue holder was submerged
in saline, and a constant saline flow at 5.6 ml/min was applied to the ablation spot to mimic
clinical PVP. Laser light delivered through the fiber moving at the speed of 4 mm/s ablated each
tissue specimen to create two 1.5-cm long grooves. The distance between the fiber tip and tissue
surface was maintained at 2 mm. Five measurements of each groove were made at each power

level (N=10 for ablation volume at each energy). To measure ablated volume the tissue was
cross-sectioned into 10 pieces. Each tissue cross-section was imaged by a digital camera (9.1M
DSC-H50, Sony Corp., Japan), and each cross-sectional area was measured with Image J
(National Institute of the Health, Bethesda, MD, USA). All the measured areas from each
specimen were integrated to quantify the total ablation volume.
3. RESULTS AND DISCUSSION
3.1 Tissue ablation rate comparison
Figure 2 displays the overall tissue ablation rate as a function of total energy delivered.
For MoXy fibers with both 120 and 200W, the tissue removal rate is almost constant up to 400
kJ of energy delivered. However, the tissue vaporization rate of the HPS fiber at 120W drops
~30% and ~50% at 100 and 300 kJ, respectively. The tissue removal rate of MoXy fiber starts
to double that of HPS fiber after 100 KJ, and the ratio continues to increases beyond 100 kJ
When delivering the same power as the HPS fiber (120W), the MoXy fiber shows
slightly lower tissue ablation rate for the first 50 kJ probably due to its lower delivered power
density than that of HPS fiber owing to the MoXy fiber’s larger core diameter. But after 50 kJ,
because of degradation of the HPS fiber, the MoXy fiber ablates at a faster rate than the HPS
fiber.

Tissue Ablation Rate Comparison

60
50
Ablation Rate (mm3/sec)
40 MoXy_200W
30
MoXy_120W
20
HPS_120W
10
0
0 100 200 300 400 500
Energy (kJ)
Figure 2. Bovine prostate tissue ablation rate of the MoXy and HPS fibers.
3.2 Cross-sectional images of ablated bovine prostate tissue
Figure 3 presents representative ablation craters induced by HPS and MoXy fibers (120W
and 200W) as a function of the energy delivered through the fiber. For the HPS fiber, the
ablation crater depth and width decrease as a function of fiber delivered energy. Unlike the HPS
fiber, the crater depth and width of the MoXy at 120W retains similar dimension through the
whole procedure up to 400kJ. When the power is increased to 200W, the MoXy fiber creates a
relatively wide crater with larger ablation area. The coagulation zone for 200W is slightly
increased, about 20% thicker than at 120W.
.

Figure 3. Cross-sectional imagess of bovine prostate tissue ablated with MoXy an

nd HPS fibers as
a function of energy delivered thhrough the respective fibers.
3.3 Change in fiber power delivery
Figure 4 shows the changge in fiber %Transmission as a function of deliivered energy for
HPS and MoXy fibers. At 120W
W, HPS fibers show a decrease in %Transmission
n as a function of
energy delivered due to glass capp material degradation. MoXy fibers at 120W shows almost no
change up to 200kJ and less thaan 10% change up to 400kJ. At 200W, MoXy
y has about 10%
transmission degradation at 200kkJ, and remains relative constant between 200 an
nd 400kJ.

Change of Fiber %Transmission

100%
MoXy_120W
90%
MoXy_200W
Relative %Transmission
80%
70%
HPS_120W
60%
50%
40%
30%
20%
10%
0%
0 100 200 300 400 500
Energy (kJ)
Figure 4. Change in fiber %Transmission of MoXy and HPS fibers.
4. CONCLUSIONS
The newly developed MoXy fibers with active cooling cap (ACC) were used to investigate the
effect of power levels of 120 and 200 W on in-vitro bovine prostate ablation using an
experimental 532 nm laser system. For comparison, HPS fibers at 120W used with an HPS laser
system were also included in this study. For procedures requiring more than 100kJ, the MoXy
fiber at 200W removes tissue at twice rate of the current HPS fiber at 120W due to its better fiber
cooling design that minimums fiber power degradation. The tissue removal rate of MoXy fiber at
200W is almost unchanged up to 400kJ. The MoXY fibers delivered 200W of 532-nm laser to
ablate bovine prostate tissue efficiently. Compared to 120W, the coagulation thickness at 200W

increased slightly, by about 20%. In conclusion, the new MoXy fiber at 200W doubled the
tissue removal rate, maintained the ablation efficiency throughout 400kJ of energy delivery, and
induced similar coagulation in comparison with the existing HPS fiber at 120W.

REFERENCES
1. R. S. Kuntzmann, R. S. Malek, and D. M. Barrett, “High-power potassium titanyl phosphate

laser vaporization prostatectomy,” Mayo Clinic Proc. 73, 798-801 (1998).
2. S. J. Berry, D. S. Coffey, P. C. Walsh, and L. L. Ewing, “The development of human benign
prostatic hyperplasia with age,” J. Urol. 132, 474-479 (1984).
3. R. M. Hoffman, R. MacDonald, J. W. Slaton, and T. J. Wilt, “Laser prostatectomy versus
transurethral resection for treating benign prostatic obstruction: a systematic review,” J. Urol.
169, 210-215 (2003).
4. A. E. Te, “Current state of the art photoselective vaporization prostatectomy: laser therapy
for benign prostatic hyperplasia,” Prostate Cancer Prostatic Dis. 10, S2-S5 (2007).
5. R. S. Malek, R. S. Kuntzman, and D. M. Barrett, “Photoselective potassiumtitanyl-phosphate
laser vaporization of the benign obstructive prostate: observations on long-term outcomes,” J.
Urol. 174, 1344-1348 (2005).
6. R. S. Malek and K. Nahen, “Photoselective vaporization of the prostate: KTP laser therapy of
obstructive benign prostatic hyperplasia,” AUA Update Series 23, 153-159 (2004).
7. H. Woo, O. Reich, A. Bachmann, B. Choi, E. Collins, J. de la Rosette, F. G. Sancha, G.
Muir, and S. Tabatabaei, “Outcome of GreenLight HPS 120-W Laser therapy in specific
patient populations: those in retention, on anicoagulants, and with large prostates (≥ 80 mL),”
Eur. Urol. 7 (suppl), 378-383 (2008).
8. M. Spaliviero, M. Araki, and C. Wong, “Short-term outcomes of Greenlight HPSTM laser
photoselective vaporization prostatectomy (PVP) for benign prostatic hyperplasia (BPH),” J.
Endourol. 22, 2341-2347 (2008).
9. R. Ruszat, M. Seitz, S. F. Wyler, G. Müller, M. Rieken, G. Bonkat, T. C. Gasser, O. Reich,
A. Bachmann, “Prospective single-centre comparison of 120-W diode-pumped solid-state
high-intensity system laser vaporization of the prostate and 200-W high-intensive diode-laser
ablation of the prostate for treating benign prostatic hyperplasia,” BJUI Int. 104, 820-825
(2009).
10. R. Ruszat, M. Seitz, S. F. Wyler, C. Abe, M. Rieken, O. Reich, T. C. Gasser, and A.
Bachmann, “Greenlight laser vaporization of the prostate: single-center experience and long-
term results after 500 procedures,” Eur. Urol. 54, 893-901 (2008).
11. T. Hermanns, T. Sulser, M. K. Baumgartner, M. Fatzer, J. M. Rey, M. W. Sigrist, and H.
Seifert, “Intra-operative power measurement of laser fibers during photoselective
vaporization of the prostate using the 80W-KTP-Greenlight laser,” Proc. SPIE 6842, 684211-
1-9 (2008).
12. T. Hermanns, T. Sulser, L. J. Hefermehl, D. Strebel, M. Michel, M. Muntener, A. H. Meier,
and H. Seifert, “Loss of power output and laser fiber degradation during 120 Watt lithium-
triborate HPS laser vaporization of the prostate,” Proc. SPIE 7161, 716111-1-10 (2009).

SPIE Proceeding - 7883B-49 - MoXy Fiber With Active Cooling Cap

Caricato da

Informazioni sul documento

Descrizione originale:

Titolo originale

Copyright

Formati disponibili

Condividi questo documento

Condividi o incorpora il documento

Opzioni di condivisione

Hai trovato utile questo documento?

Questo contenuto è inappropriato?

Copyright:

Formati disponibili

SPIE Proceeding - 7883B-49 - MoXy Fiber With Active Cooling Cap

Caricato da

Copyright:

Formati disponibili

Please verify that (1) all pages are present, (2) all figures are acceptable, (3) all

MoXy Fiber with Active Cooling Cap for Bovine Prostate

American Medical Systems -- San Jose, CA

7883B - 49 V. 1 (p.1 of 10) / Color: No / Format: Letter / Date: 2010-12-16 01:44:05 PM

SPIE USE: ____ DB Check, ____ Prod Check, Notes:

7883B - 49 V. 1 (p.2 of 10) / Color: No / Format: Letter / Date: 2010-12-16 01:44:05 PM

SPIE USE: ____ DB Check, ____ Prod Check, Notes:

XyTM fiber was

Figure 1. MoXy fiber design conncept

Bovine prostatic tissue w

SPIE USE: ____ DB Check, ____ Prod Check, Notes:

Experiments consisted of two parts: optical transmission measurement and ablation

7883B - 49 V. 1 (p.4 of 10) / Color: No / Format: Letter / Date: 2010-12-16 01:44:05 PM

SPIE USE: ____ DB Check, ____ Prod Check, Notes:

3. RESULTS AND DISCUSSION

3.1 Tissue ablation rate comparison

7883B - 49 V. 1 (p.5 of 10) / Color: No / Format: Letter / Date: 2010-12-16 01:44:05 PM

SPIE USE: ____ DB Check, ____ Prod Check, Notes:

Tissue Ablation Rate Comparison

3.2 Cross-sectional images of ablated bovine prostate tissue

7883B - 49 V. 1 (p.6 of 10) / Color: No / Format: Letter / Date: 2010-12-16 01:44:05 PM

SPIE USE: ____ DB Check, ____ Prod Check, Notes:

Figure 3. Cross-sectional imagess of bovine prostate tissue ablated with MoXy an

3.3 Change in fiber power delivery

7883B - 49 V. 1 (p.7 of 10) / Color: No / Format: Letter / Date: 2010-12-16 01:44:05 PM

SPIE USE: ____ DB Check, ____ Prod Check, Notes:

Change of Fiber %Transmission

Figure 4. Change in fiber %Transmission of MoXy and HPS fibers.

7883B - 49 V. 1 (p.8 of 10) / Color: No / Format: Letter / Date: 2010-12-16 01:44:05 PM

SPIE USE: ____ DB Check, ____ Prod Check, Notes:

7883B - 49 V. 1 (p.9 of 10) / Color: No / Format: Letter / Date: 2010-12-16 01:44:05 PM

SPIE USE: ____ DB Check, ____ Prod Check, Notes:

1. R. S. Kuntzmann, R. S. Malek, and D. M. Barrett, “High-power potassium titanyl phosphate

7883B - 49 V. 1 (p.10 of 10) / Color: No / Format: Letter / Date: 2010-12-16 01:44:05 PM

SPIE USE: ____ DB Check, ____ Prod Check, Notes:

Potrebbero piacerti anche

SPIE USE: DB Check, Prod Check, Notes:

SPIE USE: DB Check, Prod Check, Notes:

SPIE USE: DB Check, Prod Check, Notes:

SPIE USE: DB Check, Prod Check, Notes:

SPIE USE: DB Check, Prod Check, Notes:

SPIE USE: DB Check, Prod Check, Notes:

SPIE USE: DB Check, Prod Check, Notes:

SPIE USE: DB Check, Prod Check, Notes:

SPIE USE: DB Check, Prod Check, Notes:

SPIE USE: DB Check, Prod Check, Notes: