Holmium laser lithotripsy is the endoscopic treatment in which a holmium:YAG laser fibre fragments a urinary stone under direct vision. This article explains what laser lithotripsy is, how contact fragmentation, dusting and popcorning differ, what equipment a kidney stones laser lithotripsy service needs and which points the surgeon and nursing team should plan together. It is a technical overview for OR teams, not treatment advice.
What is laser lithotripsy?
In laser lithotripsy a thin optical fibre is passed through the working channel of a ureteroscope and placed against the stone. Pulses of laser energy break the stone into fragments or fine dust. The holmium:YAG laser works at about 2100 nm, a wavelength strongly absorbed by water, so the energy acts in a very short range and reaches the stone surface without needing deep tissue penetration.
Because the fibre is flexible, the method can reach stones in the ureter and throughout the kidney when combined with a flexible ureteroscope. The same laser can also be used in the percutaneous route through a nephroscope. Choosing between routes is a clinical decision; see PCNL vs RIRS for how teams frame the choice.
Fragmentation, dusting and popcorning
Three working styles are common. Fragmentation uses higher pulse energy at low frequency to break the stone into pieces that are then removed with a basket. Dusting uses lower energy and higher frequency to reduce the stone to fine particles that can be left to pass. Popcorning moves the fibre in a cavity to make fragments circulate and strike each other.
The surgeon selects the style according to stone size, composition and location, and the laser must let them tune energy, frequency and pulse width. Practical starting values are discussed in holmium laser settings for lithotripsy. Fibre size matters too, as small fibres preserve scope deflection and irrigation, while large ones carry more energy.
Laser, fibres and scopes for kidney stones laser lithotripsy
A complete set contains the laser, sterile fibres in several diameters, a ureteroscope (semi-rigid and flexible), a camera and light system, irrigation, an access sheath, baskets and graspers, and laser safety equipment. Richard Wolf's MegaPulse 70+ is a 70 W holmium:YAG laser, 2100 nm, with 0.2–5 J pulse energy and 3–60 Hz frequency. It provides Lithotripsy, Soft Tissue and Expert modes, a pulse width selectable from 50 to 1100 µs in Expert mode, RFID detection of the sterile fibre and its diameter, and a double-pedal footswitch.
On the scope side, the COBRA and BOA flexible sensor endoscopes work with the ENDOCAM Logic 4K platform. COBRA has a 3.6 Fr working channel and a separate 2.4 Fr laser channel for fibres up to 365 µm, plus a laser shifter that fixes and positions the fibre, so laser lithotripsy and stone extraction can run in parallel. BOA is a super-slim single-channel scope with an 8.7 Fr shaft that fits access sheaths of 9.5 Fr or larger. Both reach 270° deflection up and down.
Safety and OR workflow
Laser safety follows IEC 60825-1 principles: a controlled area, signage on the doors, appropriate eyewear for every person present, and a trained laser safety officer. Keep the fibre in standby when it is not in front of the stone, and never fire the laser unless the tip is visible in the scope. A blast shield, standby footswitch and automatic fibre-port shutter, as on MegaPulse 70+, add practical protection.
Plan irrigation pressure and flow, because high pressure raises the risk of backflow, and make sure the nurses know how to prepare the fibre, strip and cleave it as required, and how to check the fibre tip. Prepare a plan for fibre breakage and for retrieving stones that migrate.
Setting up a service in the UAE
Before a hospital or day-surgery centre in Dubai, Abu Dhabi or Sharjah starts a laser stone service, confirm facility licensing with DHA or DOH where applicable and the registration status of each device with the competent authority. Then plan room layout, installation, training and maintenance with the supplier.
Beckfinity can supply the MegaPulse 70+ with flexible scopes and arrange installation and training. Request a quote or consultation from our specialists to configure a laser lithotripsy set for your department.
Frequently asked questions
What is holmium laser lithotripsy?
It is an endoscopic procedure in which a holmium:YAG laser fibre, passed through a ureteroscope or nephroscope, breaks a urinary stone into fragments or dust.
Can holmium lasers treat kidney stones as well as ureteral stones?
Yes, when combined with a flexible ureteroscope or a percutaneous nephroscope. The route depends on the stone and the clinical decision.
What is the difference between dusting and fragmentation?
Fragmentation breaks the stone into pieces removed with a basket, while dusting produces fine particles that can pass naturally.
Which fibre size should be used?
It depends on the scope channel and the technique. For example, the COBRA laser channel accepts fibres up to 365 µm. Follow the instructions for use of the scope and fibre.
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