What is holmium laser technology, and why is it so common in urology? A holmium:YAG laser is a pulsed solid-state laser that emits invisible infrared light at about 2.1 micrometres, a wavelength strongly absorbed by water. Delivered through a thin optical fibre, it can fragment stones and cut or coagulate soft tissue during endoscopic surgery. This article explains the principle, the key settings and what to consider when evaluating a system.
How a holmium laser works
In a holmium:YAG laser, a crystal doped with holmium ions is pumped by a flash lamp and emits light at 2100 nm. The beam is coupled into a flexible silica fibre and carried through the working channel of an endoscope to the target. The laser is pulsed rather than continuous, which concentrates energy in short bursts.
Water in tissue and in the surrounding fluid absorbs this wavelength strongly, so the energy is deposited within a fraction of a millimetre of the fibre tip. This limits penetration into deeper tissue and is why the fibre is kept in close contact or very near the target. It is also the basis for the holmium laser wavelength's value in soft-tissue work.
Settings: energy, frequency, power and pulse width
The main parameters are pulse energy (joules), frequency (hertz) and pulse width. Average power equals energy multiplied by frequency, so a given power can be reached with high energy at low frequency or the reverse. MegaPulse 70+ offers 70 W, 0.2 to 5 J and 3 to 60 Hz at 2100 nm.
The choice of settings changes how the laser behaves: higher energy per pulse tends to fragment, higher frequency and lower energy tends to dust. MegaPulse 70+ has Lithotripsy, Soft Tissue and Expert modes, with pulse width selectable from 50 to 1100 µs in Expert mode. Surgeons choose settings according to their technique; see holmium laser settings for lithotripsy.
What the holmium laser is used for in urology
The holmium laser is used for lithotripsy of stones in the ureter, kidney and bladder, for incising strictures, for resecting or vaporising soft tissue and for holmium laser endoscopic surgery on the prostate. Enucleation of the prostate (HoLEP) is a major application, and MegaPulse 70+ is designed for stone treatment and soft-tissue work including HoLEP in BPH.
Related reading: holmium laser lithotripsy and HoLEP equipment. Whether to use a laser for a given patient is a clinical decision made by the surgeon.
Holmium laser efficiency and fibres
Efficiency in practice depends on the fibre and the delivery. Fibre diameter, quality of the cleaved tip and the bend in the endoscope all affect energy transmission. MegaPulse 70+ uses RFID detection of the sterile fibre and its diameter, so the system recognises what is connected, and an automatic fibre-port shutter supports one-handed operation.
Use only fibres approved for your laser, replace them according to the manufacturer's instruction and avoid sharp bends. Ask about fibre sizes, reusable versus disposable options and cost per case. See our holmium laser fibre guide.
Safety and evaluation
Holmium lasers are Class 4 devices. Everyone in the room needs eyewear rated for the wavelength, the room needs warning signs and the fibre should be in standby when not in use. Follow IEC 60825-1 principles and your laser safety officer's rules. A blast shield and a footswitch with standby help safe handling.
When evaluating a system, consider power, modes, footprint, cooling, service support and fibre costs. MegaPulse 70+ measures 595 x 1200 x 1074 mm, weighs 200 kg and has a foldable 12-inch touch screen. Beckfinity can arrange a demonstration and quotation; contact our specialists. For a wider view see holmium laser price.
Frequently asked questions
What wavelength does a holmium laser use?
A holmium:YAG laser emits at about 2100 nm (2.1 micrometres), a wavelength that water absorbs strongly.
What is a holmium laser used for?
In urology it is used for stone lithotripsy, incision of strictures, soft-tissue work and prostate enucleation.
How is laser power calculated?
Average power is pulse energy multiplied by frequency, for example 1 J at 20 Hz gives 20 W.
Is the holmium laser safe?
It is a Class 4 laser and safe only when proper precautions are followed: wavelength-rated eyewear, controlled access and trained staff.
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