Are we all doing it wrong? Influence of stripping and cleaving methods of laser fibers on laser lithotripsy performance.

PURPOSE We assessed whether stripping and cleaving the laser fiber tip with specialized tools, namely laser fiber strippers, or ceramic or metal scissors, would influence lithotripsy performance. MATERIALS AND METHODS Laser fiber tips were stripped with a specialized laser fiber stripper or remained coated. The tips were then cleaved with metal or ceramic scissors. Laser lithotripsy experiments were performed with the 4 fiber tip combinations using an automated laser fragmentation testing system with artificial stones made of plaster of Paris or BegoStone Plus (Bego, Lincoln, Rhode Island). High frequency-low pulse energy (20 Hz and 0.5 J) and low frequency-high pulse energy (5 Hz and 2.0 J) settings were used for 30 seconds. Fissure width, depth and volume, and laser fiber tip photos were analyzed. RESULTS Coated laser fiber tips always achieved significantly higher ablation volumes (sometimes greater than 50%) than stripped laser fiber tips (p <0.00001) regardless of cleaving scissor type, stone material or lithotripter setting. Coated fiber tips cleaved with metal scissors ablated as well as those cleaved with ceramic scissors (p = 0.16). However, stripped fibers were much less ablative when they were cut with metal scissors compared to ceramic scissors (p <0.00001). Harder stone material decreased ablation volume (p <0.00001). Low frequency-high pulse energy settings were an average of 3 times more ablative than high frequency-low pulse energy settings (p <0.00001). Stripping the fibers, a harder stone material and low frequency-high pulse energy settings were associated with increased fiber tip degradation. CONCLUSIONS Coated laser fibers provided better lithotripsy performance and metal scissors were as good as ceramic scissors to cleave coated fibers. This knowledge may improve and simplify the way that laser lithotripsy procedures are done worldwide.