Plasma bubble formation laser induced by holmium: an in vitro study.

OBJECTIVES: To use the elementary physical measurements of temperature and size to prove that the thermal effects produced by the holmium laser's pulses are due to the formation of a plasma bubble. The physical phenomenon related to high temperatures generated during procedures with the holmium laser (holmium:yttrium-aluminum-garnet) was the object of our interest. METHODS: Using a double micrometric slide attached to a 550-microm optic fiber and two thermocouples submerged in water, a series of pulses of 0.8 J at 10 to 30 Hz was delivered from a holmium:yttrium-aluminum-garnet laser, and we recorded temperatures on both frontal and lateral planes. Subsequently, samples of prostatic tissue and small stones were treated with 1.5 J at 20 Hz on both frontal and lateral planes. RESULTS: Treatment with 1.5 J at 30 Hz (frontal plane) and with 1.5 J at 20 Hz (lateral plane) produced the ablation of the structure of the thermocouple at 2 mm and 1 mm, respectively, indicating plasma formation. The dimensions of the bubble after the delivery of 1.5 J at 20 Hz was 2 x 1.5 mm. Coagulation of the prostatic tissue took place at 1 mm from the plasma bubble, on both frontal and lateral planes. CONCLUSIONS: The plasma bubble that forms at the tip of the fiber connected to the holmium:yttrium-aluminum-garnet laser makes it possible to work on stones and soft tissues. The coagulation of the prostatic tissue is caused by the hot water-vapor bubble that forms on the edge of the plasma bubble. During lithotripsy, guidewires and baskets within the expansion area of the plasma bubble risk damage.