The solid-state, flashlamp-pumped Holmium: YAG (yttrium-aluminum-garnet) laser can remove tissue and make blood clot faster. It has been used since the 1960s in surgery, especially in urological applications.
The benefit of the 2100nm wavelength is that it is highly absorbed by tissue and water. When the laser beam is fired into an aqueous medium, a small amount of laser energy at the tip of the delivery fiber will boil the water immediately near it. The resulting vapor bubble contains the laser energy of the bubble, which is carried to the targeted tissue and vaporizes it.
The laser has a penetration of 0.4mm, which means around 90% of the laser energy is already absorbed at this depth. It leads to minimal damage to surrounding tissue in surgery and limits necrosis. The laser simultaneously cuts tissue and clots the blood vessels with the least charring compared with other cauterization methods. As a result, there is less inflammation and irritation following Holmium laser surgery.
Stones and tissue ablation
2100nm Holmium wavelength technology is now the standard of care for treating kidney stones and soft-tissue ablation by urologists. The procedures are minimally invasive, requiring no incision on the body. The surgeon inserts a flexible laser fiber through the urethra and the bladder to access the patient’s kidney or ureter to break up the stones.
The other alternative to using lasers for stones is to use shockwave lithotripsy, which uses sound waves from outside the body to break up stones in the body. But holmium lasers are effective on stones of any size, hardness, or location. That makes it a superior procedure to traditional lithotripsy and reduces the chances of steinstrasse, where stone fragments block the ureter.
The Holmium laser is cost-effective and works well on all stone compositions. New fiber-optic approaches make laser energy delivery safer with new designs and better flexibility for maximum ureteroscope deflection, better ablation efficiency, and higher saline irrigation rates, etc.
Holmium laser prostate surgery
The minimally-invasive holmium laser enucleation of the prostate (HoLEP) uses the laser to remove tissue blocking urine flow through the prostate. Another instrument is then used to cut the prostate tissue into fragments that can be easily removed. The surgery needs no incisions and is an excellent option for a severely enlarged prostate in a condition known as benign prostatic hyperplasia (BPH). Compared to traditional prostate surgery, HoLEP offers faster recovery and relief from symptoms.
Holmium lasers for orthopedics
Holmium lasers are used in a number of orthopedic procedures, such as discectomy, spinal decompression, capsular shift, tendon debridement, peripheral joint surgery, etc. The ease of using the laser in multiple scenarios, the small probe size, the ease of using Holmium with fiberoptics make it highly suitable for such procedures.
Holmium YAG lasers have wide applications in urology and tissue ablation and dentistry, orthopedic surgery, laser lithotripsy, and ENT therapies. Recent research has recommended the use of holmium lasers for safer and more effective circumcision in penile surgery. In dentistry, Holmium: YAG lasers are used for smoothing the surface of teeth and closing dental tubules. In gynecology, small vesicovaginal fistula or VVF may be managed with Holmium: YAG laser treatment.
The devices below use holmium laser technology and are popular for surgical procedures.
NS3000 StoneLight 30
Specs: 30W, 532 nm aiming beam, diode laser, fiber test port, 5 programmable memory buttons, built-in test control measure, and pinpoint precision.
Applications: Open, endoscopic, and laparoscopic incision, excision, ablation, resection, vaporization, hemostasis, coagulation of soft tissue in General Surgery, Urinary Lithotripsy, and Urology.
OMNIPULSE Jr™ 1230-30 Pulsed TRIMEDYNE
Specs: 30W, PRR 5 to 20 Hz, pulse duration 350 microsecond, adjustable max 5mW red aiming beam, 0.2 to 3.5 J energy per pulse, no pre-calibration required, cooled with self-contained air/water, integrated fiber power output verification energy detection.
Applications: Small footprint and economy, ideal for lithotripsy.
OMNIPULSE MAXL 1210-VHP TRIMEDYNE
Specs: Holmium: YAG pulsed solid-state laser, 0.2 to 3.5 J energy per pulse, PRR 5 to 60 Hz, 350 microseconds (single pulse mode), 0.4 to 7.0 J per pulse, PRR 3 to 30 Hz, 700 microseconds (double pulse mode); cooling self-contained air/water, adjustable 5mQ red aiming beam, integrated fiber power output verification. No pre-calibration is needed.
Applications: Urology, lithotripsy, lumbar, thoracic & cervical discs, orthopedics, ENT, gynecology, general surgery, GI surgery.
HO: YAG BLAZE 35 Allengers
Specs: Flash lamp-pumped, max 35 W optical power, pulse frequency 5 to 20 Hz, green 532 Nm aiming beam, temperature-controlled close water system, and 7-inch display touch.
Applications: Lithotripsy, PCNL, RIRS, urethrotomy tumor excision, TUIP, general surgery.
Lumenis MOSES Pulse 120H
Specs: 120W, 4th gen tech, dual pulse, up to 6 J energy per pulse, max PRR 120 Hz,
Application: Ideal for urology, lithotripsy, PCNL, etc.
Lumenis Pulse 100H
Specs: 100W, PRR up to 50 Hz, energy per pulse up to 3.5J.
Applications: Urology, BPH, stones, tumors, strictures, ENT, General Surgery, Gynecology, Pulmonary Surgery
Lumenis Pulse 50H
Specs: 50W, PRR up to 25 Hz, energy per pulse up to 3.5J. 0.2J energy per pulse minimizes stone migration—embedded homeostasis capabilities.
Applications: BPH, stones, tumors, strictures, GI, ENT, orthopedic, thoracic & pulmonary procedures, Gynecology, Plastic surgery, and Dermatology
Lumenis Pulse 30H
Specs: 30W, PRR up to 25Hz, energy per pulse of 5 J. High res 7-inch screen, green aiming beam with 5 intensities, summary report saving last 10 treatments.
Applications: Urology, arthroscopy, urinary lithotripsy, head & neck surgery, Gynecology, General Surgery, GI, etc.
VersaPulse PowerSuite 100W (Lumenis)
Specs: 100W, PRR up to 50Hz., energy per pulse 2J/ 50 Hz, aiming beam 2.5 mW at 650 nm, 3 intensity settings.
Applications: HoLAP, bladder stone fragmentation, BPH
VersaPulse 80/100W (Lumenis)
Specs: Dual Wavelength system combines 80 W Holmium and 100W Nd: YAG lasers for high energy & strong coagulation applications. PRR 5-40 Hz, energy per pulse 2J/40 Hz, aiming beam 2.5 mW at 650 nm.
Applications: BPH, tumors, stones, strictures, pulmonology, etc.
VersaPulse 60W (Lumenis)
Specs: 60W, PRR 5-40 Hz, energy per pulse 1.5J/40 Hz, 3 intensity settings, pulse duration up to 600 microseconds, cooling self-contained water to air exchanger.
Applications: Stones, BPH, tumors, GI, Pulmonology, Orthopedics, etc.
Medilas H 20 H 100 (Dornier)
Specs: Holmium YAG laser 20W/ 100W
Applications: Treatment of stones and soft tissue, lithotripsy, BPH, and HoLEP
Dornier MedTech Systems
Medilas H 140, Medilas H Solvo machines for HoLEP and Lithotripsy.