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How can the holmium laser ablate tissue but also break stones without damaging the ureter?

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How can the holmium laser ablate tissue but also break stones without damaging the ureter?

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Q: What is the minimum size of fragments obtained with the holmium laser during lithotripsy? A: Very tiny pieces of stone can be removed during holmium laser lithotripsy. The debris in the irrigant giving the snowstorm effect with lithotripsy consists of stone “dust.” By maximizing this effect, a large volume of stone can be removed without having major fragments to retrieve or to pass.

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The minimal penetration of the laser energy into water or tissue (<0.5 mm) limits its effect. Careful visual positioning of the fiber with appropriate selection of the energy level gives extremely accurate control of the laser.

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