Preconceived Impressions Regarding Holmium:YAG Laser Safety in the Urology Operating Theatre

Abstract

Background

Since its introduction over two decades ago, the surgical laser has served in the lithotripsy of urinary calculi, resection of bladder tumours, bladder neck incisions, and prostate enucleation. Concerns regarding the safe use of holmium lasers have resulted in potentially excessive and overly precautious theatre regulations. We aimed to evaluate the preconceived impressions and practice patterns at a single site surrounding laser use in endourology.

Methods

We designed a three-part online questionnaire that could be accessed using a smart device or computer. This survey was distributed to all theatre staff involved in laser surgery at our single site, including surgical, nursing, and anaesthetic staff of varying seniority. It asked questions regarding holmium laser safety, provided an up-to-date summary of published literature surrounding the safe use of lasers, and finally gave participants further option to alter the answers to several previously encountered questions.

Results

A total of 54 theatre staff completed the survey, including 17 theatre nurses (31.5%), 10 urology consultants (18.5%), 8 urology registrars (14.8%), 7 anaesthetic registrars (13%), 4 anaesthetic consultants (7.4%). About 51.9% of participants believed that current laser safety protocols were adequate, with 38.9% finding them excessive. After reading recently published information on laser safety, 22.2% thought current laser safety measures were adequate (57% decrease) and 77.8% found them to be excessive (100% increase). About 74.1% of participants found that laser safety goggles impair their vision and that 79.6% would choose not to wear them if they were optional.

Conclusion

Strict laser safety guidelines reflect an overestimated risk associated with using holmium laser in operating theatres. Laser safety regulations should be re-evaluated to align with current research and potential hazards inherent to the device. In doing so, a more effective distribution of staff could enable greater access to laser surgery, thereby reducing patient morbidity and hospital wait times.

Keywords:

• endourology
• laser surgery
• holmium laser

Data Sharing Statement

Anonymised data are provided in supplementary file 2.

Ethics Statement

As this research survey involves low/negligible risk and only uses existing non-identifiable data, it is exempt from the Australian Human Resource Ethics Committee (HREC) review. This is in accordance with the Australian National Statement on Ethical Conduct in Human Research (2007) laws.

Consent

All participants gave informed consent prior to participation in the study.

Acknowledgments

The above abstract has been submitted and presented at the BJUI meeting.

Disclosure

The authors have no conflicts of interest to declare for this work.