Biomedical subjects

A J Welch

Publications and source records attributed to A J Welch.

At least 55 records · Page 3Linked to original sources

PubMed1999

Holmium:YAG laser lithotripsy: A dominant photothermal ablative mechanism with chemical decomposition of urinary calculi.

BACKGROUND AND OBJECTIVE: Evidence is presented that the fragmentation process of long-pulse Holmium:YAG (Ho:YAG) lithotripsy is governed by photothermal decomposition of the calculi rather than photomechanical or photoacoustical mechanisms as is widely thought. The clinical Ho:YAG laser lithotriptor (2.12 microm, 250 micros) operates in the free-running mode, producing pulse durations much longer than the time required for a sound wave to propagate beyond the optical penetration depth of this wavelength in water. Hence, it is unlikely that shock waves are produced during bubble formation. In addition, the vapor bubble induced by this laser is not spherical. Thus the magnitude of the pressure wave produced at cavitation collapse does not contribute significantly to lithotripsy. STUDY DESIGN/MATERIALS AND METHODS: A fast-flash photography setup was used to capture the dynamics of urinary calculus fragmentation at various delay times following the onset of the Ho:YAG laser pulse. These images were concurrently correlated with pressure measurements obtained with a piezoelectric polyvinylidene-fluoride needle-hydrophone. Stone mass-loss measurements for ablation of urinary calculi (1) in air (dehydrated and hydrated) and in water, and (2) at pre-cooled and at room temperatures were compared. Chemical and composition analyses were performed on the ablation products of several types of Ho:YAG laser irradiated urinary calculi, including calcium oxalate monohydrate (COM), calcium hydrogen phosphate dihydrate (CHPD), magnesium ammonium phosphate hexahydrate (MAPH), cystine, and uric acid calculi. RESULTS: When the optical fiber was placed perpendicularly in contact with the surface of the target, fast-flash photography provided visual evidence that ablation occurred approximately 50 micros after the initiation of the Ho:YAG laser pulse (250-350 micros duration; 375-400 mJ per pulse), long before the collapse of the cavitation bubble. The measured peak acoustical pressure upon cavitation collapse was negligible (< 2 bars), indicating that photomechanical forces were not responsible for the observed fragmentation process. When the fiber was placed in parallel to the calculus surface, the pressure peaks occurring at the collapse of the cavitation were on the order of 20 bars, but no fragmentation occurred. Regardless of fiber orientation, no shock waves were recorded at the beginning of bubble formation. Ablation of COM calculi (a total of 150 J; 0.5 J per pulse at an 8-Hz repetition rate) revealed different Ho:YAG efficiencies for dehydrated calculus, hydrated calculus, and submerged calculus. COM and cystine calculi, pre-cooled at -80 degrees C and then placed in water, yielded lower mass-loss during ablation (20 J, 1.0 J per pulse) compared to the mass-loss of calculi at room temperature. Chemical analyses of the ablated calculi revealed products resulting from thermal decomposition. Calcium carbonate was found in samples composed of COM calculi; calcium pyrophosphate was found in CHPD samples; free sulfur and cysteine were discovered in samples composed of cystine samples; and cyanide was found in samples of uric acid calculi. CONCLUSION: These experimental results provide convincing evidence that long-pulse Ho:YAG laser lithotripsy causes chemical decomposition of urinary calculi as a consequence of a dominant photothermal mechanism.

Holmium↗

PubMed1999

Radiometric surface temperature measurements during dye-assisted laser skin closure: in vitro and in vivo results.

BACKGROUND AND OBJECTIVE: A thermal camera was used to measure surface temperatures during laser skin welding to provide feedback for optimization of the laser parameters. STUDY DESIGN/MATERIALS AND METHODS: Two-centimeter-long, full-thickness incisions were made in guinea pig skin in vitro and in vivo. India ink was applied to the incision edges, which were then mechanically apposed. Continuous-wave, 1.06-microm Nd:YAG laser radiation was scanned over the incisions, producing an effective pulse duration of approximately 100 msec. Cooling durations between scans of 1.6, 4.0, and 8.0 sec were studied in vitro. A 5-mm-diameter laser spot was used with the power kept constant at 10 W. Thermal images were obtained at 30 frames per second with a thermal camera detecting 3-5 microm radiation. Surface temperatures were recorded at 0, 1, and 6 mm from the center line of the incision. RESULTS/CONCLUSIONS: Cooling durations of 1.6 and 4.0 seconds in vitro resulted in temperatures at the weld site that remained above approximately 65 degrees C for prolonged periods of time. Cooling durations of 8.0 seconds were sufficient both in vitro and in vivo to prevent a significant rise in baseline temperatures at the weld site over time.

Animals↗

PubMed1999

Photothermal effects of laser tissue soldering.

Low-strength anastomoses and thermal damage of tissue are major concerns in laser tissue welding techniques where laser energy is used to induce thermal changes in the molecular structure of the tissues being joined, hence allowing them to bond together. Laser tissue soldering, on the other hand, is a bonding technique in which a protein solder is applied to the tissue surfaces to be joined, and laser energy is used to bond the solder to the tissue surfaces. The addition of protein solders to augment tissue repair procedures significantly reduces the problems of low strength and thermal damage associated with laser tissue welding techniques. Investigations were conducted to determine optimal solder and laser parameters for tissue repair in terms of tensile strength, temperature rise and damage and the microscopic nature of the bonds formed. An in vitro study was performed using an 808 nm diode laser in conjunction with indocyanine green (ICG)-doped albumin protein solders to repair bovine aorta specimens. Liquid and solid protein solders prepared from 25% and 60% bovine serum albumin (BSA), respectively, were compared. The efficacy of temperature feedback control in enhancing the soldering process was also investigated. Increasing the BSA concentration from 25% to 60% greatly increased the tensile strength of the repairs. A reduction in dye concentration from 2.5 mg ml(-1) to 0.25 mg ml(-1) was also found to result in an increase in tensile strength. Increasing the laser irradiance and thus surface temperature resulted in an increased severity of histological injury. Thermal denaturation of tissue collagen and necrosis of the intimal layer smooth muscle cells increased laterally and in depth with higher temperatures. The strongest repairs were produced with an irradiance of 6.4 W cm(-2) using a solid protein solder composed of 60% BSA and 0.25 mg ml(-1) ICG. Using this combination of laser and solder parameters, surface temperatures were observed to reach 85+/-5 degrees C with a maximum temperature difference through the 150 microm thick solder strips of about 15 degrees C. Histological examination of the repairs formed using these parameters showed negligible evidence of collateral thermal damage to the underlying tissue. Scanning electron microscopy suggested albumin intertwining within the tissue collagen matrix and subsequent fusion with the collagen as the mechanism for laser tissue soldering. The laser tissue soldering technique is shown to be an effective method for producing repairs with improved tensile strength and minimal collateral thermal damage over conventional laser tissue welding techniques.

Animals↗

PubMed1999

Holmium: YAG lithotripsy: photothermal mechanism.

OBJECTIVE: A series of experiments were conducted to test the hypothesis that the mechanism of holmium:YAG lithotripsy is photothermal. METHODS AND RESULTS: To show that holmium:YAG lithotripsy requires direct absorption of optical energy, stone loss was compared for 150 J Ho:YAG lithotripsy of calcium oxalate monohydrate (COM) stones for hydrated stones irradiated in water (17+/-3 mg) and hydrated stones irradiated in air (25+/-9 mg) v dehydrated stones irradiated in air (40+/-12 mg) (P < 0.001). To show that Ho:YAG lithotripsy occurs prior to vapor bubble collapse, the dynamics of lithotripsy in water and vapor bubble formation were documented with video flash photography. Holmium:YAG lithotripsy began at 60 microsec, prior to vapor bubble collapse. To show that Ho:YAG lithotripsy is fundamentally related to stone temperature, cystine, and COM mass loss was compared for stones initially at room temperature (approximately 23 degrees C) v frozen stones ablated within 2 minutes after removal from the freezer. Cystine and COM mass losses were greater for stones starting at room temperature than cold (P < or = 0.05). To show that Ho:YAG lithotripsy involves a thermochemical reaction, composition analysis was done before and after lithotripsy. Postlithotripsy, COM yielded calcium carbonate; cystine yielded cysteine and free sulfur; calcium hydrogen phosphate dihydrate yielded calcium pyrophosphate; magnesium ammonium phosphate yielded ammonium carbonate and magnesium carbonate; and uric acid yielded cyanide. To show that Ho:YAG lithotripsy does not create significant shockwaves, pressure transients were measured during lithotripsy using needle hydrophones. Peak pressures were <2 bars. CONCLUSION: The primary mechanism of Ho:YAG lithotripsy is photothermal. There are no significant photoacoustic effects.

Analysis of Variance↗

PubMed1999

Three-dimensional reconstruction of blood vessels from in vivo color Doppler optical coherence tomography images.

PURPOSE: Current laser treatment for vascular disorders such as port wine stains can have incomplete or unacceptable results. A customized treatment strategy based on knowledge of the patient's blood vessel structure may effect an improved clinical outcome. PROCEDURE: We tested the feasibility of using color Doppler optical coherence tomography (OCT) and image processing techniques to locate, measure and reconstruct cutaneous blood vessels in rat and hamster skin. OCT is a recent, potentially noninvasive technique for imaging subsurface tissue structures with micrometer scale resolution. RESULTS: Blood vessels were identified in a series of cross-sectional images, then a three-dimensional reconstruction was made. Parameters that can affect optimum laser treatment parameters, such as average blood vessel depth and luminal diameter, were found from the images. CONCLUSION: This study shows that color Doppler OCT is a potential tool for improving laser treatment of vascular disorders.

Animals↗

PubMed1999

Spectrally resolved white-light interferometry for measurement of ocular dispersion.

Spectrally resolved white-light interferometry was used to measure the wavelength dependence of refractive index (i.e., dispersion) for various ocular components. Verification of the technique's efficacy was substantiated by accurate measurement of the dispersive properties of water and fused silica, which have both been well-characterized in the past by single-wavelength measurement of the refractive index. The dispersion of bovine and rabbit aqueous and vitreous humors was measured from 400 to 1100 nm. In addition, the dispersion was measured from 400 to 700 nm for aqueous and vitreous humors extracted from goat and rhesus monkey eyes. An unsuccessful attempt was also made to use the technique for dispersion measurement of bovine cornea and lens. The principles of white-light interferometry, including image analysis, measurement accuracy, and limitations of the technique, are discussed. In addition, alternate techniques and previous measurements of ocular dispersion are reviewed.

Animals↗

PubMed1999

Laser fluence for permanent damage of cutaneous blood vessels.

Treatment of vascular disorders may be improved by a more thorough understanding of laser-blood vessel interaction. In this study, the probability of permanent damage to a given type and size of blood vessel was determined as a function of fluence at the top (superficial edge) of the vessel lumen. A 532 nm wavelength, 10 ms pulse duration, 3 mm spot size laser was used to perform approximately 250 irradiations of subdermal blood vessels in the hamster dorsal skin flap preparation. The radiant exposure required for a 50% probability of permanent damage was calculated using a probit analysis of experimental results. Threshold radiant exposure increased with larger blood vessel diameters and was greater for arterioles than venules. Monte Carlo modeling of a typical blood vessel geometry revealed that fluence at the top of the blood vessel lumen was amplified by a factor of approximately 2.4 over tissue surface radiant exposure, due to light scattering in the tissue and internal reflection at the skin-air interfaces.

Animals↗

PubMed1998

Imaging of the irradiation of skin with a clinical CO2 laser system: implications for laser skin resurfacing.

BACKGROUND AND OBJECTIVE: Several published reports describe the benefits of using the carbon dioxide laser for cutaneous resurfacing. The mechanisms on which skin resurfacing work are still not completely understood. This study was performed to obtain quantitative and qualitative information describing the thermal response of skin during high-energy, short-pulsed CO2 laser irradiation. STUDY DESIGN/MATERIALS AND METHODS: A Tissue Technologies TruPulse CO2 laser was used to irradiate an in vivo rat model. The laser parameters that were used were a 100-micros pulse width, a 1-Hz repetition rate, a 3 mm x 3 mm square spot size, and 2.4 J/cm2 and 3.9 J/cm2 radiant exposures. A 3-5 microm thermal camera was used to obtain temperature information during irradiation. Single spots were irradiated with one pulse, and the temperature-time history was obtained. In a different experiment, 15 pulses were applied to single spots, and both thermal and video images were obtained. RESULTS: Irradiation with one pulse at 2.4 J/cm2 and 3.9 J/cm2 led to peak temperatures >100 degrees C. The temperature relaxation time was approximately 25-150 ms. Multiple-pulse irradiation at 2.4 J/cm2 led to a slight rise in the peak temperature with each pulse. At 3.9 J/cm2, the peak temperature increased with successive pulses until pulse 10, after which the peak temperature oscillated between 300 and 400 degrees C. Video images showed concurrent burning events that occurred during pulses 10-15. CONCLUSION: Temperatures >100 degrees C were measured during CO2 laser irradiation of skin. Pulse stacking can lead to peak temperatures approaching 400 degrees C and to tissue charring with as few as three stacked pulses. It is crucial for the physician to manipulate the laser handpiece at parameters with which he or she can avoid pulse overlap.

Animals↗

PubMed1998

Laser assisted soldering: microdroplet accumulation with a microjet device.

BACKGROUND AND OBJECTIVE: We investigated the feasibility of a microjet to dispense protein solder for laser assisted soldering. STUDY DESIGN: Successive micro solder droplets were deposited on rat dermis and bovine intima specimens. Fixed laser exposure was synchronized with the jetting of each droplet. After photocoagulation, each specimen was cut into two halves at the center of solder coagulum. One half was fixed immediately, while the other half was soaked in phosphate-buffered saline for a designated hydration period before fixation (1 hour, 1, 2, and 7 days). After each hydration period, all tissue specimens were prepared for scanning electron microscopy (SEM). RESULTS: Stable solder coagulum was created by successive photocoagulation of microdroplets even after the soldered tissue exposed to 1 week of hydration. CONCLUSIONS: This preliminary study suggested that tissue soldering with successive microdroplets is feasible even with fixed laser parameters without active feedback control.

Animals↗

PubMed1997

Propagation of fluorescent light.

BACKGROUND AND OBJECTIVE: In general, the remitted fluorescence spectrum is affected by the scattering and absorption properties of tissue. Other important factors are boundary conditions, geometry of the tissue sample, and the quantum yield of tissue fluorophores. Each of these factors is examined through a series of Monte Carlo simulations. STUDY DESIGN/MATERIALS AND METHODS: Monte Carlo modeling is used to simulate the propagation of excitation light and the resulting fluorescence. Remitted fluorescence is determined for semi-infinite single and multiple layer geometries and for cubic geometries representing small tissue samples. Monte Carlo results are compared to approximations obtained with a heuristic model. RESULTS: Remitted fluorescence as a function of (1) the depth of fluorescence generation and (2) radial escape position is presented for semi-infinite single and multiple layer geometries. Fluorescence from a small tissue sample is simulated in terms of a cubic geometry, and losses from the sides and bottom are presented as a function of cube dimensions in terms of optical depth of the excitation wavelength. Monte Carlo results for a homogeneous semi-infinite layer are compared to a simple, fast heuristic model. CONCLUSION: Both Monte Carlo simulations and the heuristic model clearly detail the volume of tissue interrogated by fluorescence. Since approximately 35-40% of the remitted fluorescence is due to photons originally directed away from the surface, distal layers affect the remitted fluorescence. Fluorescence spectra from small biopsy samples may not produce the correct line shape owing to wavelength dependent losses.

Aorta↗

PubMed1997

Controlled temperature tissue fusion: argon laser welding of rat intestine in vivo. Part one.

BACKGROUND AND OBJECTIVE: Thermal denaturation of proteins is recognized as a rate process governed by the local temperature-time response. Since rate processes are exponential with temperature, laser-assisted tissue welding was performed with and without temperature feedback control (TFC) to investigate the efficacy of temperature feedback in enhancing the photothermal welding process in vivo. STUDY DESIGN/MATERIALS AND METHODS: An automated system was developed for temperature feedback controlled laser irradiation. An experimental device incorporating co-aligned laser delivery and temperature detection was used to perform argon laser welded (with and without TFC) enterotomies. The weld strength and histology of laser welded and control sutured enterotomies were compared in an in vivo rat model. Animals (n = 41) were sacrificed at 1, 3, 7, and 21 days postoperatively, and the anastomotic site was removed for bursting/leaking pressure measurements and histological examination. RESULTS: Laser-welded (with and without TFC) and control sutured anastomoses in surviving animals healed comparably. Some laser-welded anastomoses without TFC ruptured spontaneously (4 out of 15) leading to the animals' death within the first 24-36 hours postoperatively. None of the animals in the other groups had this problem (control suture 0/6; laser with TFC 1 leak/8). The bursting/leaking pressures of the laser welded anastomoses were not significantly different than those of the sutured controls. CONCLUSION: TFC improves the quality of laser-welded rat intestinal anastomoses in vivo in the critical first postoperative 36 hours.

Anastomosis, Surgical↗

PubMed1997

Controlled temperature tissue fusion: Ho:YAG laser welding of rat intestine in vivo. Part two.

BACKGROUND AND OBJECTIVE: Temperature feedback control (TFC) during laser-assisted tissue welding was implemented to eliminate exponential increases in the rate of denaturation associated with rapidly increasing temperatures. This study was undertaken to investigate and compare the weld strengths and healing responses of laser welded enterotomies with and without TFC using a cw Ho:YAG laser and to examine the effects of wavelength on weld strength and histology. The Ho:YAG experimental results were compared with a similar study using cw argon ion laser irradiation. STUDY DESIGN/MATERIALS AND METHODS: An automated system was developed for temperature feedback controlled laser irradiation. An experimental device incorporating co-aligned laser delivery and temperature detection was used to perform cw Ho:YAG laser-welded enterotomies (with and without TFC). The weld strength and histology of laser welded and control sutured enterotomies were compared in an in vivo rat model (Ho:YAG, n = 42; argon, n = 41). Animals were sacrificed at 1, 3, 7, and 21 days postoperatively and the anastomotic site was removed for bursting/leaking pressure measurements and histological examination. RESULTS: Argon and Ho:YAG laser-welds with and without TFC and the control sutured anastomoses healed comparably, although wound abscesses were more prevalent in the Ho:YAG group leading to delay in mucosal healing. Laser-welded anastomoses without TFC were associated with more spontaneous ruptures and leaks (argon: 4/6 ruptures; Ho:YAG: 1/4 leak, 2/4 ruptures, & 1/3 stenosis) during the survival period than those with TFC (argon: 1/3 leak; Ho:YAG: 1/5 rupture). Bursting pressures of the Ho:YAG welds were weaker at 1 week than the argon welds, but by 3 weeks, laser welds and suture anastomoses were equally strong. CONCLUSION: From the spontaneous failure rates encountered, it is believed that TFC improves the quality and stability of laser-assisted enterotomy closures in surviving animals. However, TFC does not provide a satisfactory method to identify completion of a weld.

Anastomosis, Surgical↗

PubMed1997

Laser-tissue interaction during transmyocardial laser revascularization.

BACKGROUND: The clinical procedure known as transmyocardial revascularization has recently seen its renaissance. Despite the promising preliminary clinical results, the associated mechanisms are subject to much discussion. This study is an attempt to unravel the basics of the interaction between 800-W CO2 laser radiation and biological tissue. METHODS: Time-resolved flash photography was used to visualize the laser-induced channel formation in water and in vitro porcine myocardium. In addition, laser-induced pressures were measured. Light microscopy and birefringence microscopy were used to assess the histologic characteristics of laser-induced thermal damage. RESULTS: The channel depth increased logarithmically with time (ie, with pulse duration) in water and porcine myocardium. Pressure measurements showed the occurrence of numerous small transients during the laser pulse, which corresponded with channel formation, as well as local and partial channel collapse during the laser pulse. Twenty millimeters of myocardium was perforated in 25 ms. Increasing the pulse duration had a small effect on the maximum transversable thickness, but histologic analysis showed that thermal damage around the crater increased with increasing pulse duration. CONCLUSIONS: Several basic aspects of the interaction of high-power CO2 laser radiation with myocardial tissue and tissue phantoms were studied in vitro. Although the goal of this study was not to unravel the mechanisms responsible for the beneficial effects of transmyocardial revascularization, it provided important information on the process of channel formation and collapse and tissue damage.

Animals↗

PubMed1997

Monte Carlo model for determination of the role of heat generation in laser-irradiated tissue.

A Monte Carlo model is described for modeling photo propagation in a scattering medium. The fraction of locally absorbed photons is proportional to the local rate of heat generation in laser-irradiated tissue and the associated distribution of light (fluence rate) is obtained by dividing the rate of heat generation by the local absorption coefficient. Examples of computed distributions of the rate of heat generation are presented for situations where light scattering in tissue is important. The method is applied to analyze treatment of Port Wine Stain and the selection of laser wavelengths for cyclophotocoagulation.

Absorption↗

PubMed1997

Digital integrated retinal surgical laser system.

The year is 2001--ophthalmic retinal surgery is now fully computer assisted. Patients arriving for scheduled treatments of diabetic retinopathy, retinal tears, or macular degeneration have their retina digitally mapped by a technician. From the retinal map, the ophthalmologist plots therapeutic lesion sites with a light pen on the computer screen that will automatically be placed by a computer controlled argon laser. The treatment only requires 100 ms per lesion placement thus reducing office calls to approximately 45 minutes freeing the ophthalmologist for other pressing cases. This paper reports on the development of a clinically significant prototype system that will help bring this scenario to fruition.

Animals↗

PubMed1997

Hybrid retinal photocoagulation system using analog tracking.

We describe initial in vivo experimental results of a new hybrid digital and analog design for retinal tracking and laser beam control. An overview of the design is given. The results show in vivo tracking rates which exceed the equivalent of 38 degrees per second in the eye, with automated lesion pattern creation. Robotically-assisted laser surgery to treat conditions such as diabetic retinopathy and retinal breaks may soon be realized under clinical conditions with requisite safety using standard video hardware and inexpensive optical components based on this design.

Analog-Digital Conversion↗

PubMed1996

Light transport in tissue: Accurate expressions for one-dimensional fluence rate and escape function based upon monte carlo simulation.

BACKGROUND AND OBJECTIVE: Surface laser irradiation of tissue often produces a fluence rate that varies only with depth. Modeling of laser-induced fluorescence involves an expression for the fraction of fluorescence emitted per unit depth that escapes from the medium. We present accurate expressions for fluence rate and escape function for the one-dimensional case based upon Monte Carlo simulation results. STUDY DESIGN/MATERIAL AND METHODS: Expressions were proposed for fluence rate, phi (z)/E0 = C1exp (-k1z/delta)-C2exp(-k2z/delta), and escape function, G(z) = C3exp(-k3z/delta), that varied solely with depth relative to effective penetration depth, z/delta. The scalar (C) and exponential (k) coefficient values were found by curve fitting the expressions to Monte Carlo simulation results. RESULTS: The coefficients varied as smooth functions of diffuse reflectance, Rd, for the range Rd = 0.01-0.8, and were independent of scattering anisotropy in the range g = 0.7-0.9. Simple expressions approximated the relationship of each coefficient to Rd. CONCLUSION: The proposed expressions have accuracy comparable to Monte Carlo simulations, over an essentially unrestricted range of diffuse reflectance values. The expressions may be combined accurately to portray laser-induced fluorescence measurements of a turbid medium.

Fluorescence↗

PubMed1996

Effect of pulse duration on bubble formation and laser-induced pressure waves during holmium laser ablation.

BACKGROUND AND OBJECTIVE: One concern during laser ablation of tissue is the mechanical injury that may be induced in tissue in the vicinity of the ablation site. This injury is primarily due to rapid bubble expansion and collapse or due to laser-induced pressure waves. In this study, the effect of laser pulse duration on the thermodynamics of bubble formation and accompanying acoustic pressure wave generation has been investigated. STUDY DESIGN/MATERIALS AND METHODS: Q-switched holmium:YAG laser pulses (pulse duration 500 ns, pulse energy 14 mJ) and free-running holmium:YAG laser pulses (pulse duration 100-1,100 microseconds, pulse energy 200 mJ) were delivered in water and tissue phantoms via a 200- and 400-microns fiber, respectively. The tissue phantoms consisted of polyacrylamide gels with varying mechanical strengths. Bubble formation was recorded with a fast flash photography setup, while acoustic transients were measured with a needle hydrophone. RESULTS: It was observed that, as the pulse length was increased the bubble shape changed from almost spherical for Q-switched pulses to a more elongated cylinder shape for longer pulse durations. The bubble expansion velocity was larger for shorter pulse durations. Only the Q-switched pulse induced a measurable thermo-elastic expansion wave. All pulses that induced bubble formation generated pressure waves upon collapse of the bubble in gels as well as in water. However, the magnitude of the pressure wave depended strongly on the size and geometry of the induced bubble. CONCLUSION: The magnitude of the collapse pressure wave decreased as laser pulse duration increased. Hence it may be possible to reduce collateral mechanical tissue damage by stretching the holmium laser pulse.

Acoustics↗