Operating room noise hazards during laser lithotripsy: a comparison between the thulium fiber and holmium laser platforms

Purpose: To evaluate and assess the impact of noise hazard during laser lithotripsy using the gold standard holmium:YAG laser and the novel thulium fiber laser (TFL). Methods: Intraoperative noise measurements were obtained during ureteroscopy and laser lithotripsy from cases using both TFL and holmium laser. Readings were obtained from three key times: prior to laser activation, with the laser on but idle, and during laser activation. Questionnaires were circulated postoperatively to operating room staff regarding the effort required to perform tasks, concentrate, and communicate during the surgery. Results: Noise levels were compared from 16 TFL and 15 holmium laser lithotripsy cases from 11/2020 to 5/2021. Significantly higher noise levels were recorded during holmium lithotripsy, with a mean of 3.1 dB and 4.3 dB higher noise with the device idle and device active, respectively. When compared to baseline noise with the device off, the holmium laser had a significant rise in recorded dB where the TFL had no statistically significant rise in noise over baseline once the laser was turned on. Operating room team members rated the noise level lower and the level of effort required for concentration, communication, and task completion lower with the TFL. Conclusions: The TFL produces 3.1 to 4.3 dB less noise than the standard holmium laser, which, because of the logarithmic nature of the dB scale, translates into less than one half the overall noise energy. There was also less effort required by operating room staff to complete critical tasks during the quieter TFL cases.