A systematic review of the clinical efficacy and effectiveness of the holmium:YAG laser in urology

showing acceptable eBcacy for certain orthopaedic interIntroduction ventions. The eBcacy of a specific technique applied in specific circumstances is determined by factors related to Lasers occupy a significant position in almost all surgical specialities, as they represent an attractive alternative to characteristics of the technology, the surgical procedure and the condition being addressed, including the cellular many invasive and minimally invasive techniques. However, laser surgery is not a static discipline; on the or chemical attributes of the tissues involved. Thus, the level of clinical eBcacy must be assessed specifically for contrary, it is constantly evolving as new lasers are developed and introduced into the commercial market each surgical procedure and condition. Furthermore, eBcacy is a variable that measures the outcome of an [1,2], posing additional strains on surgeons’ abilities to cope with the newest advances. The holmium:YAG intervention under strictly controlled circumstances. The practical value of the eCect of the same technology, its (Ho:YAG) laser is one of the most recent introduced in urology, the use of which is becoming increasingly eCectiveness, is determined in practice by other issues. Attempting to measure the eCectiveness of the technolwidespread. A successful experience in orthopaedic surgery [3], together with an interesting combination of ogy best measures the real benefit obtained in routine practice. physical properties, supported its increasing popularity. However, its eBcacy (the extent to which a specific This review attempts to provide a systematic assessment of the clinical eBcacy and eCectiveness of the intervention, procedure, regimen or service produces a beneficial result under ideal conditions, ideally based on Ho:YAG laser in urology and is intended to aid the clinical (or management) decision-making process of the results of a randomized controlled trial, RCT) and eCectiveness (a measure of the extent to which a specific urologists, patients and others. The assessment was carried out by the Catalan Agency for Health Technology intervention, procedure, regimen or service, when deployed ‘in the field’ in routine circumstances, does Assessment (CAHTA) between October 1997 and July 1998, at the request of the Health Sciences Center, what is intended for a specified population) for urological indications have not yet been assessed. Winnipeg, Manitoba, Canada. The Ho:YAG laser shows promising advantages for the urologist; laser light at this wavelength can excise and Methodology ablate tissue with precision, providing suBcient coagulation, and can operate in fluid environments, accessing The assessment was based on a systematic review of the current evidence on the use of the Ho:YAG laser in remote body sites through flexible fibre-optic devices [4–6]. On these grounds, it can undoubtedly be conurology, i.e. a structured analysis of the available scientific literature to establish the level of eBcacy and sidered a ‘promising’ technology, not only in urology but also in many other disciplines. Indeed, one of the eCectiveness of the technology as reported by existing research studies. Systematic reviews assess the internal main advantages of this laser is its potential versatility, capable of being used in many disciplines, media and for and external validity of studies, by analysing aspects such as the study design, the sample size, the data many surgical indications, i.e. it has the potential, once its eCectiveness is confirmed, of becoming a cost-eCective analysis used, the precision of results, the pertinence and validity of the outcome variables, and the validity surgical instrument. However, ‘promising’ does not necessarily imply ‘eCective’, despite the Ho:YAG laser and reliability of measurement methods used. Additionally, other aspects related to the external validity include the characteristics of the patients and surgeons, Accepted for publication 23 February 1999