Fig. 2.

Surgical flow for photodynamic diagnosis (PDD)-guided dual laser ablation of renal pelvic tumors. (A) Examine the tumor under white light. (B) Examine the tumor spread with PDD. (C) Set the laser fiber as appropriate. (D) Penetrate the tumor with the laser fiber. (E) Ablate the tumor with a 15-W thulium:YAG laser while pulling it out, and repeat this procedure until the tumor becomes ischemic. (F) Resect the ischemic tumor using a holmium:YAG laser. (G) Remove the tumor fragments using a stone basket. (H) Identify the surgical margins and residual microtumors with PDD. (I) Ablate and resect residual tumors with both lasers. (J) Confirm that there are no PDD-positive tumors. f-URS = flexible ureteroscope.