Ureteroscopic Performance of High Power Super Pulse Thulium Fiber Laser for the Treatment of Urolithiasis: Results of the First Case Series in North America

Carrera, Raphael; Randall, J.; Garcia-Gil, Maurilio; Knudsen, Bodo E.; Chew, Ben H.; Thompson, Jeffrey; Humphreys, Mitchell R.; Molina, Wilson

doi:10.1016/j.urology.2020.12.054

Cited by 16 publications

(19 citation statements)

References 17 publications

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“…median stone volume of 1800 mm 3 and > 1000 HU [9], around 6 min for mean stone size of 16.5 AE 6.8 mm and 880 AE 381 HU [10], median LOT of 10.8 AE 14.1 min for stone volume >500 mm 3 and of >800 HU [16], around 34 min for renal stones with stone size of 13.1 mm and average stone density of 926 HU [17] and median LOT of 2.8 min for a median stone volume 279.6 and >1000 HU [18]. From the 5 clinical trials mentioned, only 3 had reported ablation speed and ablation efficiency, which at least two-times faster and up to two-times higher than the results in Ho:YAG RIRS [9,10,18].…”

Section: Application In Retrograde Intrarenal Surgerymentioning

confidence: 95%

“…The median lithotripsy time for the standard Ho:YAG is around 68 min with a median laser-on time (LOT) of 84%, for patients undergoing RIRS that have a stone volume >500 mm 3 [5 && ]. Clinical trials using TFL for RIRS, have shown a median LOT of 23 min for renal stones with -Ablation efficiency: Up to 2 times higher for all stone types [9][10][11][12][13][14][15][16][17][18] Retropulsion -Always present event at low-power settings [5 && ] -Less retropulsion in comparative trials [12,25] Temperature safety Not significant difference in water temperature elevation between TFL and Ho: YAG laser if proper irrigation is performed [40]. MT, Moses technology; TFL, thulium fiber laser.…”

Section: Application In Retrograde Intrarenal Surgerymentioning

confidence: 99%

“…From the 5 clinical trials mentioned, only 3 had reported ablation speed and ablation efficiency, which at least two-times faster and up to two-times higher than the results in Ho:YAG RIRS [9,10,18]. SFR was also assessed and it goes from 78.9% [16], 89% [18], 92.5%, [10], up to 95% [17] in some clinical studies. These surprising results reflect what was mentioned before about ablation efficiency, ablation speed and retropulsion obtained with this new technology, that overcomes its predecessor Ho:YAG laser and showing that TFL can perform an efficient RIRS with at least the half of the LOT, when compared to the Ho:YAG laser and for a similar stone volume and density.…”

Section: Application In Retrograde Intrarenal Surgerymentioning

confidence: 99%

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Retrograde intrarenal surgery: laser showdown (Ho:YAG vs thulium fiber laser)

Corrales

Traxer

2022

Current Opinion in Urology

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Purpose of reviewRetrograde intrarenal surgery (RIRS) has always been recommended for large stones > 20 mm, using the Ho:YAG laser. The introduction of a new technology in the urological market, the thulium fiber laser (TFL) has revolutionized the endourology world because of its characteristics and significantly shorter laser-on time (LOT) and operative time, without scarifying the champ vision. The aim of this review is to evaluate the most relevant findings of the last 2 years of each laser technology, confronting Ho:YAG vs TFL, analyzing who is more suitable for performing an efficient RIRS. Recent findingsFive full clinical trials using TFL for RIRS were found. Median LOT was between 2.8 and 34 min. All stones were similar in terms of stone volume, >500 mm 3 , and stone density, > 800 HU. Low complication rate, mostly Clavien-Dindo grade I and II and not related to the laser itself. One clinical trial only analyzed the efficacy of TFL for > 20 mm renal stones.

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Section: Application In Retrograde Intrarenal Surgerymentioning

confidence: 95%

Section: Application In Retrograde Intrarenal Surgerymentioning

confidence: 99%

Section: Application In Retrograde Intrarenal Surgerymentioning

confidence: 99%

See 1 more Smart Citation

Retrograde intrarenal surgery: laser showdown (Ho:YAG vs thulium fiber laser)

Corrales

Traxer

2022

Current Opinion in Urology

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“…The overall complication rate was 6% (Clavien-Dindo Grade I-II) and the authors concluded ablation speed for renal stones (1.16 mm 3 /s) was twice as fast as the average speed reported with the holmium laser. Carrera et al [38] recorded the first results from the first North American study on the TFL (n = 76). While this was performed in a multicentre setting, there was no control group.…”

Section: Clinical Studies: Ureteroscopy (Urs)mentioning

confidence: 99%

Current status of thulium fibre laser lithotripsy: an up‐to‐date review

2021

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To perform an up-to-date review to scope the current status of the thulium fibre laser (TFL) in the setting of stone lithotripsy and provide a guide for the clinical urologist. MethodsA review of world literature was performed to identify original articles on TFL for stone lithotripsy. Our clinical experiences of using the technology have also been shared. ResultsTo date there have been 11 clinical studies published on TFL for stone lithotripsy. Three of these have been in the setting of miniaturised percutaneous nephrolithotomy (mini-PCNL) and the remainder have been on ureteroscopy (URS). There has only been one randomised study on this technology, which has been for URS. For URS, the range of settings has been 0.1-4 J 9 7-300 Hz for both URS and mini-PCNL. Stones ranging from 0.4-3.2 and 1.5-3 cm have been treated with URS and mini-PCNL, respectively. The final stone-free rate for TFL has ranged from 66.6% to 100% and 85-100% for URS and mini-PCNL, respectively. The average length of stay ranged from 0.5 to 2.4 days in the URS group, but no studies have been reported this for mini-PCNL. Operative times in all the studies (both URS and mini PCNL) were <60 min. ConclusionInitial clinical studies reveal that TFL appears to be efficacious in the setting of stone lithotripsy. However, further randomised trials are warranted to delineate its formal position, as well as determine the optimal settings for use in clinical practice.

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“…2 Clinical use of the TFL has shown promising initial results and head-to-head trials will be likely be forthcoming in the next few years. 3 Safety of the Ho:YAG laser has been assessed and a recent CUA best practice report (BPR) has been published by Bhojani et al 4 A study from 2015 using pig eyes showed that the Ho:YAG laser can produce eye injuries in the form of corneal abrasions. 5 Researchers found that with a 272 micron laser fibre, the fibre needed to be within 5 cm of the pig's eye in order to cause damage.…”

Section: Laser Safety and Technologymentioning

confidence: 99%