A prospective, randomized comparison of a 1940 nm and a 2013 nm thulium: yttrium-aluminum-garnet laser device for Thulium VapoEnucleation of the prostate (ThuVEP): First results

Abstract

Introduction:We report the early postoperative results of the first prospective, randomized comparison of two commercially available thulium lasers with different wavelengths for the treatment of benign prostatic obstruction (BPO).Materials and Methods:From January to June 2013, 80 consecutive patients were randomized for Thulium VapoEnucleation of the prostate (ThuVEP) with a 2013 nm (RevoLix®) (n = 39) or a 1940 nm (Vela®XL) (n = 41) thulium laser. Preoperative status, surgical details and the immediate outcome were recorded for each patient. The perioperative complications were assessed and classified according to the modified Clavien classification system.Results:Median operation time, resected tissue, percentage of resected tissue, catheter time, overall operation efficiency and Hb loss differed nonsignificantly between both devices (P > 0.05). At discharge, the median maximum urinary flow rate and postvoiding residual (PVR) urine improved significantly in both groups (P < 0.001). The PVR was lower in the 1940 nm ThuVEP group (P ≤ 0.034). Perioperative complications occurred in 18 (22.5%) patients (Clavien 1: 12.5%; Clavien 2: 5%, Clavien 3b: 2.5%, Clavien 4a: 2.5%), with no differences between the groups (P = 0.5).Conclusions:The 1940 nm and the 2013 nm thulium lasers are both safe and effective for the treatment of BPO with ThuVEP. Both lasers give equivalent and satisfactory immediate micturition improvement with low perioperative morbidity.

Ex vivo and animal study of the blue diode laser, Tm fiber laser, and their combination for laparoscopic partial nephrectomy

“…This prompted us also to test thulium fiber laser (Tm laser) assisted soft tissue excision, as Tm laser applied at kidney or brain has been shown to produce efficient ablation and to possess excellent coagulative properties . Tm‐generated wavelength ( λ = 1,940 nm) is strongly absorbed by water (absorption coefficient ~1 × 10 2 cm −1 , estimated kidney‐specific absorption coefficient 79 cm −1 ), but not by hemoglobin and is efficiently used in urology for soft tissue treatment . Recent studies also suggest that Tm laser as a promising alternative for treatment of the kidney stone disease due to high stone ablation rate and generation of the small fragments explained by “micro‐explosions” mechanism .…”

Transurethral anatomical enucleation of the prostate with Tm:YAG support (ThuLEP): Evolution and variations of the technique. The inventors' perspective

“…These lasers have the potential to take over a larger share of new laser devices in clinics in the future. The difference is more or less academical, but sophistically would call for individual evaluation (Becker et al, 2019; Tiburtius, Gross, & Netsch, 2015). Summarising the above, the EAU Guidelines on Management of Non‐Neurogenic Male Lower Urinary Tract Symptoms (LUTS), incl.…”

“…120 W and 200 W Tm:YAG vapo‐enucleation demonstrate the same surgical outcome and perioperative safety (Netsch, Bach, Pohlmann, Herrmann, & Gross, 2012; Netsch et al, 2012). Equivalence was noticed for Tm:YAG at 2013nm wavelength versus Tm fibre laser at 1940 nm (Tiburtius et al, 2015).…”

Lasers in Transurethral Enucleation of the Prostate—Do We Really Need Them

“…However, in the advent of using Thulium fiber laser as a versatile tool for kidney stones management (as a dusting tool), soft tissue effects have come into focus again. Thus far, the difference of wavelengths from 1940 to 2013 nm has not translated into different clinical outcomes [24,25]. The future main academic conflict demarcation lines will most likely be located in between Tm fiber lasers and high power high frequency Ho:YAG generators, with different pulse modulations [26].…”