Comparison of the ablation rates, fissures and fragments produced with 150 µm and 272 µm laser fibers with superpulsed thulium fiber laser: an in vitro study

Panthier, F.; Doizi, Steeve; Lapouge, Pierre; Miller, Catherine; Kogane, N.; Berthe, Laurent; Traxer, Olivier

doi:10.1007/s00345-020-03186-z

Cited by 42 publications

(44 citation statements)

References 18 publications

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“…Several papers conclude that the TFL is more efficient for urinary calculus lithotripsy than the Ho:YAG laser [ 27 ], even at equivalent lithotripsy settings using the same pulse energy and the same pulse frequency [ 28 – 30 ]. With fragmentation settings, the TFL ablates twice as fast, and with dusting settings it ablates 4 to 5 times faster than the best Ho:YAG lasers [ 28 , 31 , 32 ].…”

Section: Ablation Efficiencymentioning

confidence: 99%

“…Interestingly, it is not only the four to fivefold higher dusting rate of the primary stones that makes the TFL so attractive [ 28 , 30 , 31 ]. The resulting stone particles and fragments are also significantly different from those resulting with Ho:YAG lasers.…”

Section: Dust Issuesmentioning

confidence: 99%

“…TFL laser fibres are smaller (150 μm), more flexible, resistant to bending and suffering less burnback in comparison to Ho:YAG laser fibres or even special Moses fibres [ 43 , 48 , 49 ]. One study using exclusively Ho:YAG laser fibres with a Ho:YAG laser and comparing it with a TFL using exactly the same fragmentation and dusting parameters at 7.5 W total power levels, showed up to 90% fibre breakages at extreme 9 mm bending diameters with the Ho:YAG laser but none with the TFL.…”

Section: Laser Fibresmentioning

confidence: 99%

“…The smaller diameter of the TFL laser fibres has also been shown to contribute to produce smaller stone fragments [ 49 ], and despite their diameter, they still produce higher ablation volumes than their larger Ho:YAG counterparts [ 28 , 30 ]. By using smaller core diameters the energy density delivered by these fibres is also significantly higher [ 7 ▪ ], as well as allowing better instrument deflection and offering future miniaturization possibilities [ 8 ▪ , 51 , 52 ].…”

Section: Laser Fibresmentioning

confidence: 99%

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Outcomes of thulium fibre laser for treatment of urinary tract stones: results of a systematic review

Kronenberg

Hameed

Somani

2021

Current Opinion in Urology

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Purpose of review Lasers have become a fundamental aspect of stone treatment. Although Holmium:Yttrium-Aluminum-garnet (Ho:YAG) laser is the current gold-standard in endoscopic laser lithotripsy, there is a lot of buzz around the new thulium fibre laser (TFL). We decided to evaluate the latest data to help create an objective and evidence-based opinion about this new technology and associated clinical outcomes. Recent findings Sixty full-text articles and peer-reviewed abstract presentations were included in the qualitative synthesis of this systematic review performed over the last 2 years. Current super pulsed TFL machines are capable of achieving peak powers of 500W and emit very small pulse energies of 0.025 Joules going up to 6 Joules, and capable of frequency over 2000 Hz. This makes the TFL ablate twice as fast for fragmentation, 4 times as fast for dusting, more stone dust of finer size and less retropulsion compared to the Ho:YAG laser. Because of the smaller laser fibres with the TFL, future miniaturization of instruments is also possible. Summary Based on the review, the TFL is a potential game-changer for kidney stone disease and has a promising role in the future. However larger multicentric prospective clinical studies with long-term follow-up are needed to establish the safety and efficacy of the TFL in endourology.

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Section: Ablation Efficiencymentioning

confidence: 99%

Section: Dust Issuesmentioning

confidence: 99%

Section: Laser Fibresmentioning

confidence: 99%

Section: Laser Fibresmentioning

confidence: 99%

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Outcomes of thulium fibre laser for treatment of urinary tract stones: results of a systematic review

Kronenberg

Hameed

Somani

2021

Current Opinion in Urology

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“…The second function of Kidney Stone Calculator is to provide an estimated lithotripsy time. This is based on an in vitro study assessing ablation rates with a holmium:YAG laser and a superpulsed thulium fiber laser according to the supposed stone composition, the laser fiber diameter, and the laser settings [5]. The operator can set these different parameters on the software (left corner of Fig.…”

mentioning

confidence: 99%

Developing Free Three-dimensional Software for Surgical Planning for Kidney Stones: Volume is Better than Diameter

Panthier¹,

Doizi²,

Illoul³

et al. 2021

European Urology Focus

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Understanding the ablation rate of Holmium:YAG and thulium fiber lasers. Perspectives from an in vitro study

et al. 2023

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This study sought to analyze the ablation rates of Holmium:YAG (Ho:YAG) and thulium fiber laser (TFL) under different settings combinations. Lasering was carried out by a computed spiral pattern through a stepper motor bearing a laser fiber. BegoStones were placed inside a water container and lasered therein and the ablation rate was calculated. Different combinations were tested for ~12 Watts (W) for Ho:YAG and TFL lasers. Further 25 W combination for TFL were conducted testing higher frequencies. One-hundred-one experiments were conducted. Under ~12 W, the highest ablation rate for Ho:YAG was obtained with 40 Hz/0.3 J, and Virtual Basket™ (VB) emission mode [114.35 (88.30 – 126.40) mg/min] whereas for TFL, using 40 Hz/0.3 J, and long pulse [143.40 (137.40 – 146) mg/min]. A matched-comparison for 12 Hz/1 J settings showed that TFL outperformed Ho:YAG using medium pulse [63.30 (55.30 – 81.30) vs 132.00 (115.70 – 228.60) mg/min, p=0.016] and long pulse [62.90 (51.60 – 78.90) vs 134.70 (110.60 – 149.30) mg/min, p=0.016]. In the 40 Hz/0.3 J settings, TFL outperformed Ho:YAG (p=0.034). Nonetheless, Ho:YAG with VB’s ablation rate increased [114.35 (88.30 – 126.40)], being comparable to that of TFL with medium pulse [127.5 (88.90 – 141.70)] (p=0.400). In TFL 25 W experiments, the ablation rate of 500 Hz / 0.05 J, was higher than those of 1000 Hz / 0.025 J (p=0.049). TFL ablation rate is higher than that of Ho:YAG. Moreover, the Virtual Basket™ emission mode, increased Ho:YAG ablation rates, resulting reaching similar to that of TFL in certain modalities.

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Comparison of the ablation rates, fissures and fragments produced with 150 µm and 272 µm laser fibers with superpulsed thulium fiber laser: an in vitro study

Cited by 42 publications

References 18 publications

Outcomes of thulium fibre laser for treatment of urinary tract stones: results of a systematic review

Outcomes of thulium fibre laser for treatment of urinary tract stones: results of a systematic review

Developing Free Three-dimensional Software for Surgical Planning for Kidney Stones: Volume is Better than Diameter

Understanding the ablation rate of Holmium:YAG and thulium fiber lasers. Perspectives from an in vitro study

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