Initial clinical experience with the new thulium fiber laser: first 50 cases

Corrales, Mariela; Traxer, Olivier

doi:10.1007/s00345-021-03616-6

Cited by 42 publications

(35 citation statements)

References 18 publications

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“…At same LF-DV, our study showed significantly higher ablation volume with Tm-Fiber, except in the FD (Tm-Fiber)-dusting (Ho:YAG) comparison. These findings are consistent with previous in vitro or in vivo studies [ 4 , 9 , 23 ]. At the ODV, only the FD1 lithotripsy mode (Tm-Fiber) is associated with a non-significant higher ablation volume, compared to the Ho:YAG laser in dusting mode ( Table 3 ).…”

Section: Discussionsupporting

confidence: 94%

Laser Fiber Displacement Velocity during Tm-Fiber and Ho:YAG Laser Lithotripsy: Introducing the Concept of Optimal Displacement Velocity

Panthier

Germain

Gorny

et al. 2021

JCM

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Background: Endocorporeal laser lithotripsy (EL) during flexible ureteroscopy (URS-f) often uses “dusting” settings with “painting” technique. The displacement velocity of the laser fiber (LF) at the stone surface remains unknown and could improve EL’s ablation rates. This in vitro study aimed to define the optimal displacement velocity (ODV) for both holmium:yttrium-aluminium-garnet (Ho:YAG) and thulium fiber laser (Tm-Fiber). Methods: A 50W-TFL (IRE Polus®, Russia) and a 30W-MH1-Ho:YAG laser (Rocamed®), were used with 272µm-Core-Diameter LF (Sureflex, Boston Scientific©), comparing three TFL modes, “fine dusting” (FD:0.05–0.15 J/100–600 Hz); “dusting” (D:0.5 J/30–60 Hz); “fragmentation” (Fr:1 J/15–30 Hz) and two Ho:YAG modes (D:0.5 J/20 Hz, Fr:1 J/15 Hz). An experimental setup consisting of immerged cubes of calcium oxalate monohydrate (COM) stone phantoms (Begostone Plus, Begoã) was used with a 2 seconds’ laser operation time. LF were in contact with the stones, static or with a displacement of 5, 10 or 20 mm. Experiments were repeated four times. Stones were dried and µ-scanned. Ablation volumes (mm3) were measured by 3D-segmentation. Results: ODV was higher in dusting compared to fragmentation mode during Ho:YAG lithotripsy (10 mm/sec vs. 5 mm/sec, respectively). With Tm-Fiber, dusting and fragmentation OVDs were similar (5 mm/sec). Tm-Fiber ODV was lower than Ho:YAGs in dusting settings (5 mm/s vs. 10 mm/sec, respectively). Without LF displacement, ablation volumes were at least two-fold higher with Tm-Fiber compared to Ho:YAG. Despite the LF-DV, we report a 1.5 to 5-fold higher ablation volume with Tm-Fiber compared to Ho:YAG. Conclusions: In dusting mode, the ODVTm-Fiber is lower compared to ODVHo:YAG, translating to a potential easier Tm-Fiber utilization for “painting” dusting technique. The ODV determinants remain unknown. Dynamic ablation volumes are higher to static ones, regardless of the laser source, settings or LF displacement velocity.

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Section: Discussionsupporting

confidence: 94%

Laser Fiber Displacement Velocity during Tm-Fiber and Ho:YAG Laser Lithotripsy: Introducing the Concept of Optimal Displacement Velocity

Panthier

Germain

Gorny

et al. 2021

JCM

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“…Recently, a study from Russia showed the efficacy of TFL for ureteral stones with the authors recommending a setting of 0.5 J, 30 Hz for fragmentation and 0.15 J and 100 Hz for dusting [17]. Another study for TFL on 50 patients showed the safety and efficacy for both ureteral and renal stones [18].…”

Section: Emerging Advancements In Laser Techniques and Technologymentioning

confidence: 99%

Outcomes of Ureteroscopy and Laser Stone Fragmentation (URSL) for Kidney Stone Disease (KSD): Comparative Cohort Study Using MOSES Technology 60 W Laser System versus Regular Holmium 20 W Laser

Pietropaolo

Hughes

Mani

et al. 2021

JCM

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Background: For ureteroscopy and laser stone fragmentation (URSL), the use of laser technology has shifted from low power to higher power lasers and the addition of Moses technology, that allows for ‘fragmentation, dusting and pop-dusting’ of stones. We wanted to compare the outcomes of URSL for Moses technology 60 W laser system versus matched regular Holmium 20 W laser cases. Methods: Prospective data were collected for patients who underwent URSL using a Moses 60 W laser (Group A) and matched to historical control data using a regular Holmium 20 W laser (Group B), performed by a single surgeon. Data were collected for patient demographics, stone location, size, pre- and post-operative stent, operative time, length of stay, complications and stone free rate (SFR). Results: A total of 38 patients in each group underwent the URSL procedure. The stones were matched for their location (17 renal and 11 ureteric stones). The mean single and cumulative stone sizes (mm) were 10.9 ± 4.4 and 15.5 ± 9.9, and 11.8 ± 4.0 and 16.5 ± 11.3 for groups A and B, respectively. The mean operative time (min) was 51.6 ± 17.1 and 82.1 ± 27.0 (p ≤ 0.0001) for groups A and B. The initial SFR was 97.3% and 81.6% for groups A and B, respectively (p = 0.05), with 1 and 7 patients in each group needing a second procedure (p = 0.05), for a final SFR of 100% and 97.3%. While there were 2 and 5 Clavien I/II complications for groups A and B, none of the patients in group A had any infection related complication. Conclusions: Use of Moses technology with higher power was significantly faster for stone lithotripsy and reduced operative time and the number of patients who needed a second procedure to achieve a stone free status. It seems that the use of Moses technology with a mid-power laser is likely to set a new benchmark for treating complex stones, without the need for secondary procedures in most patients.

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“…Also, no cost analysis was performed to compare the two laser modalities. Corrales et al [39] reported outcomes in a sample of 50 patients from France. The median PE and frequency settings were 0.4 J 9 40 Hz and 0.3 J 9 100 Hz for ureteric and renal stones, respectively.…”

Section: Clinical Studies: Ureteroscopy (Urs)mentioning

confidence: 99%

“…The safety implications of this would suggest its real-world use will adopt much lower values on a day-to-day basis. Lower frequencies should also be maintained in the ureter [39,49].…”

Section: Disadvantages Of Tflmentioning

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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Initial clinical experience with the new thulium fiber laser: first 50 cases

Cited by 42 publications

References 18 publications

Laser Fiber Displacement Velocity during Tm-Fiber and Ho:YAG Laser Lithotripsy: Introducing the Concept of Optimal Displacement Velocity

Laser Fiber Displacement Velocity during Tm-Fiber and Ho:YAG Laser Lithotripsy: Introducing the Concept of Optimal Displacement Velocity

Outcomes of Ureteroscopy and Laser Stone Fragmentation (URSL) for Kidney Stone Disease (KSD): Comparative Cohort Study Using MOSES Technology 60 W Laser System versus Regular Holmium 20 W Laser

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

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