Safety and Short-Term Oncological Outcomes of Thulium Fiber Laser En Bloc Resection of Non-Muscle-Invasive Bladder Cancer: A Prospective Non-Randomized Phase II Trial

Enikeev, Dmitry; Taratkin, Mark; Margulis, Vitaly; Сорокин, Н И; Severgina, L O; Парамонова, Н. Б.; Kislyakov, Dmitry; Kozlov, Vasiliy; Rapoport, L.; Shariat, Shahrokh F.; Glybochko, Petr

doi:10.3233/blc-200275

Cited by 15 publications

(14 citation statements)

References 28 publications

(34 reference statements)

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“…Also, TFL ERBT demonstrated a lower complication rate (like obturator nerve reflex, perforation) and better specimen quality compared to conventional TURBT (showing better detrusor rate on pathology). The only reported disadvantage for TFL ERBT was the prolonged surgery duration time (39.0 ( ± 16.5) vs 34.0 ( ± 8.8) min for TURBT) (41).…”

Section: Thulium Fiber Laser For Soft Tissues: Clinical Trialsmentioning

confidence: 99%

“…BPH surgery aside, TFL proved itself to be a suitable device for en bloc resection of bladder tumor (ERBT), predominantly NMIBC, within a prospective clinical trial (41). It was shown that patients after TFL ERBT had a better relapse-free rate than TURBT at both 3 (97.2% and 84.5%, p = 0.011) and 6 months (91.5% and 67.2%, p < 0.001).…”

Section: Thulium Fiber Laser For Soft Tissues: Clinical Trialsmentioning

confidence: 99%

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Thulium fiber laser in BPH surgery: Bench to bedside - a systematic review on behalf of YAU Urotechnology Working Group

et al. 2022

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IntroductionThe Thulium fiber laser (TFL) is a new device that in contrast to the other solid-state YAG-based lasers takes a different approach to pulse formation allowing for two different modes: in the QCW (quasi-continuous wave) function, TFL is convenient for soft tissue surgery and in the SP (Superpulsed) mode it is highly effective in lithotripsy. Thus, unlike the other thulium lasers (Tm : YAG), TFL can be used in a wide range of surgical procedures.Materials and MethodsWe conducted a systematic search in 3 databases: Medline, Scopus and Cochrane library. All original articles (both preclinical and clinical) on TFL application in soft tissue surgery were included in data analysis.ResultsIn terms of its cutting properties, QCW TFL is not inferior to the other thulium lasers, and in fact allows for decreased carbonization (due to lower heat production) compared to continuous lasers (e.g. Tm : YAG). It has been used successfully in endoscopic enucleation of the prostate (EEP) and in en bloc resection of bladder tumors (ERBT). The efficacy and safety of this laser is comparable to TURP and simple prostatectomy, but the recovery period is shorter and the learning curve is slightly superior to other endoscopic procedures. There are no significant differences between TFL and Ho : YAG in terms of efficacy and safety during EEP. Unfortunately, there are no clinical studies that analyse the efficacy and safety of SP TFL in EEP or ERBT.ConclusionTFL is a safe and effective tool for BPH surgery. In terms of parameters, it is in no way inferior to Tm : YAG or Ho : YAG during EEP. However, TFL surpasses these lasers in terms of usability and serviceability. These advantages are likely to render it more popular over time.

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Section: Thulium Fiber Laser For Soft Tissues: Clinical Trialsmentioning

confidence: 99%

Section: Thulium Fiber Laser For Soft Tissues: Clinical Trialsmentioning

confidence: 99%

Thulium fiber laser in BPH surgery: Bench to bedside - a systematic review on behalf of YAU Urotechnology Working Group

et al. 2022

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“…At the time of writing, there is a published paper by Enikeev and colleagues who look at the safety and short-term oncological outcomes of TFL for EBRT. 40…”

Section: Bladder Tumoursmentioning

confidence: 99%

A Systematic Review of Thulium Fiber Laser: Applications and Advantages of Laser Technology in the Field of Urology

Rice

Somani²

2021

RRU

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Laser technology is widely used in urological surgery, from lithotripsy, prostate surgery to en-bloc resection of tumours. While Holmium:YAG has been widely employed over the last two decades, in recent years, there has been a surge of interest in Thulium Fiber Laser (TFL), which offers theoretical advantages of better water absorption and lower stone ablation thresholds. A systematic review was conducted to assess the evidence from clinical research on TFL's application for lithotripsy and prostate surgery. It identified 357 articles and 8 (1506 patients) were selected, of which 4 clinical studies each investigated TFL enucleation of prostate (ThuFLEP) and TFL lithotripsy. For flexible ureteroscopic lithotripsy (FURSL), stone ablation settings ranged from 0.1-4 J, and 7-300 Hz, mean operative time ranged from 23.4-39.8 minutes and lasing time ranged from 1.2-10 minutes. For stone dusting in percutaneous nephrolithotomy (PCNL), settings of 0.2 J and 125-200 Hz were found to be optimal. For ThuFLEP, all studies showed a significant improvement in IPSS (International Prostate Symptom Score), urinary flow rate (Q max ), quality of life measures, and post-void residual volume, with mean operative time ranging from 67-104.5 minutes. Our review shows that there is limited evidence on the use and clinical outcomes of TFL. ThuFLEP might suggest equivalence to the widely used HoLEP in the available evidence so far. TFL lithotripsy shows promising results but further prospective, randomized trials are required to properly assess its usability, clinical effectiveness and standardisation of the settings for successful adoption of the technology.

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“…Previous studies using Thulium laser found that obturator jerk occurs more with conventional TURBT than with Thulium laser en bloc resection. [ 5 - 7 ] This is due to the absence of electric current in LASER resection and the shallow penetration of LASER. Monopolar en bloc resection would not obviate obturator jerk as reported by Yang et al .…”

Section: Discussionmentioning

confidence: 99%

Thulium laser en bloc resection versus conventional transurethral resection of urinary bladder tumor: A comparative prospective study

et al. 2022

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Background: Transurethral resection of bladder tumors (TURBT) is the standard management for urinary bladder tumors; however, new techniques as Thulium laser en bloc resection of bladder tumors (TmLRBT) have been introduced as a substitute to TURBT. Objectives: In this study safety, efficacy, and tumor recurrence after TmLRBT and TURBT were prospectively compared in patients with primary (<4 cm) bladder tumors. Patients and Methods: Between August 2019 and May 2021, patients with primary (<4 cm) bladder tumors were enrolled. Patients were randomized between the two procedures. All perioperative data were collected prospectively. Pathological specimen findings and recurrence rates were reported during follow-up visits. Results: Sixty patients underwent TURBT, and another 60 had TmLRBT. No significant differences were detected in patient demographics or preoperative tumor characteristics between the two groups. Operation time was less (28.2 vs. 38.9 min, P < 0.001), and rate of bladder perforation was lower with TmLRBT compared to TURBT (3.3% vs. 15.0%, P = 0.027). In the TmLRBT group, higher rate of muscle detection (95.0% vs. 78.3%, P < 0.001) in the pathological specimen, and lower rate of tissue destruction (0.0% vs. 21.6%, P < 0.001) were obtained compared to TURBT. Recurrence rate in cases of nonmuscle invasive bladder cancer was lower with TmLRBT (6.7% vs. 33.0%, P < 0.001). Conclusion: In this study, TmLRBT showed reduced operative time with lower perforation rates. Higher detection of detrusor muscle and less tissue destruction in the pathological specimen were obtained with TmLRBT, as well as lower rates of tumor recurrence. These findings suggest that TmLRBT is a safe and efficacious substitute to TURBT in tumors <4 cm.

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Safety and Short-Term Oncological Outcomes of Thulium Fiber Laser En Bloc Resection of Non-Muscle-Invasive Bladder Cancer: A Prospective Non-Randomized Phase II Trial

Cited by 15 publications

References 28 publications

Thulium fiber laser in BPH surgery: Bench to bedside - a systematic review on behalf of YAU Urotechnology Working Group

Thulium fiber laser in BPH surgery: Bench to bedside - a systematic review on behalf of YAU Urotechnology Working Group

A Systematic Review of Thulium Fiber Laser: Applications and Advantages of Laser Technology in the Field of Urology

Thulium laser en bloc resection versus conventional transurethral resection of urinary bladder tumor: A comparative prospective study

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