Thulium fiber laser lithotripsy using tapered fibers

Blackmon, Richard L.; Irby, Pierce B.; Fried, Nathaniel M.

doi:10.1002/lsm.20883

Cited by 42 publications

(42 citation statements)

References 11 publications

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“…Other common presenting symptoms are suprapubic discomfort, recurrent SUI, de novo frequency and de novo urgency. Also, higher irrigation rates allow for improved visibility and can therefore make technically difficult procedures more feasible (18). Finally, the thulium laser fibre releases a continuous, operator dependent, pulse when deployed and is 5-10 times more efficient than the conventional holmium:YAG laser for vaporizing urinary tract calculi at identical pulse energies.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Endoscopic Laser Excision of Polypropylene Mesh/Sutures Following Anti-Incontinence Procedures

et al. 2012

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Section: Discussionmentioning

confidence: 99%

Evaluation of Endoscopic Laser Excision of Polypropylene Mesh/Sutures Following Anti-Incontinence Procedures

et al. 2012

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“…Smaller optical fiber tips previously have been shown to experience greater burnback for both the TFL and Ho:YAG lasers during lithotripsy. 3,16 For a given set of laser parameters, fiber burnback also was consistently less for UA stones than for COM stones, presumably due to the softer composition and smoother surface of the UA stones. On the contrary, the COM stones exhibited a more irregular surface that increased the probability of the fiber tip becoming lodged and damaged in the stone crevices.…”

Section: Fiber Tip Degradation Studiesmentioning

confidence: 97%

“…However, our research group has recently been studying the thulium fiber laser (TFL) as an alternative lithotripter. [1][2][3][4][5] The TFL has several potential advantages over the Ho:YAG laser. The TFL wavelength (λ ¼ 1908 nm) more closely matches a high-temperature water absorption peak in tissue than the Ho:YAG wavelength (λ ¼ 2120 nm), 6 which results in a factor of four lower stone ablation threshold 5,7 and may lead to increased stone ablation rates.…”

Section: Introductionmentioning

confidence: 99%

“…2 For lithotripsy procedures that require extreme bending of the miniature ureteroscope (e.g., into the lower pole of the kidney), a smaller fiber permits greater flexibility of the instrument. The smaller fiber also permits increased irrigation through the minute working channel within the instrument, 3,8 thus improving visibility and safety of the procedure.…”

Section: Introductionmentioning

confidence: 99%

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Enhanced thulium fiber laser lithotripsy using micro-pulse train modulation

2012

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Abstract. The thulium fiber laser (TFL) is currently being studied as an alternative to the conventional holmium:YAG (Ho:YAG) laser for lithotripsy. The diode-pumped TFL may be electronically modulated to operate with variable parameters (e.g., pulse rate, pulse duration, and duty cycle) for studying the influence of pulse train mode on stone ablation rates. The TFL under study was operated at 1908 nm, 35-mJ pulse energy, and 500-μs pulse duration, in a train of 5 micro-pulses, with macro-pulse rates of 10 Hz, compared with conventional TFL operation at 10 to 50 Hz. TFL energy was delivered through 100-μm-core fibers in contact with human uric acid (UA) and calcium oxalate monohydrate (COM) stones. Mass removal rates, optical coherence tomography, and light microscopy were used to analyze the ablation craters. Stone retropulsion and fiber tip degradation studies also were conducted for these laser parameters. TFL operation in micro-pulse train (MPT) mode resulted in a factor of two increase in the ablation rate of 414 AE 94 μg∕s and 122 AE 24 μg∕s for the UA and COM stones, respectively, compared to 182 AE 69 μg∕s and 60 AE 14 μg∕s with standard pulse trains delivered at 50 Hz (P < 0.05). Stone retropulsion remained minimal (<2 mm after 1200 pulses) for both pulse modes. Fiber burnback was significant for both pulse modes and was higher for COM stones than UA stones. TFL operation in MPT mode results in increased stone ablation rates which, with further optimization, may approach levels comparable to Ho:YAG laser lithotripsy in the clinic.

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“…[1][2][3][4][5] The superior TFL Gaussian beam profile has been focused to a diameter as small as 70 μm, providing efficient coupling of higher laser energy into smaller fibers, thus leaving more irrigation space in the working channel, without hindering the flexibility of the ureteroscope. 1,3 Furthermore, the TFL wavelength (1908 nm) more closely matches a major water absorption peak in tissue than does the holmium laser wavelength (2120 nm), leading to lower ablation thresholds and higher ablation rates. 6 Finally, the TFL parameters (e.g., pulse length, pulse rate, and duty cycle) are more adjustable, thus providing more efficient stone ablation with reduced retropulsion and fiber tip degradation.…”

Section: Introductionmentioning

confidence: 99%

Fiber-optic manipulation of urinary stone phantoms using holmium:YAG and thulium fiber lasers

et al. 2013

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Abstract. Fiber-optic attraction of urinary stones during laser lithotripsy may be exploited to manipulate stone fragments inside the urinary tract without mechanical grasping tools, saving the urologist time and space in the ureteroscope working channel. We compare thulium fiber laser (TFL) high pulse rate/low pulse energy operation to conventional holmium:YAG low pulse rate/high pulse energy operation for fiber-optic suctioning of plaster-ofparis (PoP) stone phantoms. A TFL (wavelength of 1908 nm, pulse energy of 35 mJ, pulse duration of 500 μs, and pulse rate of 10 to 350 Hz) and a holmium laser (wavelength of 2120 nm, pulse energy of 35 to 360 mJ, pulse duration of 300 μs, and pulse rate of 20 Hz) were tested using 270-μm-core optical fibers. A peak drag speed of ∼2.5 mm∕s was measured for both TFL (35 mJ and 150 to 250 Hz) and holmium laser (210 mJ and 20 Hz). Particle image velocimetry and thermal imaging were used to track water flow for all parameters. Fiber-optic suctioning of urinary stone phantoms is feasible. TFL operation at high pulse rates/low pulse energies is preferable to holmium operation at low pulse rates/high pulse energies for rapid and smooth stone pulling. With further development, this novel technique may be useful for manipulating stone fragments in the urinary tract. © The Authors. Published by SPIE under a Creative Commons Attribution 3.0 Unported License. Distribution or reproduction of this work in whole or in part requires full attribution of the original publication, including its DOI.

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Thulium fiber laser lithotripsy using tapered fibers

Abstract: The short tapered distal fiber tip allows expansion of the laser beam, resulting in decreased fiber tip damage compared to conventional small-core fibers, without compromising fiber bending, stone vaporization efficiency, or irrigation rates.

Cited by 42 publications

References 11 publications

Evaluation of Endoscopic Laser Excision of Polypropylene Mesh/Sutures Following Anti-Incontinence Procedures

Evaluation of Endoscopic Laser Excision of Polypropylene Mesh/Sutures Following Anti-Incontinence Procedures

Enhanced thulium fiber laser lithotripsy using micro-pulse train modulation

Fiber-optic manipulation of urinary stone phantoms using holmium:YAG and thulium fiber lasers

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