A clinical experience of thulium fibre laser in miniperc to dust with suction: a new horizon

Dm, Shah; Patil, Abhijit; Reddy, Naveen Krishna; Singh, Abhishek; Ganpule, Arvind; Sabnis, Ravindra; Desai, Mahesh

doi:10.1007/s00345-020-03458-8

Cited by 28 publications

(31 citation statements)

References 24 publications

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“…One study that specifically investigated optimal settings for stone dusting in PCNL found 0.2 J and 125-200 Hz to be optimal. 21 Stone volume ranged from 179-2338 mm 3 , stone density ranged from 880-1301 Hounsfield Units (HU), mean operative time (MOT) ranged from 23.4-39.8 minutes. Laser on time (LOT) ranged from 1.2 to 10 minutes.…”

Section: Stone Surgerymentioning

confidence: 99%

“…With reference to the theoretical advantages of minimal retropulsion and enhanced visibility of TFL: retropulsion that interfered with operative progress was reported in 1.4% of cases and insignificant retropulsion was reported in 11.7% of cases; and suboptimal visibility was reported in 14.6% of cases, with no significant correlation between frequency and visibility noted. Addressing the safety of TFL, the authors suggested that the high- 21 The authors sorted through stone sizes using sieves to calibrate the TFL settings to perform mainly dusting and therefore allowing the use of concurrent dust aspiration to decrease operative time. They achieved a 100% stone-free rate at one month, with a mean operative time of 39.9 minutes.…”

Section: Stone Surgerymentioning

confidence: 99%

“…This "Moses" effect is also reported by the uniform pulse energies of TFL, and due to the lower power, uniformity, and lack of a peak, there is local pressure an order of magnitude lower than Ho: YAG. [16][17][18][19][20][21]…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Stone Surgerymentioning

confidence: 99%

Section: Stone Surgerymentioning

confidence: 99%

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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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“…Other technological developments and lines of research are underway for the TFL. These include vibrating laser fibre tips [ 52 ], or detailed research on vapour bubble formation and surfactant supplementation of irrigation fluids or tweaking of the energy pulse shape to increase working distance if desired [ 42 , 68 , 69 ], as well as to associate TFL lithotripsy with suction [ 70 ]. All of these features are to further enhance TFL efficiency.…”

Section: Ongoing and Future Researchmentioning

confidence: 99%

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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“…Secondary outcomes were SFR, total procedure, fluoroscopy, postoperative hospital stay, and postoperative ureteral stent placement durations, as well as complication rates according to Clavien-Dindo classification. 17 SFR was defined as follows: SFR at the end of the procedure, no evidence of endoscopically confirmed residual fragments larger than 1 mm; and SFR after 3 months, no residual fragments larger than 3 mm detected using CT.…”

Section: Study Design and Patient Populationmentioning

confidence: 99%

Ureteroscopy‐assisted puncture for ultrasonography‐guided renal access significantly improves overall treatment outcomes in endoscopic combined intrarenal surgery

et al. 2021

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Objectives: To assess the impact and availability of ureteroscopy-assisted puncture for percutaneous renal access during ultrasonography-guided miniaturized (mini)-endoscopic combined intrarenal surgery for large volume renal and/or proximal ureteral stones. Methods: We conducted a multi-institutional retrospective cohort study for urolithiasis treatment. Data from a total of 313 patients who underwent mini-endoscopic combined intrarenal surgery to treat renal and/or ureteral stones between January 2016 and April 2020 were collected. We compared the outcomes between ultrasonography-guided miniendoscopic combined intrarenal surgery with and without ureteroscopy-assisted puncture (ureteroscopy-assisted puncture(+) group [n = 126] and ureteroscopy-assisted puncture(À) group [n = 187] group, respectively). The primary outcome was requirement for additional surgical intervention. Secondary outcomes were stone-free rate, complications and total procedure, fluoroscopy, hospital stay, and postoperative ureteral stent placement durations. Results: The ureteroscopy-assisted puncture(+) group had a lower additional surgical intervention rate and a higher stone-free rate immediately after and 3 months after surgery than the ureteroscopy-assisted puncture(À) group (5.6% vs 19.7%, P < 0.001; 82.5% vs 65.8%, P = 0.001; 59.5% vs 44.6%, P = 0.011). The median total procedure, fluoroscopy, and postoperative ureteral stent placement durations were 18 min, 3 min, and 5 days shorter, respectively, in the ureteroscopy-assisted puncture(+) group. Multivariate analyses showed that ureteroscopy-assisted puncture was associated with a decreased risk of additional surgical intervention (odds ratio 0.31, P = 0.011) and postoperative infection (odds ratio 0.34, P = 0.003) and decreased total procedure (estimate = À11 min; P = 0.011), fluoroscopy (estimate = À3 min; P = 0.034), and postoperative ureteral stent placement (estimate = À8 days; P = 0.011) durations. Female patients and those with smaller stone volumes or without hydronephrosis were identified as ideal ureteroscopy-assisted puncture candidates. Conclusions: Ureteroscopy-assisted puncture during mini-endoscopic combined intrarenal surgery could provide favorable surgical outcomes, especially in female patients without collecting system obstruction.

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A clinical experience of thulium fibre laser in miniperc to dust with suction: a new horizon

Cited by 28 publications

References 24 publications

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

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

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

Ureteroscopy‐assisted puncture for ultrasonography‐guided renal access significantly improves overall treatment outcomes in endoscopic combined intrarenal surgery

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