Experimental verification of thulium lithotripsy

Rapoport, L.; Vinarov, A Z; Сорокин, Н И; Dymov, Alim; Enikeev, Dmitry; Цариченко, Д Г; Lekarev, Vladimir; Klimov, Roman; Andreeva, Viktoria; Kovalenko, A.

doi:10.18565/urology.2018.5.74-80

Cited by 7 publications

(5 citation statements)

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“…Moreover, higher stone ablation rates with lower retropulsion could also be seen [ 13 , 15 ]. However, very fine dusting was not possible due to a limitation of the frequency [ 6 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

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First Clinical Experience of a Novel Pulsed Solid-State Thulium:YAG Laser during Percutaneous Nephrolithotomy

Bergmann

Rosenbaum

Netsch

et al. 2023

JCM

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Introduction: Laser lithotripsy during Mini-PCNL is one treatment option in urinary stone disease. In recent years, a new era in stone treatment has been initiated with the introduction of new pulsed thulium lasers. The aim of this study was to investigate the safety and efficacy of laser lithotripsy with a new pulsed solid-state thulium:YAG laser during mini-PCNL. Materials and methods: All patients, regardless of stone size, who were treated with a Mini-PCNL using the new pulsed thulium laser were prospectively enrolled. Operation times, stone size, laser time, and laser settings were noted. The stone-free rate was assessed postoperatively with sonography and either x-ray or computed tomography as a clinical standard. The complications were analyzed using the Clavien-Dindo classification. Results: A total of 50 patients with a mean age of 52 years were included. 31 (62 %) patients were male. The average stone size was 242.3 (±233.1) mm2 with an average density of 833 (±325) Hounsfield units. The mean operating time was 30.56 (±28.65) minutes, and the laser-on-time was 07:07 (± 07:08) minutes. The most commonly used settings were 0.4 J and 115 Hz (46 W). The mean total energy for stone ablation was 14,166 (±17,131) kJ. The total stone-free rate was 84 %, with an overall complication rate of 32% according to Clavien-Dindo (grade 1: n = 9, grade 2: n = 6, 3b: n = 1). In the group of patients with singular stones (n = 25), the stone-free rate was 88%. Summary: The new pulsed solid-state Thulium:YAG laser allows a safe and effective lithotripsy during Mini-PCNL. The stone-free rates were high regardless of stone size with a comparable low rate of complications.

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“…Moreover, higher stone ablation rates with lower retropulsion could also be seen [ 13 , 15 ]. However, very fine dusting was not possible due to a limitation of the frequency [ 6 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…Pulsed thulium lasers were currently established and showed better results in various in vitro experiments compared to Ho:YAG lasers [ 16 , 17 , 18 ]. Presently, there are two different types of pulsed thulium lasers available for clinical practice: TFLs and solid-state Tm:YAG lasers.…”

Section: Discussionmentioning

confidence: 99%

First Clinical Experience of a Novel Pulsed Solid-State Thulium:YAG Laser during Percutaneous Nephrolithotomy

Bergmann

Rosenbaum

Netsch

et al. 2023

JCM

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“…Several preclinical studies have proved the efficacy of SuperPulsed TFL in lithotripsy. 10,13 The Ho:YAG laser and the SuperPulsed TFL (500 W) have the same mechanism of stone ablation: thermomechanical (explosive vaporization). However, whereas the Ho:YAG laser relies on higher energies (due to its peak power of 2-10 kJ), the SuperPulsed TFL uses higher frequencies, which allows an improved ablation rate and minimizes retropulsion.…”

Section: Discussionmentioning

confidence: 99%

“…Several preclinical studies have proved the efficacy of SuperPulsed TFL in lithotripsy 10,13 . The Ho:YAG laser and the SuperPulsed TFL (500 W) have the same mechanism of stone ablation: thermomechanical (explosive vaporization).…”

Section: Discussionmentioning

confidence: 99%

Endoscopic lithotripsy with a SuperPulsed thulium‐fiber laser for ureteral stones: A single‐center experience

et al. 2020

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Objectives To estimate the efficacy and safety of SuperPulsed thulium‐fiber laser ureteral lithotripsy and to identify optimal laser settings. Methods Patients with solitary stones were prospectively included. Lithotripsy was performed with a SuperPulsed thulium‐fiber laser (NTO IRE‐Polus, Fryazino, Russia) using a rigid ureteroscope 7.5 Ch (Richard Wolf, Knittlingen, Germany). We analyzed the efficacy of lithotripsy by measuring total energy required for stone disintegration, "laser‐on" time, ablation speed, ablation efficacy, and energy consumption. Stone retropulsion and visibility were assessed using a three‐point Likert scale. Complications were assessed using the Clavien–Dindo classification system. Results A total of 149 patients were included. The mean stone density was 985 ± 360 Hounsfield units, the median (interquartile range) stone volume was 179 (94–357) mm3. The median (interquartile range) total energy was 1 (0.4–2) kJ, and laser‐on time 1.2 (0.5–2.7) min. The median (interquartile range) stone ablation speed was 140 (80–279) mm3/min, energy for ablation of 1 mm3 was 5.6 (3–9.9) J/mm3 and energy consumption was 0.9 (0.6–1) J/min. A correlation was found between retropulsion and the energy used (r = 0.5, P < 0.001). Multivariable analysis showed energy to be a predictor of increased retropulsion (odds ratio 65.7, 95% confidence interval 1.6–2774.1; P = 0.028). No predictors for worse visibility were identified. Conclusion The SuperPulsed thulium‐fiber laser provides effective and safe lithotripsy during ureteroscopy regardless of stone density. Fiber diameter and laser frequency do not influence visibility or safety. Optimal laser settings are 0.5 J × 30 Hz for fragmentation and 0.15 J × 100 Hz for dusting.

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“…To improve the results of laser lithotripsy and reduce its duration, we used a superpulse TFL with λ = 1.94 µm and a peak power of up to 500 W (FiberLase U2) [10,15]. The performed preliminary comparative experimental studies on the efficiency of the proposed Ho:YAG laser in lithotripsy showed a high efficiency of TFL lithotripsy in all fragmentation regimes [16].…”

Section: Introductionmentioning

confidence: 99%

Mechanism of Lithotripsy by Superpulse Thulium Fiber Laser and Its Clinical Efficiency

et al. 2020

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Thulium fiber laser with a wavelength of 1.94 µm is widely used in urology for lithotripsy. This paper studies the mechanism of lithotripsy and evaluates its clinical efficiency using the superpulse thulium fiber laser with a wavelength of 1.94 µm and a peak power of 500 W. An experimental setup was developed to study the mechanism of lithotripsy. The superpulse thulium fiber laser (TFL) with a wavelength of 1.94 µm with a peak power of 500 W (FiberLase U2 from “IRE-POLUS” Ltd., Fryazino, Moscow Region, Russia) was used for the lithotripsy of stone phantoms (BegoStone). The processes were recorded with a high-speed camera. The acoustic signals registered during lithotripsy were studied with wideband and needle hydrophones. The main mechanism of lithotripsy performed by using superpulse TFL was thermal cavitation in the water-filled pore space and thermal destruction of the phantom. During the clinical application of the superpulse thulium fiber laser, the high efficiency of laser lithotripsy was established. The performed optical and acoustic studies showed that the mechanism of the destruction of stones was based on the synergic effect of the explosive boiling of water in the pore space of the stone, and its thermal destruction is associated with the heating of the stone to several hundred degrees with laser radiation.

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Experimental verification of thulium lithotripsy

Cited by 7 publications

References 0 publications

First Clinical Experience of a Novel Pulsed Solid-State Thulium:YAG Laser during Percutaneous Nephrolithotomy

First Clinical Experience of a Novel Pulsed Solid-State Thulium:YAG Laser during Percutaneous Nephrolithotomy

Endoscopic lithotripsy with a SuperPulsed thulium‐fiber laser for ureteral stones: A single‐center experience

Mechanism of Lithotripsy by Superpulse Thulium Fiber Laser and Its Clinical Efficiency

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