Mp22-05 efficacy of Super-Pulse Thulium Fiber Laser in Endoscopic Management of Lower Ureteric Stones in Indian Population

Mistry, Tejas; Pahwa, Mrinal; Tyagi, Vipin

doi:10.1097/ju.0000000000000855.05

Cited by 3 publications

(8 citation statements)

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“…Current clinical full-text evidence confirms that less energy is needed to ablate 1 mm 3 of stone volume, regardless of the stone density [ 37 , 38 , 39 , 40 , 41 , 42 , 43 ] ( Table 2 ), which agrees with the clinical experience presented in different conference abstracts about the TFL’s capacity to ablate all stone types [ 9 , 20 , 21 , 22 , 25 , 26 , 28 , 31 , 32 , 33 , 34 , 35 ]. This more efficient energy delivery can be hypothesized to be due to two factors: the water absorption and the pulse profile.…”

Section: Resultssupporting

confidence: 78%

“…The initial clinical experiences have demonstrated that the different laser settings used in the operating room are safe for patients. Many combinations of laser settings have been tested for ureteral, renal, and bladder stone lithotripsies presented in various conference abstracts [ 9 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ] and in full-text clinical experiences [ 37 , 38 , 39 , 40 , 41 , 42 , 43 ] ( Table 2 ). However, the ideal one has not yet been established.…”

Section: Resultsmentioning

confidence: 99%

“…To date, no current clinical experiences have shown evidence of severe tissue thermal damage during surgery or follow-up [ 9 , 20 , 21 , 22 , 25 , 26 , 28 , 31 , 32 , 33 , 34 , 35 , 37 , 38 , 39 , 40 , 41 , 42 , 43 ].…”

Section: Resultsmentioning

confidence: 99%

“…Confirmed with safety [ 9 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 ]…”

Section: Resultsunclassified

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Managing Urolithiasis with Thulium Fiber Laser: Updated Real-Life Results—A Systematic Review

Traxer

Corrales

2021

JCM

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Thirty-three years ago, pulsed lasers marked the beginning of a new era in endoscopic lithotripsy, and the one that was highlighted because of its potential was the Holmium: YAG laser, which became and still is the gold standard in endourology. Recently, a new laser technology has been accepted for clinical use in lithotripsy: the thulium fiber laser (TFL), showing appealing characteristics not seen before in several preclinical studies. A review of the literature was performed and all relevant in vitro studies and clinical trials until April 2021 were selected. The search came back with 27 clinical experiences (7 full-text clinical trials and 20 peer-reviewed abstracts) and 33 laboratory studies (18 full-text articles and 15 peer-reviewed abstracts). The clinical experiences confirmed the clinical safety of using the wide parameter range of the TFL. This technology demonstrated the performance at a higher ablation speed, the higher ablation efficiency, and the better dust quality of the TFL, as well as reduced stone retropulsion, thus helping to maintain an optimal visibility. No thermal or radiation damage was found. Given the current evidence, we may be facing the future gold standard laser in endoscopic lithotripsy.

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Section: Resultssupporting

confidence: 78%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…Confirmed with safety [ 9 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 ]…”

Section: Resultsunclassified

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Managing Urolithiasis with Thulium Fiber Laser: Updated Real-Life Results—A Systematic Review

Traxer

Corrales

2021

JCM

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“…Concerning the safety of this new technology, the clinical and prospective data from several patient cohorts is coherent in deeming the TFL safe to use, in any anatomical location, and regardless of its endoscopic surgical approach [ 15 – 17 , 27 , 38 – 40 , 45 , 46 , 51 , 55 , 57 , 58 ]. One of the safety features of the TFL is its laser fibres higher resistance to extreme bending diameters, even using high power, thereby avoiding their breakage with consequent laser emission inside the fragile flexible scopes [ 50 ▪▪ , 59 ].…”

Section: Safetymentioning

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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Comparison of Thulium Fiber Laser versus Holmium laser in ureteroscopic lithotripsy: a Meta-analysis and systematic review

Tang,

Wu,

et al. 2024

BMC Urol

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Objectives To compare the efficacy and safety of thulium fiber laser (TFL) to holmium: YAG (Ho: YAG) laser in ureteroscopic lithotripsy for urolithiasis. Methods PubMed, Web of Science, Embase, CENTRAL, SinoMed, CNKI database, VIP and Wanfang Database were systematically searched for all relevant clinical trials until September 2023. References were explored to identify the relevant articles. Meta-analysis was carried out for the retrieved studies using RevMan5.4.1 software, and the risk ratio, mean difference and 95% confidence interval were expressed. Statistical significance was set at p < 0.05. The main outcomes of this meta-analysis were stone-free rate (SFR), perioperative outcomes and intraoperative or postoperative complications. Results Thirteen studies, including 1394 patients, were included. According to the results of pooled analysis, TFL was associated with significantly higher stone-free rate (SFR) [0.52, 95% CI (0.32, 0.85), P = 0.009], shorter operation time [-5.47, 95% CI (-8.86, -2.08), P = 0.002], and less stone migration [0.17, 95% CI (0.06, 0.50), P = 0.001]. However, there was no significant difference in terms of the laser time, duration of hospital stay, drop of hemoglobin level, total energy, postoperative ureteral stenting, the incidence of intraoperative complications or postoperative complications between TFL and Ho: YAGs. Conclusion The findings of this study demonstrated several advantages of TFL in terms of higher SFR, shorter operative time and less stone migration. Trial registration The protocol of this systematic review was listed in PROSPERO (www.crd.york.ac.uk/PROSPERO) (Protocol number: CRD42022362550).

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Mp22-05 efficacy of Super-Pulse Thulium Fiber Laser in Endoscopic Management of Lower Ureteric Stones in Indian Population

Cited by 3 publications

References 0 publications

Managing Urolithiasis with Thulium Fiber Laser: Updated Real-Life Results—A Systematic Review

Managing Urolithiasis with Thulium Fiber Laser: Updated Real-Life Results—A Systematic Review

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

Comparison of Thulium Fiber Laser versus Holmium laser in ureteroscopic lithotripsy: a Meta-analysis and systematic review

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