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

Abstract

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.

Outcomes of Ureteroscopy and Laser Stone Fragmentation (URSL) for Kidney Stone Disease (KSD): Comparative Cohort Study Using MOSES Technology 60 W Laser System versus Regular Holmium 20 W Laser

“…The Moses technology has been shown to increase fragmentation and reduce retropulsion. There is now emergence of a thulium fiber laser (TFL) which allows improvements in ablation efficiency and retropulsion with the added advantage of portability, and while more clinical studies need to be done, it has increased the playing field of the laser market giving more choice to the endourologists [16]. Recently, a study from Russia showed the efficacy of TFL for ureteral stones with the authors recommending a setting of 0.5 J, 30 Hz for fragmentation and 0.15 J and 100 Hz for dusting [17].…”

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

“…28 In a randomized study, ThuFLEP was compared with HoLEP and MEP. 22 The authors found that ThuFLEP was associated with simple learning curve, achieving proficiency in as few as [8][9][10][11][12][13][14][15][16] procedures. This illustrates a key advantage over HoLEP which typically requires 50-60 procedures.…”

“…7,8 TFL has demonstrated efficacy and safety in ex vivo research and is now being deployed in clinical research. 9,10 One advantage of TFL is its higher water-absorption coefficient compared with Ho:YAG, which means that water absorbs TFL energy around four times higher than it does with Ho:YAG laser energy. Using water absorption as a model for cell absorption, the implication of this is that more energy from TFL is absorbed by cells and therefore they are better ablated.…”

Thulium fiber laser versus holmium

“…A systematic review of TFL by Kronenberg et al . [ 17 ] summarized that the ablation efficiency of TFL was two times faster for fragmentation and four times faster for dusting mode as compared to Ho:YAG laser. In our study also, when we compared the fragmentation mode of TFL with Ho:YAG laser in Miniperc, and we observed that the fragmentation was two times faster with TFL.…”