Preclinical comparison of superpulse thulium fiber laser and a holmium:YAG laser for lithotripsy

Andreeva, Viktoria; Винаров, А.З.; Yaroslavsky, Ilya V.; Kovalenko, Anastasia; Vybornov, Alexander; Rapoport, L.; Enikeev, Dmitry; Сорокин, Н И; Dymov, Alim; Цариченко, Д Г; Glybochko, Petr; Fried, Nathaniel M.; Traxer, Olivier; Altshuler, Gregory B.; Gapontsev, Valentin

doi:10.1007/s00345-019-02785-9

Cited by 119 publications

(114 citation statements)

References 25 publications

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“…Our new target system with its feedback mechanism provides the user with the certainty that even if the laser is fired unintentionally, no laser emission will occur, and therefore, no tissue damage and no unnecessary heat build-up are likely. The same mechanism is also probably compatible with any other laser (e.g., Thulium laser), but this will have to be proven in future studies [14,15]. With this intelligent laser technology, new possibilities and an entirely new approach in the field of medical interventions are created.…”

Section: Discussionmentioning

confidence: 96%

Laser-guided real-time automatic target identification for endoscopic stone lithotripsy: a two-arm in vivo porcine comparison study

et al. 2020

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Introduction and objective Thermal injuries associated with Holmium laser lithotripsy of the urinary tract are an underestimated problem in stone therapy. Surgical precision relies exclusively on visual target identification when applying laser energy for stone disintegration. This study evaluates a laser system that enables target identification automatically during bladder stone lithotripsy, URS, and PCNL in a porcine animal model. Methods Holmium laser lithotripsy was performed on two domestic pigs by an experienced endourology surgeon in vivo. Human stone fragments (4–6 mm) were inserted in both ureters, renal pelvises, and bladders. Ho:YAG laser lithotripsy was conducted as a two-arm comparison study, evaluating the target identification system against common lithotripsy. We assessed the ureters’ lesions according to PULS and the other locations descriptively. Post-mortem nephroureterectomy and cystectomy specimens were examined by a pathologist. Results The sufficient disintegration of stone samples was achieved in both setups. Endoscopic examination revealed numerous lesions in the urinary tract after the commercial Holmium laser system. The extent of lesions with the feedback system was semi-quantitatively and qualitatively lower. The energy applied was significantly less, with a mean reduction of more than 30% (URS 27.1%, PCNL 52.2%, bladder stone lithotripsy 17.1%). Pathology examination revealed only superficial lesions in both animals. There was no evidence of organ perforation in either study arm. Conclusions Our study provides proof-of-concept for a laser system enabling automatic real-time target identification during lithotripsy on human urinary stones. Further studies in humans are necessary, and to objectively quantify this new system’s advantages, investigations involving a large number of cases are mandatory.

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Section: Discussionmentioning

confidence: 96%

Laser-guided real-time automatic target identification for endoscopic stone lithotripsy: a two-arm in vivo porcine comparison study

et al. 2020

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“…To our knowledge, this is the first case of biliary stone lithotripsy using a thulium laser. The technique seems to be safe, and faster and more effective than standard holmium laser lithotripsy [3].…”

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confidence: 88%

Thulium laser to manage a difficult biliary lithiasis: a first case report

et al. 2019

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“…This connection does not seem to have any practical application; we suppose that the reason is that it is easier for the surgeon to keep a bigger stone at the laser focus constantly, which results in higher effectiveness of a procedure. A series of preclinical in vitro tests showed that the SuperPulsed TFL is at least as effective as the Ho:YAG laser (in fragmentation mode) or has a three to four times higher ablation rate (in dusting modes) 12 …”

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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Preclinical comparison of superpulse thulium fiber laser and a holmium:YAG laser for lithotripsy

Cited by 119 publications

References 25 publications

Laser-guided real-time automatic target identification for endoscopic stone lithotripsy: a two-arm in vivo porcine comparison study

Laser-guided real-time automatic target identification for endoscopic stone lithotripsy: a two-arm in vivo porcine comparison study

Thulium laser to manage a difficult biliary lithiasis: a first case report

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

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