Superpulse thulium fiber laser lithotripsy: an in vitro comparison of 200 μm and 150 μm laser fibers

Taratkin, Mark; Azilgareeva, Camilla; Corrales, Mariela; Teoh, Jeremy Yuen‐Chun; Allenov, S.; Inoyatov, Jasur; Ali, Stanislav; Rivas, Juan Gómez; Markovina, Irina; Enikeev, Dmitry

doi:10.1007/s00345-021-03800-8

Cited by 14 publications

(9 citation statements)

References 21 publications

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“…Stones were chosen to match a diameter of about 5 mm, accepting that not all stones were perfectly spherical. This was in a comparable size range with other in vitro Ho:YAG and TFL ablation studies using human kidney stones [ 21 – 24 ] and stone phantoms [ 25 , 26 ]. To simulate in vivo settings, all stones were immersed in saline for 24 h prior to experiments, due to kidney stones being of a crystalline structure primarily, but growing in a biological environment with complex intercrystalline spaces likely filled with urine [ 27 ].…”

Section: Methodssupporting

confidence: 76%

Pulsed Thulium:YAG laser – What is the lithotripsy ablation efficiency for stone dust from human urinary stones? Results from an in vitro PEARLS study

Kwok,

Ventimiglia,

De Coninck

et al. 2023

World J Urol

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Background The novel pulsed thulium:yttrium–aluminum–garnet (p-Tm:YAG) laser was recently introduced. Current studies present promising p-Tm:YAG ablation efficiency, although all are based on non-human stone models or with unknown stone composition. The present study aimed to evaluate p-Tm:YAG ablation efficiency for stone dust from human urinary stones of known compositions. Methods Calcium oxalate monohydrate (COM) and uric acid (UA) stones were subjected to lithotripsy in vitro using a p-Tm:YAG laser generator (Thulio®, Dornier MedTech GmbH, Germany). 200 J was applied at 0.1 J × 100 Hz, 0.4 J × 25 Hz or 2.0 J × 5 Hz (average 10W). Ablated stone dust mass was calculated from weight difference between pre-lithotripsy stone and post-lithotripsy fragments > 250 µm. Estimated ablated volume was calculated using prior known stone densities (COM: 2.04 mg/mm3, UA: 1.55 mg/mm3). Results Mean ablation mass efficiency was 0.04, 0.06, 0.07 mg/J (COM) and 0.04, 0.05, 0.06 mg/J (UA) for each laser setting, respectively. This translated to 0.021, 0.029, 0.034 mm3/J (COM) and 0.026, 0.030, 0.039 mm3/J (UA). Mean energy consumption was 26, 18, 17 J/mg (COM) and 32, 23, 17 J/mg (UA). This translated to 53, 37, 34 J/mm3 (COM) and 50, 36, 26 J/mm3 (UA). There were no statistically significant differences for laser settings or stone types (all p > 0.05). Conclusion To our knowledge, this is the first study showing ablation efficiency of the p-Tm:YAG laser for stone dust from human urinary stones of known compositions. The p-Tm:YAG seems to ablate COM and UA equally well, with no statistically significant differences between differing laser settings.

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Section: Methodssupporting

confidence: 76%

Pulsed Thulium:YAG laser – What is the lithotripsy ablation efficiency for stone dust from human urinary stones? Results from an in vitro PEARLS study

Kwok,

Ventimiglia,

De Coninck

et al. 2023

World J Urol

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“…This aspect has been investigated in series of invitro trials [22][23][24][25]. Taratkin et al [23] compared two laser thulium laser fibers -150 and 200 mm in different setups. The authors concluded that there were no differences in retropulsion, temperature increase, fiber burnback or energy transmission between 150 and 200 mm fibers.…”

Section: Fibersmentioning

confidence: 99%

“…Such a reduction in diameter results in a more-intense laser beam which in turn supposedly leads to more efficient stone ablation [21]. This aspect has been investigated in series of invitro trials [22][23][24][25]. Taratkin et al [23] compared two laser thulium laser fibers -150 and 200 mm in different setups.…”

Section: Fibersmentioning

confidence: 99%

Thulium fiber laser in endourology: current clinical evidence

Enikeev

Herrmann

Taratkin

et al. 2022

Current Opinion in Urology

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Purpose of review To review and summarize preclinical and clinical data on thulium fiber laser's (TFL) effectiveness (ablation rate, stone-free rate etc.) and safety in terms of laser injuries and thermal damage. This enables us to assess how the in-vitro evidence translates into the clinical real-life scenario. Recent findings In this analysis, a total of 21 preclinical trials have been included. Most of the trials use conventional Holmium:YAG laser as a comparator, with only a few assessing lasers with pulse modulation. Most of the trials focus on the superior ablation rate and superior dusting features of TFL, as well as comparison of retropulsion (both in conventional Ho:YAG and in a pulse modulation), with a few studies assessing safety aspects. A total of 13 trials assessed TFL, clinically, in percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS). The clinical data obtained suggest that lithotripsy by TFL is safe, facilitates effective stone fragmentation, and results in a reduction of retropulsion. Unfortunately, most of the clinical trials lack a direct comparator, and so no clear-cut comparisons are possible. Summary During in-vitro studies, TFL demonstrated to be a new energy source with a great potential for improved ablation, lower retropulsion and improved dusting. These claims are supported in contemporary clinical studies, reporting superior ablation and negligible retropulsion in both PCNL and RIRS. However, it should be noted that the data regarding clinical results compared with conventional Ho:YAG is still limited.

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“…First preclinical studies revealed that 150 mm fiber is as efficient and well tolerated as the 200 mm fiber, with no significant differences in retropulsion, temperature increase, fiber burnback or energy transmission. However, it has a potential for decreasing stone particles during lithotripsy, thus facilitating the surgery [32]. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.…”

Section: Beam Profilementioning

confidence: 99%

Thulium fiber laser in urology: physics made simple

Taratkin

Azilgareeva

Cacciamani

et al. 2021

Current Opinion in Urology

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Purpose of reviewIn this narrative review, we will focus on a novel thulium fiber laser's physical properties in terms of its clinical applicability.Recent findings TFL has successfully moved forward from the preclinical trials into clinical practice and now is being widely used in clinics around the world. The available data suggest that the device effectively operates in soft tissues -benign prostate hyperplasia (BPH) and bladder tumors, as well as in lithotripsy. Also, the first promising results were obtained from laparoscopic surgery showing its possible applicability in the management of renal cell carcinoma. The constructional changes in fiber laser's design, lead to alteration of laser-tissue interactions, which resulted in clinical advantages of the device. Yet, the exact mechanism often is considered complex for understanding. With this work, we are aiming to build a bridge between biophysics and clinical practice and give a simple explanation of how the devices is working and why the knowledge of it is important for a clinician.

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Superpulse thulium fiber laser lithotripsy: an in vitro comparison of 200 μm and 150 μm laser fibers

Cited by 14 publications

References 21 publications

Pulsed Thulium:YAG laser – What is the lithotripsy ablation efficiency for stone dust from human urinary stones? Results from an in vitro PEARLS study

Pulsed Thulium:YAG laser – What is the lithotripsy ablation efficiency for stone dust from human urinary stones? Results from an in vitro PEARLS study

Thulium fiber laser in endourology: current clinical evidence

Thulium fiber laser in urology: physics made simple

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