Thulium-fiber laser for lithotripsy: First clinical experience in percutaneous nephrolithotomy

Enikeev, Dmitry; Taratkin, Mark; Alyaev, Yu G; Rapoport, L.; Korolev, Dmitry; Ali, Stanislav; Klimov, Roman; Glybochko, P.

doi:10.1016/s2666-1683(20)30017-3

Cited by 54 publications

(23 citation statements)

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“…To our knowledge, this series is the first to report clinical complications of the SuperPulsed TFL in URS. During previous trials on retrograde intrarenal surgery and percutaneous nephrolithotomy, we were unable to identify higher complication rates in patients who underwent SuperPulsed TFL treatment 8,9 …”

Section: Discussionmentioning

confidence: 93%

“…The SuperPulsed TFL may become the next possible option for URS. It has already shown effective fragmentation and dusting during retrograde intrarenal surgery and percutaneous nephrolithotomy 8,9 . Moreover, its ability to use higher pulse frequencies (up to 300 Hz) and lower minimum pulse energy has already been shown to be superior in in vitro studies and in clinical trials 10,11 …”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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“…TFL with high peak power or SPTFL improved lithotripsy efficiency vastly and made its debut in retrograde intrarenal surgery and percutaneous nephrolithotomy. 12,13 As peak power has been set as default, pulse energy and frequency are commonly adjusted parameters during the surgery. Our results showed both energy and frequency affected ablation efficiency.…”

Section: Discussionmentioning

confidence: 99%

“…[9][10][11] As super-pulse thulium fiber laser (SPTFL) is introduced into clinical practice in recent years, it has demonstrated efficacy and safety in the treatment of stone disease. 12,13 Optimal laser setting and fiber usage are still under investigation to achieve the full potential of SPTFL lithotripsy, and there is sparse data focusing on this area. In this study, we aim to investigate how laser setting and fiber usage affect ablation of SPTFL and provide evidence for clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Ablation Efficiency of a Novel Thulium Fiber Laser: An In Vitro Study on Laser Setting and Fiber Usage

Liu

Peng

Wang

et al. 2021

Journal of Endourology

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Introduction: To investigate the ablation efficiency of super-pulse thulium fiber laser (SPTFL) with different laser settings and fiber usage. Materials and Methods: SPTFL machine was attached with different fibers. Artificial stones were fixed in water, whereas laser fiber was driven on a platform for ablation. Pulse energy, frequency, fiber-moving speed, fiber-to-stone distance, and fiber size were adjusted in each trial. The cross-sectional area of craters on the lateral stone surface was measured for comparison of ablation rate, combined with fiber-moving speed.Results: There was a trend that the ablation rate increased as pulse energy or frequency increased. When pulse energy was set as 0.2 J and frequency was increased from 50 to 150 Hz, the cross-sectional area of the crater was enlarged from 0.21 to 0.37 mm 2 ( p < 0.05); when the frequency was set as 100 Hz and pulse energy was increased from 0.1 to 0.3 J, the crater was enlarged from 0.10 to 0.45 mm 2 ( p < 0.05). Furthermore, energy demonstrated greater impact on ablation rate and the crater was enlarged from 0.20 mm 2 in the 0.1 J • 300 Hz group to 0.44 mm 2 in the 0.3 J • 100 Hz group ( p < 0.05). Then fiber was set at different moving speeds with the same laser setting; the ablation rate of 3 mm/second group was 3.64 times higher than 0.5 mm/second group ( p < 0.05). Ablation diminished as fiber-to-stone distance grew. A 200 lm fiber produced thinner and deeper fissure than 272 and 550 lm fibers, and the ablation rate was the highest for the 200 lm fiber. Conclusion: Pulse energy is a more important factor in influencing ablation efficiency compared with frequency. Closer fiber-to-stone distance, faster fiber movement, and smaller fiber size increase ablation efficiency.

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“…These findings are interesting and seem promising for better treatment of urinary tract stones. The authors' previous clinical studies have also demonstrated the efficacy and safety of TFL during PCNL 4 and RIRS 5 . There are still several issues that need to be investigated, such as the optimal laser settings for different types of stones and locations, comparisons between conventional or newly developed holmium:YAG laser technology, and long‐term follow‐up of renal function.…”

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confidence: 99%

Editorial Comment from Dr Taguchi to Endoscopic lithotripsy with a SuperPulsed thulium‐fiber laser for ureteral stones: A single‐center experience

Taguchi

2020

Int J of Urology

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and pulse rate. The authors concluded that SP TFL provided effective and safe lithotripsy during rigid ureteroscopy regardless of stone density, and that there were no intraoperative complications, postoperative ureteral stenosis, or hydronephrosis. Optimal laser settings were 0.5 J 9 30 Hz for fragmentation and 0.15 J 9 100 Hz for dusting. The study by Enikeev et al. had several limitations. Its prospective single-center design did not allow the comparison of SP TFL with Ho:YAG laser for ureteral lithotripsy. Furthermore, the optimal settings for SP TFL were previously established in a series of in vitro tests. 3 However, the study showed the real profile data on SP TFL for ureteral lithotripsy, demonstrating its efficacy and safety during ureteroscopy based on the need for low energy and short laser time. The SP TFL operates at 1940 nm, which is closer to the water absorption peak than the wavelength of the Ho:YAG laser (2120 nm). SP TFL treatment, with an optimal wavelength and long pulse duration, resulted in faster stone ablation and lower retropulsion compared with Ho:YAG laser treatment. Additionally, there was no substantial difference in the maximum water temperature elevation around the stones between the SP TFL and the Ho: YAG laser. 4 The SP TFL surpasses the Ho:YAG laser in several aspects: (i) a laser fiber diameter as small as 50 lm; (ii) pulse energy as low as 0.025 J; (iii) a pulse rate range up to 2000 Hz; and (iv) a markedly smaller laser device compared to the Ho:YAG laser. Furthermore, the ablation rate was three times higher, the retropulsion effect was three times lower, and the fiber burnback was more than two times lower with the SP TFL than with the Ho:YAG laser. 4,5 However, further randomized prospective studies including larger cohorts in clinical practice settings are warranted to compare SP TFL with Ho:YAG laser treatment.

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Thulium-fiber laser for lithotripsy: First clinical experience in percutaneous nephrolithotomy

Cited by 54 publications

References 0 publications

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

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

Ablation Efficiency of a Novel Thulium Fiber Laser: An In Vitro Study on Laser Setting and Fiber Usage

Editorial Comment from Dr Taguchi to Endoscopic lithotripsy with a SuperPulsed thulium‐fiber laser for ureteral stones: A single‐center experience

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