Thulium fiber laser in BPH surgery: Bench to bedside - a systematic review on behalf of YAU Urotechnology Working Group

Abstract

IntroductionThe Thulium fiber laser (TFL) is a new device that in contrast to the other solid-state YAG-based lasers takes a different approach to pulse formation allowing for two different modes: in the QCW (quasi-continuous wave) function, TFL is convenient for soft tissue surgery and in the SP (Superpulsed) mode it is highly effective in lithotripsy. Thus, unlike the other thulium lasers (Tm : YAG), TFL can be used in a wide range of surgical procedures.Materials and MethodsWe conducted a systematic search in 3 databases: Medline, Scopus and Cochrane library. All original articles (both preclinical and clinical) on TFL application in soft tissue surgery were included in data analysis.ResultsIn terms of its cutting properties, QCW TFL is not inferior to the other thulium lasers, and in fact allows for decreased carbonization (due to lower heat production) compared to continuous lasers (e.g. Tm : YAG). It has been used successfully in endoscopic enucleation of the prostate (EEP) and in en bloc resection of bladder tumors (ERBT). The efficacy and safety of this laser is comparable to TURP and simple prostatectomy, but the recovery period is shorter and the learning curve is slightly superior to other endoscopic procedures. There are no significant differences between TFL and Ho : YAG in terms of efficacy and safety during EEP. Unfortunately, there are no clinical studies that analyse the efficacy and safety of SP TFL in EEP or ERBT.ConclusionTFL is a safe and effective tool for BPH surgery. In terms of parameters, it is in no way inferior to Tm : YAG or Ho : YAG during EEP. However, TFL surpasses these lasers in terms of usability and serviceability. These advantages are likely to render it more popular over time.

Thulium fiber laser vs. holmium laser enucleation of the prostate: results of a prospective randomized non-inferiority trial

“…However, our study showed no significant differences regarding overall operation time and morcellation time. This finding is supported by all previous data and the review of Taratkin et al [ 10 , 18 , 19 , 22 ]. Although the TFL was a relatively new laser source for our surgeons, who were all used to the holmium laser, our reported ThuFLEP enucleation efficiency of 1.45g/min is still higher than achieved in other publications (1.04 to 1.40g/min) [ 8 , 10 , 13 , 17 , 19 , 20 , 28 ].…”

“…The only randomized prospective study, which was conducted by Enikeev et al defined the severity of urinary incontinence according to the ICIQ-MLUTS as primary outcome [ 10 ]. There is still limited evidence on the use and clinical outcomes of ThuFLEP [ 8 , 21 , 22 ]. To fill this void, we conducted the following prospective randomized trial.…”

A prospective analysis of thulium laser enucleation in benign prostatic hyperplasia comparing low- and high-power approaches for prostates exceeding 80 g

“…During prostate enucleation, extensive energy consumption could lead to tissue carbonization “black escharing” which might obscure the surgical planes and cause harm to the adjacent capsule and urethral sphincter [ 16 ]. Therefore, mechanical dissection-dependent enucleation using different lasers has been advocated by some authors to avoid loss of surgical planes, whereas the prostate enucleation relies mainly on the mechanical dissection exerted through the resectoscope sheath tip after making the initial incisions [ 17 – 19 ].…”