Thulium fiber laser: the new player for kidney stone treatment? A comparison with Holmium:YAG laser

Abstract

Purpose To compare the operating modes of the Holmium:YAG laser and Thulium fiber laser. Additionally, currently available literature on Thulium fiber laser lithotripsy is reviewed. Materials and methods Medline, Scopus, Embase, and Web of Science databases were searched for articles relating to the operating modes of Holmium:YAG and Thulium fiber lasers, including systematic review of articles on Thulium fiber laser lithotripsy. Results The laser beam emerging from the Holmium:YAG laser involves fundamental architectural design constraints compared to the Thulium fiber laser. These differences translate into multiple potential advantages in favor of the Thulium fiber laser: four-fold higher absorption coefficient in water, smaller operating laser fibers (50-150 µm core diameter), lower energy per pulse (as low as 0.025 J), and higher maximal pulse repetition rate (up to 2000 Hz). Multiple comparative in vitro studies suggest a 1.5-4 times faster stone ablation rate in favor of the Thulium fiber laser. Conclusions The Thulium fiber laser overcomes the main limitations reported with the Holmium:YAG laser relating to lithotripsy, based on preliminary in vitro studies. This innovative laser technology seems particularly advantageous for ureteroscopy and may become an important milestone for kidney stone treatment.

The stone density does not affect the stone-free rate of kidney pelvic stones (2-3 cm) treated with flexible ureterorenoscopy

“…FURS is considered to be the perfect way to treat kidney stones due to its low invasiveness, small damage and high SFR. With the improvement of lithotripsy techniques (YAG laser), SFR was further enhanced [8]. But because of the stone density and the limitation of operating time, with one operation, we still can't crush all the stones.…”

Laser dissection for recalcitrant pancreaticojejunostomy anastomotic stricture

“…In this technique (Video 1, available online at www.VideoGIE.org), the laser fiber is placed side by side to the guidewire and water immersion is performed before dissection. The fiber is then used to target specific areas of the stricture with water irrigation used to optimize visualization of the dissection and to absorb the laser energy to reduce the risk of known adverse events of laser therapy including bleeding and perforation 1, 2. This therapy eliminated the recurrent acute attacks of pancreatitis and improved the patency of the anastomotic stricture (Fig.…”

A 70 W thulium-doped all-fiber laser operating at 1940 nm

“…Fiber-based laser sources comprising continuous-wave (CW) [1][2], nanosecond [3][4][5], picosecond [6][7][8], femtosecond [9][10][11] fiber lasers and amplifiers as well as supercontinuum sources [12][13][14] offer the efficient generation of laser radiation from compact lowmaintenance devices, which have created a wide range of applications in the industry. Especially medical applications like surgery of soft biological tissues have gained a lot of interest recently [15][16][17]. Lasers used in microsurgery operate at wavelengths corresponding to local peaks at ~2.94 μm and 1.94 μm.…”