V03-02 First Clinical Study on Superpulse Thulium Fiber Laser for Lithotripsy

Abstract

INTRODUCTION AND OBJECTIVES: We investigated the prognostic significance of the various manifestations of extrarenal extension which comprise pathologic stage T3a renal cell carcinoma (RCC) among patients treated with extirpative therapy for nonmetastatic disease.METHODS: A retrospective review of 595 patients who underwent nephrectomy for pathologically-confirmed T3aN0/NxM0 clear cell RCC between 1970 and 2011 was performed. All pathologic slides were re-reviewed by a single urologic pathologist. Associations of the type of extrarenal extension (perinephric fat, renal sinus fat, and renal vein in isolation or in any combination) with disease progression, death from RCC, and death from any cause were evaluated using Cox models adjusting for demographic and pathologic features.RESULTS: Overall, perinephric fat invasion, renal sinus fat invasion, renal vein tumor thrombus, and multiple sources of extrarenal extension were present in 160 (27%), 59 (10%), 167 (28%), and 209 (35%) patients, respectively. Median follow-up after surgery was 9.1 years (IQR 6.7, 13.2), during which time 343 patients developed disease progression at a median of 1.5 years (IQR 0.5-4.3), 271 patients died from RCC at a median of 3.5 years (IQR 1.6-7.3), and 463 patients died from any cause at a median of 4.9 years (IQR 2.0-10.0) following surgery. No significant differences in the rates of disease progression, death from RCC, or death from any cause were observed in the presence of isolated perinephric fat invasion, renal sinus fat invasion, or renal vein tumor thrombus. However, on multivariable analyses, patients with multiple sources of extrarenal extension were at a significantly increased risk of disease progression (HR 1.31, 95%CI¼1.05-1.64, P¼0.017), death from RCC (HR 1.64, 95%CI¼1.28-2.11, P<0.001), and death from any cause (HR 1.31, 95%CI¼1.08-1.60, P¼0.007) compared to patients with an isolated source of extrarenal extension.CONCLUSIONS: Isolated involvement of the perinephric fat, renal sinus fat, or renal vein carry similar prognostic weight, justifying grouped classification as T3a in the contemporary AJCC primary tumor classification. However, presence of multiple sources of extrarenal extension is associated with higher risk for disease progression, cancerrelated death, and death from any cause after nephrectomy. If validated, these findings may help refine risk-stratification of non-metastatic T3a RCC.

Consultation on kidney stones, Copenhagen 2019: aspects of intracorporeal lithotripsy in flexible ureterorenoscopy

“…Comparing laser setting options, TFL offers frequencies of 5-2200 Hz, pulse energies of 0.025-6 J, and pulse durations of 200-12,000 microsec [76,[80][81][82][83], whereas Ho:YAG offers 5-100 Hz, 0.2-6 J, and 50-1300 microsec [81,84]. These qualities of the TFL laser give this technology the potential to produce 3-4 times more dust compared to high-power Ho-YAG lasers [78,85,86]. Furthermore, due to the novel laser beam generation by laser diodes in TFL, smaller fibres (50 µm) can be utilized, which may result in higher energy intensity at the tip of the fibre, better scope deflection, and better irrigation, all of which can potentially increase stone ablation volume at comparable settings [74,80,81].…”

High power holmium:YAG versus thulium fiber laser treatment of kidney stones in dusting mode: ablation rate and fragment size studies

“…Potential advantages of TFL technology have recently been reviewed in the literature . While the majority of previous reports have been based on preliminary laboratory studies , the TFL has also shown promise in early clinical studies as well . Electronic modulation of the diode‐pumped TFL enables it to be operated with a wide range of laser parameters, including pulse energies from 5 mJ up to 6 J, pulse durations of 100 μs to 100's of ms, and pulse rates of 1–2,000 Hz.…”

Managing Urolithiasis with Thulium Fiber Laser: Updated Real-Life Results—A Systematic Review

“…The initial clinical experiences have demonstrated that the different laser settings used in the operating room are safe for patients. Many combinations of laser settings have been tested for ureteral, renal, and bladder stone lithotripsies presented in various conference abstracts [ 9 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ] and in full-text clinical experiences [ 37 , 38 , 39 , 40 , 41 , 42 , 43 ] ( Table 2 ). However, the ideal one has not yet been established.…”

“…The TFL showed its appealing characteristics in several preclinical studies, possessing the widest and most flexible range of parameters among the actual laser lithotripters [ 7 , 8 ]. Later on, the first clinical trial was developed in Russia in 2018, making it the only country with clinical approval given by the Ministry of Health of the Russian Federation [ 9 ]. It was only in June 2020 that this technology was approved worldwide with incredible results [ 6 ].…”