1
|
Mishra A, Margolin EJ, Stewart AW, Medairos RE, Antonelli J, Preminger GM, Zhong P, Lipkin ME. Optimizing Fragmentation while Minimizing Thermal Injury Risk with the Thulium Fiber Laser in Ureteral Stone Lithotripsy: An In Vitro Study. J Endourol 2025. [PMID: 40346771 DOI: 10.1089/end.2024.0637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2025] Open
Abstract
Objective: To optimize thulium fiber laser (TFL) settings for effective stone fragmentation although minimizing thermal injury in confined ureteral spaces using a three-dimensional ureter model. Materials and Methods: A hydrogel-based ureter model was maintained at 37.2 ± 0.5°C, with a cylindrical BegoStone (10 × 10 mm, 1.00 ± 0.07 gm) occluding the ureter. Ureteroscopy was performed using a 150 µm TFL fiber for 3 minutes with room temperature irrigation and differing rates (0, 20, 40 mL/min) and power settings (6.4 to 20 W). Maximum sustained temperature (MST) and cumulative thermal dose (cumulative equivalent minutes at 43°C) were assessed against a 120-minute safety threshold. We also evaluated the effects of ureter volume and irrigation temperature. Stone mass treated was calculated by subtracting the mass of residual fragments >3 mm from the initial mass. Results: At 6.4 and 10 W, MSTs were below body temperature, and thermal doses were under 1 minute, indicating minimal thermal risk. At 20 W with 20 mL/min irrigation, MST exceeded 43°C within seconds, and thermal doses surpassed 120 minutes. Treatment efficiency was highest at 20 W (1.58 mg/s), followed by 10 W (1.15 mg/s) and 6.4 W (0.78 mg/s). Among 10 W settings, 1.0 J/10 Hz was more efficient than 2.0 J/5 Hz and 3.0 J/3 Hz. Safe settings produced 95.5% fine dust, whereas high-energy pulses 2-3 J produced significantly more fragments (1-3 mm) compared with settings with pulse energy 0.5-1.0 J. Increasing irrigation to 40 mL/min or using 15°C irrigation effectively reduced MST and improved efficiency, particularly at 20 W. Conclusion: Our study demonstrates the risk of thermal injury with 20 W TFL treatment. Conversely, 10 W settings at 2.0 J/5 Hz are safe and effective for fragmentation. Future research will focus on validating these optimal settings for human stone treatment.
Collapse
Affiliation(s)
- Arpit Mishra
- Thomas Lord Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
| | - Ezra J Margolin
- Division of Urology, Duke University Medical Center, Durham, North Carolina, USA
| | - Aaron W Stewart
- Division of Urology, Duke University Medical Center, Durham, North Carolina, USA
| | - Robert E Medairos
- Division of Urology, Duke University Medical Center, Durham, North Carolina, USA
| | - Jodi Antonelli
- Division of Urology, Duke University Medical Center, Durham, North Carolina, USA
| | - Glenn M Preminger
- Division of Urology, Duke University Medical Center, Durham, North Carolina, USA
| | - Pei Zhong
- Thomas Lord Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
| | - Michael E Lipkin
- Division of Urology, Duke University Medical Center, Durham, North Carolina, USA
| |
Collapse
|
2
|
Moretto S, Quarà A, Zorzi F, Bravo-Balado A, Madden A, Cabrera J, Corrales M, Candela L, Doizi S, Panthier F, Traxer O. Stone dust in endourology: a systematic review of its definition, management, and clinical impact. BJU Int 2025. [PMID: 40345994 DOI: 10.1111/bju.16765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2025]
Abstract
OBJECTIVE To evaluate and synthesise the existing literature on stone dust (DUST) in endourology, focusing on its definition, creation methods, and removal techniques. METHODS A comprehensive electronic literature search was conducted using the PubMed/Medline, Web Of Science, and Embase databases to identify reports published until October 2024. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed to identify eligible studies. The outcomes assessed included the definition of DUST, the method by which DUST was created, and how it was removed, evaluating both in vitro and in vivo studies. The review also assessed the efficacy of different laser technologies, including holmium-yttrium-aluminium-garnet (Ho:YAG) laser, thulium fibre laser (TFL), and pulsed thulium-YAG laser (p-Tm:YAG) laser, in generating DUST and their clinical relevance in stone management. RESULTS The systematic review identified 43 eligible studies, revealing significant variability in the definition and evaluation of DUST. Criteria for DUST ranged from sub-millimetre particle sizes to functional properties like floatability and aspiration capability. While Ho:YAG lasers remain widely used for stone dusting, emerging technologies such as TFL and p-Tm:YAG lasers have shown superior efficiency in producing finer particles and reducing retropulsion. No consensus emerged regarding the settings used by surgeons and the pre-settings provided by laser manufacturers. CONCLUSIONS Despite the widespread use of dusting techniques in endourology, a standardised definition of DUST remains lacking, with significant variability in laser settings, particle sizes, and evacuation methods. It must be clarified whether DUST should be defined as a noun-representing a distinct entity with a precise definition-or as the result of the dusting process, in which case clear criteria are needed to characterise it accurately. Establishing standardised definitions and protocols through international consensus is crucial to optimising clinical outcomes and ensuring consistency in future research.
Collapse
Affiliation(s)
- Stefano Moretto
- Service d'Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, Paris, France
- GRC n°20, Santé de l'homme, Hôpital Tenon, Sorbonne Université, Paris, France
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Milan, Italy
| | - Alberto Quarà
- Service d'Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, Paris, France
- GRC n°20, Santé de l'homme, Hôpital Tenon, Sorbonne Université, Paris, France
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Federico Zorzi
- Service d'Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, Paris, France
- GRC n°20, Santé de l'homme, Hôpital Tenon, Sorbonne Université, Paris, France
- Urology Clinic, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Alejandra Bravo-Balado
- Service d'Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, Paris, France
- GRC n°20, Santé de l'homme, Hôpital Tenon, Sorbonne Université, Paris, France
| | - Aideen Madden
- Service d'Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, Paris, France
- GRC n°20, Santé de l'homme, Hôpital Tenon, Sorbonne Université, Paris, France
| | - Johan Cabrera
- Service d'Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, Paris, France
- GRC n°20, Santé de l'homme, Hôpital Tenon, Sorbonne Université, Paris, France
| | - Mariela Corrales
- Service d'Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, Paris, France
- GRC n°20, Santé de l'homme, Hôpital Tenon, Sorbonne Université, Paris, France
| | - Luigi Candela
- Service d'Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, Paris, France
- GRC n°20, Santé de l'homme, Hôpital Tenon, Sorbonne Université, Paris, France
| | - Steeve Doizi
- Service d'Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, Paris, France
- GRC n°20, Santé de l'homme, Hôpital Tenon, Sorbonne Université, Paris, France
| | - Frederic Panthier
- Service d'Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, Paris, France
- GRC n°20, Santé de l'homme, Hôpital Tenon, Sorbonne Université, Paris, France
| | - Olivier Traxer
- Service d'Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, Paris, France
- GRC n°20, Santé de l'homme, Hôpital Tenon, Sorbonne Université, Paris, France
| |
Collapse
|
3
|
Bravo-Balado A, Moretto S, Jannello LMI, Quarà A, Zorzi F, Doizi S, Traxer O, Panthier F. High-frequency in laser lithotripsy: do we truly know what it means? World J Urol 2025; 43:287. [PMID: 40341980 DOI: 10.1007/s00345-025-05650-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2025] [Accepted: 04/19/2025] [Indexed: 05/11/2025] Open
Abstract
INTRODUCTION AND OBJECTIVE High frequency (HF) in laser lithotripsy lacks a consistent definition, potentially impacting clinical outcomes and patient safety. This review aims to analyze available evidence on the definition of HF. MATERIALS AND METHODS A comprehensive literature search of MEDLINE, Scopus, and Cochrane databases identified English-language studies published up to November 2024. Those mentioning HF focused on Holmium:YAG (Ho:YAG), Thulium Fiber Laser (TFL), and pulsed Thulium:YAG (p-Tm:YAG) in ureteral and renal endoscopic procedures; in vitro experiments and reviews/editorials were also included. User manuals from high-power laser manufacturers, and data from artificial intelligence (AI) platforms were also analyzed. RESULTS From 1030 initial records, 857 studies were screened after duplicate removal, and 106 studies were ultimately included. Most articles came from Europe (46), followed by North America (37) and Asia (20). HF was poorly defined in 25 articles, distributed across Europe (11), North America (7), and Asia (7). Most studies evaluated Ho:YAG (N = 80), followed by TFL (N = 13) and p-Tm:YAG (N = 1); the rest evaluated the first two lasers or all three. HF definitions varied, with European studies reporting ranges from 10 to 200 Hz, North American studies from 10 to 120 Hz, and Asian studies from 10 to 200 Hz. On average, HF ranged from 40 to 50 Hz. Among manufacturers, only four out of eight provided HF definitions in pre-setting/starting guidelines. AI platforms defined HF as 15-100 Hz for Ho:YAG, 50-2000 Hz for TFL, and 20-500 Hz for p-Tm:YAG. CONCLUSIONS There is no consensus on HF definitions in laser lithotripsy, with limited manufacturer guidelines and overly broad AI-defined ranges. Standardized terminology is essential. We propose defining HF as > 30 Hz for renal and > 15 Hz for ureteral procedures. Based on the available evidence, the use of HF settings does not appear to be necessary for dusting or popcorning techniques with current technologies.
Collapse
Affiliation(s)
- Alejandra Bravo-Balado
- Endolase lab, GRC20, Sorbonne Université and PIMM-Arts et Métiers Paris Tech, Paris, France.
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France.
| | - Stefano Moretto
- Endolase lab, GRC20, Sorbonne Université and PIMM-Arts et Métiers Paris Tech, Paris, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Milan, Italy
| | - Letizia Maria Ippolita Jannello
- Endolase lab, GRC20, Sorbonne Université and PIMM-Arts et Métiers Paris Tech, Paris, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France
- Unit of Urology, Department of Health Science, University of Milan, ASST Santi Paolo and Carlo, Via A. Di Rudini 8, 20142, Milan, Italy
- Università degli Studi di Milano, Milan, Italy
| | - Alberto Quarà
- Endolase lab, GRC20, Sorbonne Université and PIMM-Arts et Métiers Paris Tech, Paris, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France
- Department of Urology, AOU San Luigi Gonzaga-University of Turin, Orbassano (Turin), Italy
| | - Federico Zorzi
- Endolase lab, GRC20, Sorbonne Université and PIMM-Arts et Métiers Paris Tech, Paris, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France
- Urology Clinic, Department of Medical, Surgical and Health Sciences, University of Trieste, 34127, Trieste, Italy
| | - Stevee Doizi
- Endolase lab, GRC20, Sorbonne Université and PIMM-Arts et Métiers Paris Tech, Paris, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France
- Endourology Technology Section of European Association of Urology (EAU), Arnhem, The Netherlands
| | - Olivier Traxer
- Endolase lab, GRC20, Sorbonne Université and PIMM-Arts et Métiers Paris Tech, Paris, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France
- Endourology Technology Section of European Association of Urology (EAU), Arnhem, The Netherlands
| | - Frédéric Panthier
- Endolase lab, GRC20, Sorbonne Université and PIMM-Arts et Métiers Paris Tech, Paris, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France
- Endourology Technology Section of European Association of Urology (EAU), Arnhem, The Netherlands
| |
Collapse
|
4
|
Villani R, Liernur TD, Windisch OL, Valerio M, Schoofs FT, Kwok JL, Sierra A, Eberli D, Iselin C, Traxer O, Keller EX. With great power comes great risk: High ureteral stricture rate after high-power, high-frequency Thulium fiber laser lithotripsy in ureteroscopy. World J Urol 2025; 43:232. [PMID: 40249411 PMCID: PMC12008075 DOI: 10.1007/s00345-025-05553-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2025] [Accepted: 03/04/2025] [Indexed: 04/19/2025] Open
Abstract
PURPOSE To compare the safety and efficacy of Thulium Fiber Laser (TFL) using either manufacturer presets (MP) or individualized presets (IP) in ureteroscopy. METHODS Multi-institutional, retrospective analysis on the first patients treated with SOLTIVE® Premium (Olympus Medical Systems®) TFL in Switzerland in 2020. MP were used at the University Hospital of Geneva, while IP were used at the University Hospital of Zurich. Patient demographics, stone characteristics, and procedural details were collected. Primary outcome was postoperative ureteral stricture (US). Secondary outcome was stone-free rate (SFR). RESULTS A total of 158 patients were analyzed, 79 in each group. Demographics were similar between the two groups, except for a lower pre-stenting rate in the MP group (56% vs. 91%; p < 0.001) and a higher rate of ureteral access sheath use in the MP group (65% vs. 44%; p = 0.011). No significant differences in stone burden (median stone diameter 9 mm, median stone volume 267 mm3), nor in the rate of impacted ureteral stones (29% vs. 34%; p = 0.49). Mean power, maximal power, frequency settings, and energy consumption were significantly higher in the MP group. US rate was 11% in MP group compared to 1% in IP group (p = 0.009). MP were a significant predictor of US on multivariable analysis (OR 12.4; p = 0.02), independently from impacted ureteral stones. No difference in SFR between groups (85% and 84%; p = 0.67). CONCLUSION High-power, high-frequency laser settings from manufacturer laser presets increase the risk of US, without improving SFR. Future studies shall further evaluate optimal laser settings depending on patient characteristics and intraoperative situation.
Collapse
Affiliation(s)
- Riccardo Villani
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Thibaut Dominique Liernur
- Department of Surgery, Service of Urology, University Hospital Geneva, University of Geneva, Geneva, Switzerland
| | - Olivier Laurent Windisch
- Department of Surgery, Service of Urology, University Hospital Geneva, University of Geneva, Geneva, Switzerland
| | - Massimo Valerio
- Department of Surgery, Service of Urology, University Hospital Geneva, University of Geneva, Geneva, Switzerland
| | - Fabian Thierry Schoofs
- Department of Surgery, Service of Urology, University Hospital Geneva, University of Geneva, Geneva, Switzerland
| | - Jia-Lun Kwok
- Department of Urology, Tan Tock Seng Hospital, Singapore, Singapore
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Section of Endourology, European Association of Urology, Arnhem, The Netherlands
| | - Alba Sierra
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Section of Endourology, European Association of Urology, Arnhem, The Netherlands
- Urology Department, Hospital Clinic de Barcelona, Villarroel 170, Barcelona, 08036, Spain
- Young Academic Urologists (YAU), Endourology & Urolithiasis Working Group, Arnhem, The Netherlands
| | - Daniel Eberli
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Christophe Iselin
- Department of Surgery, Service of Urology, University Hospital Geneva, University of Geneva, Geneva, Switzerland
- Cabinet privé, 76b Av. de la Roseraie, Geneva, Switzerland
| | - Olivier Traxer
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Section of Endourology, European Association of Urology, Arnhem, The Netherlands
- Service d'Urologie, Sorbonne Université, Hôpital Tenon, Paris, France
- Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Paris, F-75020, France
| | - Etienne Xavier Keller
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France.
- Section of Endourology, European Association of Urology, Arnhem, The Netherlands.
- Young Academic Urologists (YAU), Endourology & Urolithiasis Working Group, Arnhem, The Netherlands.
| |
Collapse
|
5
|
Marom R, Glienke L, Robinson JW, Hall TL, Roberts WW, Ghani KR. Characterizing stone ablation with the thulium fiber laser: a single-pulse comparison of different pulse durations. Urolithiasis 2025; 53:42. [PMID: 40025336 DOI: 10.1007/s00240-025-01714-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2024] [Accepted: 02/13/2025] [Indexed: 03/04/2025]
Abstract
Stone ablation using the thulium fiber laser (TFL) at different pulse duration/peak power or laser fiber-to-stone distances requires further research to understand effective and safe settings. In this study we characterized the vapor bubble anatomy and stone crater morphology at various settings and standoff distances. Optical profiles of 1 J short pulse (SP), 1 J long pulse (LP), 3 J SP, and 2.4 J LP of a TFL system (Fiberdust, Quanta) were assessed. We used high-speed imaging and segmentation to quantify the vapor bubble. Using Begostones, stone craters from a single pulse at each setting were compared at 0, 0.5, 1, 2 and 3 mm standoff distances. The temporal optical profile of TFL is rectangular in shape with a peak power of ~ 180W (LP) and ~ 470W (SP). Increasing the pulse energy did not increase the peak power. LP generated a channel-like bubble while SP formed multiple generations of a spherical bubble. Ablation volume with SP was greater than LP for all distances (p < 0.001) with up to 350% increased crater volume at contact. Ablation reduced as distance increased with both modes. There was no ablation at > 1 mm distance with LP. For SP, increasing the pulse energy had minimal impact on crater depth. The SP creates a bubble geometry that tends to collapse more quickly in comparison to LP. Peak power of TFL is a function of pulse duration, not pulse energy. LP results in weak ablation. When using SP, increasing the pulse energy increased ablation volume by increasing crater area rather than depth.
Collapse
Affiliation(s)
- Ron Marom
- Department of Urology, University of Michigan, 4432 Medical Science I, 1301 Catherine Street, Ann Arbor, MI, 48109-5330, USA.
| | - Leilane Glienke
- Department of Urology, University of Michigan, 4432 Medical Science I, 1301 Catherine Street, Ann Arbor, MI, 48109-5330, USA
| | - John W Robinson
- Department of Chemistry, University of Michigan, Ann Arbor, MI, USA
| | - Timothy L Hall
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - William W Roberts
- Department of Urology, University of Michigan, 4432 Medical Science I, 1301 Catherine Street, Ann Arbor, MI, 48109-5330, USA
| | - Khurshid R Ghani
- Department of Urology, University of Michigan, 4432 Medical Science I, 1301 Catherine Street, Ann Arbor, MI, 48109-5330, USA
| |
Collapse
|
6
|
Panthier F, Solano C, Chicaud M, Kutchukian S, Candela L, Doizi S, Corrales M, Traxer O. Thulium fiber laser versus pulsed Thulium:YAG for laser lithotripsy during flexible ureteroscopy. Lasers Med Sci 2024; 39:294. [PMID: 39676085 DOI: 10.1007/s10103-024-04267-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 12/10/2024] [Indexed: 12/17/2024]
Abstract
To compare the pulsed-Thulium: YAG(p-Tm: YAG) and Thulium Fiber(TFL) lasers in terms of efficiency and safety profiles during flexible ureteroscopy(fURS) and endocorporeal laser lithotripsy(ELL). A prospective single-center open-label comparative study included consecutive patients with ureteral and renal stones who underwent fURS using Thulio(p-Tm: YAG, Dornier©,Germany) or TFL Drive(TFL, Coloplast©,Danemark), with 270 μm and 150/200μm laser fibers(LF), respectively. fURS were performed by a single operator in each group. Demographics, stone size, stone density, laser-on time(LOT) and laser settings were recorded. Ablation speed(mm3/s), energy consumption(J/mm3) values for each procedure were also assessed. Stone-free rate(SFR, <3 mm fragments) and zero fragment rate(ZFR) on non-contrast computed tomography within 3 months postoperatively were also recorded. 36 and 39 patients were included in p-Tm: YAG and TFL group, respectively. Groups presented similar demographics but for high blood pressure(53vs23%,p = 0,005), anatomical abnormalities(8vs33%,p = 0,03), lower pole(8vs26%,p = 0,04) and pelvic stones(25vs13%,p = 0,04) for p-Tm: YAG and TFL, respectively. The median stone maximum diameter was higher in the p-Tm: YAG group(17.3vs13.8 mm, p = 0,001) but stone volume was similar among groups(1514vs1347mm3,p = 0,6). Laser settings were similar among groups(0,6-15 Hz,10-12 W). Shorter LOT(< 0,001) and lower UAS insertion(0,01) rates were reported for TFL compared to p-Tm: YAG. The median J/mm3 was similar(14vs17,p = 0,2) but p-Tm: YAG presented higher ablation speed(0,91vs0,73mm3/s, p = 0,04). SFR were similar among groups(75vs77%,p = 0,8) but ZFR was higher in TFL group(39vs64%,p = 0,008). No difference in complications was reported. Both p-Tm: YAG and TFL are safe and effective for ELL during fURS. SFR were similar between TFL and p-Tm: YAG but the latter presented lower ZFR, traducing its lower ability to dust. Using 200 μm laser fibers with p-Tm: YAG could nuance these findings.
Collapse
Affiliation(s)
- Frédéric Panthier
- Groupe de Recherche Clinique sur la Lithiase Urinaire, GRC n°20, Hôpital Tenon, Sorbonne Université, Paris, 75020, France.
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, Paris, 75020, France.
- PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, 151 bd de l'Hôpital, Paris, F-75013, France.
- Progressive Endourological Association for Research and Leading Solutions (PEARLS group), Paris, France.
| | - Catalina Solano
- Groupe de Recherche Clinique sur la Lithiase Urinaire, GRC n°20, Hôpital Tenon, Sorbonne Université, Paris, 75020, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, Paris, 75020, France
- Department of Endourology, Uroclin SAS, Medellin, Colombia
| | - Marie Chicaud
- Groupe de Recherche Clinique sur la Lithiase Urinaire, GRC n°20, Hôpital Tenon, Sorbonne Université, Paris, 75020, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, Paris, 75020, France
- PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, 151 bd de l'Hôpital, Paris, F-75013, France
- Service d'Urologie, CHU Limoges, Limoges, 87000, France
| | - Stessy Kutchukian
- Groupe de Recherche Clinique sur la Lithiase Urinaire, GRC n°20, Hôpital Tenon, Sorbonne Université, Paris, 75020, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, Paris, 75020, France
- PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, 151 bd de l'Hôpital, Paris, F-75013, France
- Department of Urology, Poitiers University Hospital, 2 Rue de la Milétrie, Poitiers, 86000, France
| | - Luigi Candela
- Groupe de Recherche Clinique sur la Lithiase Urinaire, GRC n°20, Hôpital Tenon, Sorbonne Université, Paris, 75020, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, Paris, 75020, France
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vital-Salute San Raffaele University, Milan, Italy
| | - Steeve Doizi
- Groupe de Recherche Clinique sur la Lithiase Urinaire, GRC n°20, Hôpital Tenon, Sorbonne Université, Paris, 75020, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, Paris, 75020, France
- PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, 151 bd de l'Hôpital, Paris, F-75013, France
| | - Mariela Corrales
- Groupe de Recherche Clinique sur la Lithiase Urinaire, GRC n°20, Hôpital Tenon, Sorbonne Université, Paris, 75020, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, Paris, 75020, France
- Progressive Endourological Association for Research and Leading Solutions (PEARLS group), Paris, France
| | - Olivier Traxer
- Groupe de Recherche Clinique sur la Lithiase Urinaire, GRC n°20, Hôpital Tenon, Sorbonne Université, Paris, 75020, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, Paris, 75020, France
- PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, 151 bd de l'Hôpital, Paris, F-75013, France
- Progressive Endourological Association for Research and Leading Solutions (PEARLS group), Paris, France
| |
Collapse
|
7
|
Chicaud M, Kutchukian S, Berthe L, Corrales M, Solano C, Candela L, Doizi S, Smith D, Traxer O, Panthier F. In Vitro Comparison of Pulsed-Thulium:YAG, Holmium:YAG, and Thulium Fiber Laser. J Endourol 2024; 38:1427-1435. [PMID: 39283822 DOI: 10.1089/end.2024.0424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2024] Open
Abstract
Objective: To characterize the pulse characteristics and risk of fiber fracture (ROF) of the pulsed-Thulium:YAG (p-Tm:YAG) laser and to compare its ablation volumes (AVs) against Holmium:Yttrium-Aluminium-Garnet (Ho:YAG) laser and Thulium fiber laser (TFL). Materials and Methods: p-Tm:YAG (100 W-Thulio, Dornier-Medtech©, Germany) was characterized using single-use 272 μm core-diameter-fibers. p-Tm:YAG characterization included pulse shape, duration, and peak power (PP) studies. ROF was assessed after 5 minutes of continuous laser activation (CLA) at five decreasing fiber bend radii (1, 0.9, 0.75, 0.6, and 0.45 cm). p-Tm:YAG, Ho:YAG (120 W-Cyber-Ho, Quanta®, USA), and TFL (60 W-TFLDrive, Coloplast®, Denmark) AVs were compared using a 20-mm linear CLA at 2 mm/second velocity in contact with 20 mm3 hard stone phantoms (HSP) and soft stone phantoms (SSP) (15:3 and 15:5 water to powder ratio, respectively) fully submerged in saline at 0.5 J-20 Hz or 1 J-10 Hz. After CLA, phantoms underwent three-dimensional (3D) micro-scanning (CT) and subsequent 3D segmentation to estimate the AVs, using 3DSlicer©. Each experiment was performed in triplicate. Results: p-Tm:YAG presents a uniform pulse profile in all of the available preset modes. PP ranged from 564 to 2199 W depending on pulse mode. No laser fiber fracture occurred at any bend radius. p-Tm:YAG achieved similar mean AVs to TFL and Ho:YAG for HSP (8.96 ± 3.1 vs 9.78 ± 1.1 vs 8.8 ± 2.8 mm3, p = 0.67) but TFL was associated with higher AVs compared with p-Tm:YAG and Ho:YAG (12.86 ± 1.85 vs 10.12 ± 1.89 vs 7.56 ± 2.21 mm3, p = 0.002) against SSP. AVs for HSP increased with pulse energy for p-Tm:YAG and Ho:YAG and (11.56 ± 1.8 vs 6.36 ± 0.84 mm3 and 11.27 ± 1.98 vs 6.34 ± 0.55 mm3, p = 0.03 and p = 0.02), whereas AVs for SSP were similar across laser settings for all laser sources. AVs with TFL were similar across laser settings for both phantom types. Conclusion: p-Tm:YAG combines intermediate PP between Ho:YAG and TFL, a uniform pulse profile, no ROF with increasing deflection and effective ablation rates. Further clinical studies are needed to confirm these in vitro results.
Collapse
Affiliation(s)
- Marie Chicaud
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, Paris, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, Paris, France
- PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, 151 bd de l'Hôpital, Paris, France
- Service d'Urologie, CHU Limoges, Limoges, France
| | - Stessy Kutchukian
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, Paris, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, Paris, France
- PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, 151 bd de l'Hôpital, Paris, France
- Department of Urology, Poitiers University Hospital, Poitiers, France
| | - Laurent Berthe
- PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, 151 bd de l'Hôpital, Paris, France
| | - Mariela Corrales
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, Paris, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, Paris, France
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
| | - Catalina Solano
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, Paris, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, Paris, France
- Department of Endourology, Uroclin SAS Medellin, Medellin, Colombia
| | - Luigi Candela
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, Paris, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, Paris, France
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vital-Salute San Raffaele University, Milan, Italy
| | - Steeve Doizi
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, Paris, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, Paris, France
- PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, 151 bd de l'Hôpital, Paris, France
| | - Daron Smith
- Department of Urology, Westmoreland Street Hospital, UCLH NHS Foundation Trust, London, United Kingdom
- Endourology Academy, London, United Kingdom
- Social Media Committee, Endourological Society, London, United Kingdom
| | - Olivier Traxer
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, Paris, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, Paris, France
- PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, 151 bd de l'Hôpital, Paris, France
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
| | - Frédéric Panthier
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, Paris, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, Paris, France
- PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, 151 bd de l'Hôpital, Paris, France
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Department of Urology, Westmoreland Street Hospital, UCLH NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
8
|
Sierra A, Panthier F, Castillo E, Mercadé A, Peri L, Alcaraz A, Traxer O, López JM, Luque MP. Assessment of Holmium:YAG, Pulsed-Thulium:YAG and Thulium Fiber Lasers for Urinary Stone Ablation. In Vitro Study. J Endourol 2024; 38:1209-1216. [PMID: 39225163 DOI: 10.1089/end.2024.0349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
Abstract
Objective: To evaluate the ablation speed (AS), laser efficiency and direct thermal lesions during urinary stone lithotripsy with the current available laser technologies: Holmium:YAG (Ho:YAG), pulsed-Thulium:YAG (p-Tm:YAG) and thulium fiber laser (TFL) in vitro using different laser settings. Materials and Methods: Ho:YAG, p-Tm:YAG, and TFL laser system were used in an in vitro ureteral model with a volume of 125 mm3 Begostone. The following parameters were tested across all laser devices: 0.6J/10 Hz (6 W), 0.6 J/20 Hz (12 W), 1.5 J/10 Hz (15 W), and 1.5 J/20 Hz (30 W), employing short pulse width for all lasers and long pulse width for Ho:YAG and p-Tm:YAG. Ten participants conducted the experimental setup during 3-minutes laser on time, combining the laser technology, settings, and pulse widths, with a total of 20 different combinations. The efficiency, AS and ureteral damage resulting from each intervention were analyzed. Results: p-Tm:YAG and TFL demonstrated significantly higher efficiency compared with Ho:YAG (0.049 ± 0.02 Δgr/KJ and 0.042 ± 0.01 Δgr/KJ vs 0.029 ± 0.01 Δgr/KJ; p < 0.05). In all laser sources, as the power increases, the AS also increases (p < 0.05). Furthermore, only at high-energy settings (1.5 J) higher frequency led to increase AS (p < 0.05). Both, p-Tm:YAG and TFL exhibited higher AS compared to Ho:YAG (0.64 ± 0.33 Δgr/s and 0.62 ± 0.31 Δgr/s vs 0.44 ± 0.22 Δgr/s; p < 0.05). Regarding ureteral injuries, as the power increases, there is a higher chance of ureteral damage (p = 0.031). No differences were observed between laser technologies (p = 0.828). Conclusions: Both, p-Tm:YAG and TFL exhibited superior performances during laser lithotripsy compared with Ho:YAG, as they demonstrated higher efficiency and ablation speed. Thermal damage did not appear to be associated with specific laser equipment, but higher grades of lesions are described by increasing power.
Collapse
Affiliation(s)
- Alba Sierra
- Department of Urology, Hospital Clinic-University of Barcelona, Barcelona, Spain
| | - Frederic Panthier
- Department of Urology AP-HP, Sorbonne University, Tenon Hospital, Paris, France
| | | | - Asier Mercadé
- Department of Urology, Hospital Clinic-University of Barcelona, Barcelona, Spain
| | - Lluís Peri
- Department of Urology, Hospital Clinic-University of Barcelona, Barcelona, Spain
| | - Antonio Alcaraz
- Department of Urology, Hospital Clinic-University of Barcelona, Barcelona, Spain
| | - Olivier Traxer
- Department of Urology AP-HP, Sorbonne University, Tenon Hospital, Paris, France
| | - Juan Manuel López
- Department of Urology, Hospital Clinic-University of Barcelona, Barcelona, Spain
| | - Maria Pilar Luque
- Department of Urology, Hospital Clinic-University of Barcelona, Barcelona, Spain
| |
Collapse
|
9
|
Sierra A, Solano C, Corrales M, Ventimiglia E, Panthier F, Kwok JL, Chicaud M, Keller EX, Traxer O. Steady-state versus burst lasing techniques for thulium fiber laser. World J Urol 2024; 42:487. [PMID: 39158747 PMCID: PMC11333515 DOI: 10.1007/s00345-024-05102-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 06/01/2024] [Indexed: 08/20/2024] Open
Abstract
OBJECTIVE To evaluate the stone ablation rate and direct thermal damage from thulium fiber laser (TFL) lithotripsy using continuous (C) and burst (B) lasing techniques on an in vitro ureteral model. METHODS The TFL Drive (Coloplast, Humlebaek, Denmark) was used in an in vitro saline-submerged ureteral model. Ten participants, including five junior and five experienced urologists, conducted the experimental setup with 7 different settings comparing two lasing techniques: steady-state lasing (0.5 J/10 Hz = 5W for 300 s and 0.5 J/20 Hz = 10W for 150 s) and burst, intermittent 5 s on/off lasing (0.5 J/20 Hz, 0.5 J/30 Hz, 0.5 J/60 Hz, 0.1 J/200 Hz, and 0.05 J/400 Hz) with a target cumulative energy of 1500 J using cubic 125 mm3 phantom BegoStonesTM. Ureteral damage was graded 1-3 based on the severity of burns and holes observed on the surface of the ureteral model. RESULTS The were no significant differences in stone ablation mass neither between C and B lasing techniques, nor between expertise levels. At C lasing technique had only mild ureteral lesions with no significant differences between expertise levels (p: 0.97) or laser settings (p: 0.71). At B lasing technique, different types of thermal lesions were found with no expertise (p: 0.11) or setting (p: 0.83) differences. However, B laser setting had higher grade direct thermal lesions than C (p: 0.048). CONCLUSION Regarding efficacy, C and B lasing techniques achieve comparable stone ablation rates. Safety-wise, B lasing mode showed higher grade of direct thermal lesions. These results should be further investigated to verify which of the lasing mode is the safest in vivo. Until then and unless proven otherwise, a C mode with low frequency should be recommended to avoid ureteral wall lesions.
Collapse
Affiliation(s)
- Alba Sierra
- Urology Department, Hospital Clínic de Barcelona, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain.
- Sorbonne University GRC Urolithiasis No. 20 Tenon Hospital, 75020, Paris, France.
- Department of Urology AP-HP, Tenon Hospital, Sorbonne University, 75020, Paris, France.
- Progressive Endourological Association for Research and Leading Solutions (PEARLS Group), Paris, France.
| | - Catalina Solano
- Sorbonne University GRC Urolithiasis No. 20 Tenon Hospital, 75020, Paris, France
- Department of Urology AP-HP, Tenon Hospital, Sorbonne University, 75020, Paris, France
- Uroclin, Medellín, Colombia
| | - Mariela Corrales
- Sorbonne University GRC Urolithiasis No. 20 Tenon Hospital, 75020, Paris, France
- Department of Urology AP-HP, Tenon Hospital, Sorbonne University, 75020, Paris, France
- Progressive Endourological Association for Research and Leading Solutions (PEARLS Group), Paris, France
| | - Eugenio Ventimiglia
- Sorbonne University GRC Urolithiasis No. 20 Tenon Hospital, 75020, Paris, France
- Department of Urology AP-HP, Tenon Hospital, Sorbonne University, 75020, Paris, France
- Progressive Endourological Association for Research and Leading Solutions (PEARLS Group), Paris, France
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Università Vita-Salute San Raffaele, Milan, Italy
| | - Frederic Panthier
- Sorbonne University GRC Urolithiasis No. 20 Tenon Hospital, 75020, Paris, France
- Department of Urology AP-HP, Tenon Hospital, Sorbonne University, 75020, Paris, France
- Progressive Endourological Association for Research and Leading Solutions (PEARLS Group), Paris, France
| | - Jia-Lun Kwok
- Sorbonne University GRC Urolithiasis No. 20 Tenon Hospital, 75020, Paris, France
- Department of Urology AP-HP, Tenon Hospital, Sorbonne University, 75020, Paris, France
- Departament of Urology, University Hospital Zürich, Zurich, Switzerland
- Departament of Urology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Marie Chicaud
- Department of Urology, Limoges University Hospital, 2 Avenue Martin Luther King, 87000, Limoges, France
| | - Etienne Xavier Keller
- Progressive Endourological Association for Research and Leading Solutions (PEARLS Group), Paris, France
- University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Olivier Traxer
- Sorbonne University GRC Urolithiasis No. 20 Tenon Hospital, 75020, Paris, France
- Department of Urology AP-HP, Tenon Hospital, Sorbonne University, 75020, Paris, France
| |
Collapse
|
10
|
Tokas T, Herrmann TRW. Novel Thulium Lasers and Ho:YAG pulse modifications. World J Urol 2024; 42:303. [PMID: 38719984 DOI: 10.1007/s00345-024-04923-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 06/11/2023] [Indexed: 01/04/2025] Open
Affiliation(s)
- Theodoros Tokas
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Greece.
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria.
| | - Thomas R W Herrmann
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria
- Department of Urology, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland
| |
Collapse
|
11
|
Panthier F, Kwok JL, Tzou DT, Monga M, Traxer O, Keller EX. What is the definition of stone dust and how does it compare with clinically insignificant residual fragments? A comprehensive review. World J Urol 2024; 42:292. [PMID: 38704492 DOI: 10.1007/s00345-024-04993-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 04/12/2024] [Indexed: 05/06/2024] Open
Abstract
PURPOSE During endoscopic stone surgery, Holmium:YAG (Ho:YAG) and Thulium Fiber Laser (TFL) technologies allow to pulverize urinary stones into fine particles, ie DUST. Yet, currently there is no consensus on the exact definition of DUST. This review aimed to define stone DUST and Clinically Insignificant Residual Fragments (CIRF). METHODS Embase, MEDLINE (PubMed) and Cochrane databases were searched for both in vitro and in vivo articles relating to DUST and CIRF definitions, in November 2023, using keyword combinations: "dust", "stones", "urinary calculi", "urolithiasis", "residual fragments", "dusting", "fragments", "lasers" and "clinical insignificant residual fragments". RESULTS DUST relates to the fine pulverization of urinary stones, defined in vitro as particles spontaneously floating with a sedimentation duration ≥ 2 sec and suited for aspiration through a 3.6Fr-working channel (WC) of a flexible ureteroscope (FURS). Generally, an upper size limit of 250 µm seems to agree with the definition of DUST. Ho:YAG with and without "Moses Technology", TFL and the recent pulsed-Thulium:YAG (pTm:YAG) can produce DUST, but no perioperative technology can currently measure DUST size. The TFL and pTm:YAG achieve better dusting compared to Ho:YAG. CIRF relates to residual fragments (RF) that are not associated with imminent stone-related events: loin pain, acute renal colic, medical or interventional retreatment. CIRF size definition has decreased from older studies based on Shock Wave Lithotripsy (SWL) (≤ 4 mm) to more recent studies based on FURS (≤ 2 mm) and Percutaneous Nephrolithotomy(PCNL) (≤ 4 mm). RF ≤ 2 mm are associated with lower stone recurrence, regrowth and clinical events rates. While CIRF should be evaluated postoperatively using Non-Contrast Computed Tomography(NCCT), there is no consensus on the best diagnostic modality to assess the presence and quantity of DUST. CONCLUSION DUST and CIRF refer to independent entities. DUST is defined in vitro by a stone particle size criteria of 250 µm, translating clinically as particles able to be fully aspirated through a 3.6Fr-WC without blockage. CIRF relates to ≤ 2 RF on postoperative NCCT.
Collapse
Affiliation(s)
- Frederic Panthier
- GRC No 20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France.
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 Rue de la Chine, 75020, Paris, France.
- UMR 8006 CNRS-Arts et Métiers ParisTech, PIMM, 151 bd de l'Hôpital, 75013, Paris, France.
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France.
| | - Jia-Lun Kwok
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Urology, Tan Tock Seng Hospital, Singapore, Singapore
| | - David T Tzou
- Department of Urology, University of Arizona, Tucson, AZ, USA
| | - Manoj Monga
- Department of Urology, University of California-San Diego School of Medicine, La Jolla, CA, USA
| | - Olivier Traxer
- GRC No 20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 Rue de la Chine, 75020, Paris, France
- UMR 8006 CNRS-Arts et Métiers ParisTech, PIMM, 151 bd de l'Hôpital, 75013, Paris, France
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
| | - Etienne X Keller
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Endourology & Urolithiasis Working Group, Young Academic Urologists (YAU), Arnhem, The Netherlands
| |
Collapse
|
12
|
Corrales M, Hasan MN, Carioti GE, Emiliani E, Doizi S, Traxer O. Arterial pseudoaneurysm: a rare complication following laser lithotripsy-case series and literature review. World J Urol 2024; 42:280. [PMID: 38693433 DOI: 10.1007/s00345-024-04980-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/05/2024] [Indexed: 05/03/2024] Open
Abstract
OBJECTIVE To perform a comprehensive narrative review that will examine the risk factors and treatment outcomes of arterial pseudoaneurysm following laser flexible ureteroscopy (F-URS). METHODS A retrospective case series and a review of literature was performed. Clinical records from three patients treated for postoperative arterial pseudoaneurysm from January of 2021 to November 2023 were identified. A comprehensive literature review was also performed. The MEDLINE and Scopus databases were searched. The analysis was made by a narrative synthesis. RESULTS Three cases of postoperative arterial pseudoaneurysm were included, one from our center, one from Dubai, UAE, and one from Barcelona. The literature review identified six case reports, two after endocorporeal laser lithotripsy with thulium fiber laser (TFL) and four with Ho:YAG laser. All cases, from our series and literature review, presented with macroscopic hematuria and used high-power laser settings. All cases were treated by selective embolization. CONCLUSION Ho:YAG or TFL lasers are both capable of causing arterial pseudoaneurysms following F-URS if high-power settings are used. Selective artery embolization continues to be the treatment of choice with good outcomes.
Collapse
Affiliation(s)
- Mariela Corrales
- Sorbonne University GRC Urolithiasis No. 20 Tenon Hospital, 75020, Paris, France
- Department of Urology AP-HP, Tenon Hospital, Sorbonne University, 75020, Paris, France
| | - Mudhar N Hasan
- Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE
- Department of Urology, Mediclinic City Hospital, Dubai, UAE
| | - Giada Eleonora Carioti
- Department of Urology, Fundacion Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Estenan Emiliani
- Department of Urology, Fundacion Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Steeve Doizi
- Sorbonne University GRC Urolithiasis No. 20 Tenon Hospital, 75020, Paris, France
- Department of Urology AP-HP, Tenon Hospital, Sorbonne University, 75020, Paris, France
| | - Olivier Traxer
- Sorbonne University GRC Urolithiasis No. 20 Tenon Hospital, 75020, Paris, France.
- Department of Urology AP-HP, Tenon Hospital, Sorbonne University, 75020, Paris, France.
| |
Collapse
|
13
|
Panthier F, Chicaud M, Candela L, Solano C, Corrales M, Traxer O. Comment to: Dusting efficacy between the regular setting of holmium laser (Ho:YAG) versus vapor tunnel pulse modality for non-complex kidney stones. Lasers Med Sci 2024; 39:115. [PMID: 38662209 DOI: 10.1007/s10103-024-04058-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 04/17/2024] [Indexed: 04/26/2024]
Affiliation(s)
- Frédéric Panthier
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, Paris, 75020, France.
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, Paris, 75020, France.
- PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, 151 bd de l'Hôpital, Paris, F-75013, France.
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France.
| | - Marie Chicaud
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, Paris, 75020, France
- PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, 151 bd de l'Hôpital, Paris, F-75013, France
- Service d'Urologie, CHU Limoges, Limoges, 87000, France
| | - Luigi Candela
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, Paris, 75020, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, Paris, 75020, France
- Division of experimental oncology/unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vital-Salute San Raffaele University, Milan, Italy
| | - Catalina Solano
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, Paris, 75020, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, Paris, 75020, France
- Department of endourology, Uroclin SAS Medellin, Medellín, Colombia
| | - Mariela Corrales
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, Paris, 75020, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, Paris, 75020, France
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
| | - Olivier Traxer
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, Paris, 75020, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, Paris, 75020, France
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
| |
Collapse
|
14
|
Æsøy MS, Juliebø-Jones P, Beisland C, Ulvik Ø. Temperature Measurements During Flexible Ureteroscopic Laser Lithotripsy: A Prospective Clinical Trial. J Endourol 2024; 38:308-315. [PMID: 38185920 DOI: 10.1089/end.2023.0660] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024] Open
Abstract
Objective: The primary aim of the study was to explore intrarenal temperatures (IRTs) during flexible ureteroscopic laser lithotripsy (FURSL). The secondary aim was to investigate the correlation between temperatures and renal pelvis anteroposterior diameter (APD). Materials and Methods: From February 2023 to June 2023, 10 patients with an indwelling nephrostomy tube (NT) undergoing FURSL were enrolled in the study. Sheathless FURSL was performed using gravitational irrigation (23°C) at 60 cm. A sterile K-type thermocouple was inserted through the NT. Temperatures were recorded for 120 seconds with continuous laser activation and for another 60 seconds after deactivation. Thulium fiber laser delivered energy using a 150 μm fiber and incremental power settings of 5, 10, 20, and 30 W. The laser was deactivated whenever the IRT reached 43°C. Results: IRT correlated directly to power settings. Each time the power settings were increased, the temperature rose significantly. The increase in average peak temperature was 2.6°C between 5 and 10 W (p < 0.001), 3.4°C between 10 and 20 W (p < 0.001), and 2.5°C between 20 and 30 W (p < 0.001). Temperatures reached 43°C in three patients applying 20 W and in eight patients applying 30 W. The shortest activation-time until threshold was 12 and 28 seconds with 30 and 20 W settings, respectively. When reaching 43°C, temperatures remained above this threshold for an additional 29 seconds on average. There was a significant correlation between IRT and renal APD. For example, when 10 W was applied in the setting of APD ≤20 mm, the recorded temperature was on average 2.3°C higher compared with APD >20 mm, with the same power settings applied, p < 0.001. Conclusion: During FURSL, IRT correlates directly with power settings and is inversely correlated with renal pelvic APD. Using a sheathless approach, power settings ≥20 W should arguably be avoided, especially in the context of a nondilated renal pelvis. ClinicalTrials: The study was registered on ClinicalTrials.gov (NCT05677425).
Collapse
Affiliation(s)
- Mathias Sørstrand Æsøy
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine (K1), University of Bergen, Bergen, Norway
| | - Patrick Juliebø-Jones
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine (K1), University of Bergen, Bergen, Norway
| | - Christian Beisland
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine (K1), University of Bergen, Bergen, Norway
| | - Øyvind Ulvik
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine (K1), University of Bergen, Bergen, Norway
| |
Collapse
|
15
|
Sierra A, Ventimiglia E, Corrales M, Solano C, Candela L, Traxer O. A historical comparison of thulium fiber laser systems for stone lithotripsy: navigating toward safe and effective parameters. World J Urol 2024; 42:145. [PMID: 38478094 DOI: 10.1007/s00345-024-04789-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 01/10/2024] [Indexed: 01/04/2025] Open
Abstract
INTRODUCTION AND OBJECTIVES Medical device companies have introduced new TFL machines, including Soltive (Olympus, Japan), Fiber Dust (Quanta System, Italy), and TFLDrive (Coloplast, France). The primary objective of this study is to compare our initial clinical experiences with TFL using those devices. Through this historical comparison of Thulium Fiber Laser systems for stone lithotripsy, we aim to advance our understanding and approach toward achieving safe and effective TFL parameters. MATERIALS AND METHODS The data for this comparative analysis were extracted from three distinct prospective series that were previously published, outlining our initial clinical experience with the Soltive (Olympus, Japan), FiberDust laser (Quanta System, Italy), and TFLDrive laser (Coloplast, France). Parameters such as stone size, stone density, laser-on time (LOT), and laser settings were meticulously recorded. Additionally, we assessed critical variables such as ablation speed (expressed in mm3/s) and Joules/mm3 for each lithotripsy procedure. RESULTS A total of 149 patients were enrolled in this study. Among them, 120 patients were subjected to analysis concerning renal stones. Statistically significant differences were observed in the median (IQR) stone volume: 650 (127-6027) mm3 for TFLDrive, 1800 (682.8-2760) mm3 for Soltive, and 1125 (294-4000) mm3 for FiberDust (p: 0.007); while there were no differences regarding stone density among the groups. Significant variations were identified in median (IQR) pulse energy, frequency, and total power. The Soltive group exhibited lower energy levels (0.3 J vs. 0.6 J, p: 0.002) but significantly higher pulse frequency (100 Hz vs. 17.5 Hz, p: 0.003) and total power (24 W vs. 11W, p: 0.001) compared to the other groups. Laser-on time showed no substantial differences across all three groups. Additionally, a statistically significant difference was observed in median J/mm3, with the TFLDrive group using higher values (24 J/mm3, p: 0.001), while the Soltive group demonstrated a higher median ablation speed of 1.16 mm3/s (p: 0.001). The overall complication rate remained low for all groups, with comparable stone-free rates. CONCLUSION By reducing pulsed frequency, we improved laser efficiency, but smaller volumes lead to decreased efficiency due to increased retropulsion and fragment movement. Further studies are needed to identify and establish the appropriate laser settings for this new technology.
Collapse
Affiliation(s)
- Alba Sierra
- Department of Urology, Hospital Clinic, University of Barcelona, Barcelona, Spain
- Department of Urology AP-HP, Sorbonne University GRC Urolithiasis No. 20 Tenon Hospital, F-75020, Paris, France
| | - Eugenio Ventimiglia
- Department of Urology AP-HP, Sorbonne University GRC Urolithiasis No. 20 Tenon Hospital, F-75020, Paris, France
- Division of Experimental Oncology/Unit of Urology, URI; IRCCS Ospedale San Raffaele, Università Vita-Salute San Raffaele, Milan, Italy
| | - Mariela Corrales
- Department of Urology AP-HP, Sorbonne University GRC Urolithiasis No. 20 Tenon Hospital, F-75020, Paris, France
| | - Catalina Solano
- Department of Urology AP-HP, Sorbonne University GRC Urolithiasis No. 20 Tenon Hospital, F-75020, Paris, France
| | - Luigi Candela
- Department of Urology AP-HP, Sorbonne University GRC Urolithiasis No. 20 Tenon Hospital, F-75020, Paris, France
- Division of Experimental Oncology/Unit of Urology, URI; IRCCS Ospedale San Raffaele, Università Vita-Salute San Raffaele, Milan, Italy
| | - Olivier Traxer
- Department of Urology AP-HP, Sorbonne University GRC Urolithiasis No. 20 Tenon Hospital, F-75020, Paris, France.
| |
Collapse
|
16
|
Panthier F, Ventimiglia E, Traxer O, Corrales M, Keller EX. Lasers and Stones: Towards an Approach that Depends on the Stone Type? A Point of View from PEARLS Members. Eur Urol 2024; 85:e92-e93. [PMID: 37996293 DOI: 10.1016/j.eururo.2023.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/19/2023] [Indexed: 11/25/2023]
Affiliation(s)
- Frédéric Panthier
- Sorbonne University GRC Urolithiasis No. 20, Tenon Hospital, Paris, France; Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France; Processes and Engineering in Mechanics and Materials, CNRS-UMR 8006, Arts et Métiers ParisTech, Paris, France; Department of Urology, Sorbonne University, Tenon Hospital, AP-HP, Paris, France.
| | - Eugenio Ventimiglia
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France; Young Academic Urologists Endourology & Urolithiasis Working Group, Arnhem, The Netherlands; Division of Experimental Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Olivier Traxer
- Sorbonne University GRC Urolithiasis No. 20, Tenon Hospital, Paris, France; Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France; Processes and Engineering in Mechanics and Materials, CNRS-UMR 8006, Arts et Métiers ParisTech, Paris, France; Department of Urology, Sorbonne University, Tenon Hospital, AP-HP, Paris, France
| | - Mariela Corrales
- Sorbonne University GRC Urolithiasis No. 20, Tenon Hospital, Paris, France; Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France; Young Academic Urologists Endourology & Urolithiasis Working Group, Arnhem, The Netherlands; Department of Urology, Sorbonne University, Tenon Hospital, AP-HP, Paris, France
| | - Etienne Xavier Keller
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France; Young Academic Urologists Endourology & Urolithiasis Working Group, Arnhem, The Netherlands; Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| |
Collapse
|
17
|
Mishra A, Medairos R, Chen J, Soto-Palou F, Antonelli J, Preminger GM, Lipkin ME, Zhong P. Exploring optimal settings for safe and effective thulium fibre laser lithotripsy in a kidney model. BJU Int 2024; 133:223-230. [PMID: 37942684 PMCID: PMC10947524 DOI: 10.1111/bju.16218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
OBJECTIVES To explore the optimal laser settings and treatment strategies for thulium fibre laser (TFL) lithotripsy, namely, those with the highest treatment efficiency, lowest thermal injury risk, and shortest procedure time. MATERIALS AND METHODS An in vitro kidney model was used to assess the efficacy of TFL lithotripsy in the upper calyx. Stone ablation experiments were performed on BegoStone phantoms at different combinations of pulse energy (EP ) and frequency (F) to determine the optimal settings. Temperature changes and thermal injury risks were monitored using embedded thermocouples. Experiments were also performed on calcium oxalate monohydrate (COM) stones to validate the optimal settings. RESULTS High EP /low F settings demonstrated superior treatment efficiency compared to low EP /high F settings using the same power. Specifically, 0.8 J/12 Hz was the optimal setting, resulting in a twofold increase in treatment efficiency, a 39% reduction in energy expenditure per unit of ablated stone mass, a 35% reduction in residual fragments, and a 36% reduction in total procedure time compared to the 0.2 J/50 Hz setting for COM stones. Thermal injury risk assessment indicated that 10 W power settings with high EP /low F combinations remained below the threshold for tissue injury, while higher power settings (>10 W) consistently exceeded the safety threshold. CONCLUSIONS Our findings suggest that high EP /low F settings, such as 0.8 J/12 Hz, are optimal for TFL lithotripsy in the treatment of COM stones. These settings demonstrated significantly improved treatment efficiency with reduced residual fragments compared to conventional settings while keeping the thermal dose below the injury threshold. This study highlights the importance of using the high EP /low F combination with low power settings, which maximizes treatment efficiency and minimizes potential thermal injury. Further studies are warranted to determine the optimal settings for TFL for treating kidney stones with different compositions.
Collapse
Affiliation(s)
- Arpit Mishra
- Thomas Lord Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina
| | - Robert Medairos
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Junqin Chen
- Thomas Lord Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina
| | - Francois Soto-Palou
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Jodi Antonelli
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Glenn M. Preminger
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Michael E. Lipkin
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Pei Zhong
- Thomas Lord Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina
| |
Collapse
|
18
|
Ortner G, Somani BK, Güven S, Kitzbichler G, Traxer O, Giusti G, Proietti S, Liatsikos E, Kallidonis P, Krambeck A, Goumas IK, Duvdevani M, Kamphuis GM, Ferretti S, Dragos L, Ghani K, Miernik A, Juliebø-Jones P, Jung H, Tailly T, Pietropaolo A, Hamri SB, Papatsoris A, Sarica K, Scoffone CM, Cracco CM, Keller EX, Durutovic O, Pereira S, Herrmann TRW, Nagele U, Gözen AS, Tokas T. Experts' recommendations in laser use for the treatment of urolithiasis: a comprehensive guide by the European Section of Uro-Technology (ESUT) and Training-Research in Urological Surgery and Technology (T.R.U.S.T.)-Group. World J Urol 2024; 42:33. [PMID: 38217743 DOI: 10.1007/s00345-023-04726-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/30/2023] [Indexed: 01/15/2024] Open
Abstract
PURPOSE To identify laser lithotripsy settings used by experts for specific clinical scenarios and to identify preventive measures to reduce complications. METHODS After literature research to identify relevant questions, a survey was conducted and sent to laser experts. Participants were asked for preferred laser settings during specific clinical lithotripsy scenarios. Different settings were compared for the reported laser types, and common settings and preventive measures were identified. RESULTS Twenty-six laser experts fully returned the survey. Holmium-yttrium-aluminum-garnet (Ho:YAG) was the primary laser used (88%), followed by thulium fiber laser (TFL) (42%) and pulsed thulium-yttrium-aluminum-garnet (Tm:YAG) (23%). For most scenarios, we could not identify relevant differences among laser settings. However, the laser power was significantly different for middle-ureteral (p = 0.027), pelvic (p = 0.047), and lower pole stone (p = 0.018) lithotripsy. Fragmentation or a combined fragmentation with dusting was more common for Ho:YAG and pulsed Tm:YAG lasers, whereas dusting or a combination of dusting and fragmentation was more common for TFL lasers. Experts prefer long pulse modes for Ho:YAG lasers to short pulse modes for TFL lasers. Thermal injury due to temperature development during lithotripsy is seriously considered by experts, with preventive measures applied routinely. CONCLUSIONS Laser settings do not vary significantly between commonly used lasers for lithotripsy. Lithotripsy techniques and settings mainly depend on the generated laser pulse's and generator settings' physical characteristics. Preventive measures such as maximum power limits, intermittent laser activation, and ureteral access sheaths are commonly used by experts to decrease thermal injury-caused complications.
Collapse
Affiliation(s)
- Gernot Ortner
- Department of Urology and Andrology, General Hospital Hall I.T., Milser Straße 10, 6060, Hall in Tirol, Austria.
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria.
| | - Bhaskar Kumar Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, England
| | - Selcuk Güven
- Department of Urology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Gerhard Kitzbichler
- Department of Urology and Andrology, General Hospital Hall I.T., Milser Straße 10, 6060, Hall in Tirol, Austria
| | - Olivier Traxer
- Sorbonne University, GRC N°20 Lithiase Renale, AP-HP, Hôpital Tenon, Paris, France
| | - Guido Giusti
- Department of Urology, San Raffaele Hospital, Milan, Italy
| | | | | | | | | | | | - Mordechai Duvdevani
- Department of Urology, Hadassah Ein-Kerem University Hospital, The Hebrew University, Jerusalem, Israel
| | - Guido M Kamphuis
- Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Stefania Ferretti
- Department of Urology, Hospital, University of Modena, Modena, Italy
| | - Laurian Dragos
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Khurshid Ghani
- Department of Urology, University of Michigan, Ann Arbor, USA
| | - Arkadiusz Miernik
- Department of Urology, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | | | - Helene Jung
- Department of Urology, Hospital Lillebaelt, University of Southern Denmark, Vejle, Denmark
| | - Thomas Tailly
- Department of Urology, University Hospital Ghent, Ghent, Belgium
| | - Amelia Pietropaolo
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, England
| | - Saeed Bin Hamri
- Urology Department at Specialized Medical Center SMC2, Riyadh, Saudi Arabia
| | - Athanasios Papatsoris
- 2nd Department of Urology, Sismanoglio Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Kemal Sarica
- Department of Urology, Medical School, Health Sciences University, Prof Dr I. Varank Training and Educational Hospital, Istanbul, Turkey
| | | | | | | | - Otas Durutovic
- Department of Urology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Sergio Pereira
- Department of Urology, North Lisbon University Hospital, Lisbon School of Medicine, Lisbon, Portugal
| | - Thomas R W Herrmann
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria
- Department of Urology, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland
| | - Udo Nagele
- Department of Urology and Andrology, General Hospital Hall I.T., Milser Straße 10, 6060, Hall in Tirol, Austria
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria
| | - Ali Serdar Gözen
- Department of Urology, Medius Kliniken, Ruit, Baden-Württemberg, Germany
| | - Theodoros Tokas
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Greece
| |
Collapse
|
19
|
Kronenberg P, Cerrato C, Juliebø-Jones P, Herrmann T, Tokas T, Somani BK. Advances in lasers for the minimally invasive treatment of upper and lower urinary tract conditions: a systematic review. World J Urol 2023; 41:3817-3827. [PMID: 37906263 DOI: 10.1007/s00345-023-04669-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/26/2023] [Indexed: 11/02/2023] Open
Abstract
PURPOSE Technological advancements in laser lithotripsy are expanding into numerous fields of urology, like ureteroscopy (URS), percutaneous nephrolithotomy (PCNL), and benign and malignant soft-tissue treatments. Since the amount of research regarding lasers in urology has grown exponentially, we present a systematic review of the most recent and relevant advances encompassing all lasers used in urological endoscopic treatment. METHODS We performed a literature search using PubMed (May 2023) to obtain information about lasers for urological purposes. We included only recent data from published articles between 2021 and 2023 or articles ahead of print. RESULTS Lasers are widely used in lithotripsy for ureteric, renal, and bladder stones, benign prostate surgery, and bladder and upper tract tumor ablation. While the holmium (Ho:YAG) laser is still predominant, there seems to be more emphasis on pulse modulation and newer lasers such as thulium fiber laser (TFL) and pulsed Tm:YAG laser. CONCLUSION The use of lasers and related technological innovations have shown increasing versatility, and over time have proven to be invaluable in the management of stone lithotripsy, treatment of benign and malignant prostate diseases, and urothelial tumors. Laser endoscopic treatment is heavily based on technological nuances, and it is essential to know at least the basics of these technologies. Ultimately the choice of laser used depends on its availability, cost, surgeon experience and expertise.
Collapse
Affiliation(s)
| | - Clara Cerrato
- University Hospital Southampton NHS Trust, Southampton, UK
| | | | - Thomas Herrmann
- Department of Urology, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria
| | - Theodoros Tokas
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria
- Department of Urology, Medical School, University General Hospital of Heraklion, University of Crete, Heraklion, Greece
| | | |
Collapse
|
20
|
Kwok JL, Ventimiglia E, De Coninck V, Panthier F, Barghouthy Y, Danilovic A, Shrestha A, Smyth N, Schmid FA, Hunziker M, Poyet C, Daudon M, Traxer O, Eberli D, Keller EX. Pulsed Thulium:YAG laser - What is the lithotripsy ablation efficiency for stone dust from human urinary stones? Results from an in vitro PEARLS study. World J Urol 2023; 41:3723-3730. [PMID: 37831156 PMCID: PMC10693514 DOI: 10.1007/s00345-023-04640-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/10/2023] [Indexed: 10/14/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Jia-Lun Kwok
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
- Department of Urology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Eugenio Ventimiglia
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Endourology & Urolithiasis Working Group, Young Academic Urologists (YAU), Arnhem, The Netherlands
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Vincent De Coninck
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Endourology & Urolithiasis Working Group, Young Academic Urologists (YAU), Arnhem, The Netherlands
- Department of Urology, AZ Klina, Brasschaat, Belgium
| | - Frédéric Panthier
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- GRC N°20, Groupe de Recherche Clinique Sur La Lithiase UrinaireHôpital Tenon, Sorbonne Université, 75020, Paris, France
| | - Yazeed Barghouthy
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Department of Urology, Centre Hospitalier de Valenciennes, Valenciennes, France
| | - Alexandre Danilovic
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Department of Urology, Universidade de São Paulo Hospital das Clínicas-HCUSP, São Paulo, Brazil
- Department of Urology, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Anil Shrestha
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Department of Urology, National Academy of Medical Sciences, Bir Hospital and B&B Hospital, Gwarko Lalitpur, Nepal
| | - Niamh Smyth
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- University Hospital Monklands, Monkscourt Avenue, Airdrie, ML60JS, UK
| | - Florian Alexander Schmid
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Manuela Hunziker
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Cédric Poyet
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Michel Daudon
- Hôpital Tenon, CRISTAL Laboratory, Sorbonne Université, Paris, France
| | - Olivier Traxer
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- GRC N°20, Groupe de Recherche Clinique Sur La Lithiase UrinaireHôpital Tenon, Sorbonne Université, 75020, Paris, France
| | - Daniel Eberli
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Etienne Xavier Keller
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France.
- Endourology & Urolithiasis Working Group, Young Academic Urologists (YAU), Arnhem, The Netherlands.
| |
Collapse
|
21
|
Solano C, Candela L, Panthier F, Corrales M, Traxer O. Initial experience with the graphical user interface for laser parameters setting of a new thulium fibre laser source device for urinary pathologies treatment. World J Urol 2023; 41:3765-3771. [PMID: 37833547 DOI: 10.1007/s00345-023-04631-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 09/15/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND AND OBJECTIVE We aimed to evaluate the concordance between the pre-settings ranges of thulium fibre laser (TFL) (Coloplast TFL Drive, Denmark) with easy-to-use graphical user interface and the laser settings used by a high-volume endo-urologist during surgical procedures. MATERIALS AND METHODS In October 2022, we prospectively collected data of 67 patients who underwent TFL Drive (Coloplast, Denmark) for the management of urinary stones. Urothelial tumour (upper tract urinary cancer (UTUC) and bladder) 200 and 150 μm laser fibres were used for procedures. Stones characteristics (size and density) tumours and stenosis localizations, laser-on time (LOT), and laser settings were recorded. We also assessed the ablation speed (mm3/s), laser power (W), and Joules/mm3 values for each lithotripsy. RESULTS A total 67 patients took part in the study. Median age was 52 (15-81) years. 55 (82%), 8 (12%), and 4 (6%) patients presented urinary stones, urothelial tumour, and stenosis, respectively. Median stone volume was 438 (36-6027) mm3 and median density was 988 (376-2000) HU. Median pulse energy was 0.6 (0.3-1.2), 0.8 (0.5-1) and 1 J for urinary stones, urothelial tumour and stenosis respectably. Endoscopically stone-free rate was 89%. Graphical user interface and surgeon accordance with the safety range were observed in 93.2%, 100% and 100% for urinary stones, UTUC and stenosis, respectively. CONCLUSION During endoscopic procedures for urinary stones treatment, it is frequently needed to change laser parameters. These new TFL and GUI technology parameters remained in the pre-set security range in 94.1% of procedures.
Collapse
Affiliation(s)
- Catalina Solano
- GRC n20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
- Department of Endourology, Uroclin S.A.S, Medellín, Colombia
| | - Luigi Candela
- GRC n20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
- Division of Experimental Oncology/Unit of Urology, URI-Urological Research Institute IRCCS Ospedale San Raffaele, Milan, Italy
| | - Frederic Panthier
- GRC n20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
| | - Mariela Corrales
- GRC n20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
| | - Olivier Traxer
- GRC n20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France.
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France.
| |
Collapse
|
22
|
Chen J, Mishra A, Medairos R, Antonelli J, Preminger GM, Lipkin ME, Zhong P. In vitro investigation of stone ablation efficiency, char formation, spark generation, and damage mechanism produced by thulium fiber laser. Urolithiasis 2023; 51:124. [PMID: 37917225 PMCID: PMC10880548 DOI: 10.1007/s00240-023-01501-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/25/2023] [Indexed: 11/04/2023]
Abstract
To investigate stone ablation characteristics of thulium fiber laser (TFL), BegoStone phantoms were spot-treated in water at various fiber tip-to-stone standoff distances (SDs, 0.5 ~ 2 mm) over a broad range of pulse energy (Ep, 0.2 ~ 2 J), frequency (F, 5 ~ 150 Hz), and power (P, 10 ~ 30 W) settings. In general, the ablation speed (mm3/s) in BegoStone decreased with SD and increased with Ep, reaching a peak around 0.8 ~ 1.0 J. Additional experiments with calcium phosphate (CaP), uric acid (UA), and calcium oxalate monohydrate (COM) stones were conducted under two distinctly different settings: 0.2 J/100 Hz and 0.8 J/12 Hz. The concomitant bubble dynamics, spark generation and pressure transients were analyzed. Higher ablation speeds were consistently produced at 0.8 J/12 Hz than at 0.2 J/100 Hz, with CaP stones most difficult yet COM and UA stones easier to ablate. Charring was mostly observed in CaP stones at 0.2 J/100 Hz, accompanied by strong spark-generation, explosive combustion, and diminished pressure transients, but not at 0.8 J/12 Hz. By treating stones in parallel fiber orientation and leveraging the proximity effect of a ureteroscope, the contribution of bubble collapse to stone ablation was found to be substantial (16% ~ 59%) at 0.8 J/12 Hz, but not at 0.2 J/100 Hz. Overall, TFL ablation efficiency is significantly better at high Ep/low F setting, attributable to increased cavitation damage with less char formation.
Collapse
Affiliation(s)
- Junqin Chen
- Thomas Lord Department of Mechanical Engineering and Materials Science, Duke University, Box 90300, Durham, NC, 27708, USA
| | - Arpit Mishra
- Thomas Lord Department of Mechanical Engineering and Materials Science, Duke University, Box 90300, Durham, NC, 27708, USA
| | - Robert Medairos
- Department of Urology, Duke University Medical Center, Durham, NC, USA
| | - Jodi Antonelli
- Department of Urology, Duke University Medical Center, Durham, NC, USA
| | - Glenn M Preminger
- Department of Urology, Duke University Medical Center, Durham, NC, USA
| | - Michael E Lipkin
- Department of Urology, Duke University Medical Center, Durham, NC, USA
| | - Pei Zhong
- Thomas Lord Department of Mechanical Engineering and Materials Science, Duke University, Box 90300, Durham, NC, 27708, USA.
| |
Collapse
|
23
|
Panthier F, Abid N, Hoznek A, Traxer O, Meria P, Almeras C. 2022 Recommendations of the AFU Lithiasis Committee: Laser - utilization and settings. Prog Urol 2023; 33:825-842. [PMID: 37918982 DOI: 10.1016/j.purol.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 11/04/2023]
Abstract
Endocorporeal lithotripsy has progressed thanks to the development of lasers. Two laser sources are currently available: Holmium:YAG (Ho:YAG) and more recently Thulium Fiber Laser (TFL). The settings generally used are dusting, fragmentation, and "pop-corning". These are the first recommendations on laser use for stone management and their settings. Settings must be modulated and can be changed during the treatment according to the expected and obtained effects, the location and stone type that is treated. METHODOLOGY: These recommendations have been developed using two methods: the Clinical Practice Recommendation (CPR) method and the ADAPTE method, depending on whether or not the question was considered in the European Association of Urology (EAU) recommendations (https://uroweb.org/guidelines/urolithiasis [EAU Guidelines on urolithiasis. 2022]) and their adaptability to the French context.
Collapse
Affiliation(s)
- F Panthier
- GRC lithiase, AP-HP, Sorbonne université, Paris, France; Laboratoire PIMM, arts et métiers Paris Tech, Paris, France
| | - N Abid
- Department of Urology and Transplantation Surgery, Hospices Civils de Lyon, Edouard-Herriot Hospital, Lyon, France
| | - A Hoznek
- Service d'urologie, hôpital Henri-Mondor, AP-HP, université Paris Est Créteil, Paris, France
| | - O Traxer
- GRC lithiase, AP-HP, Sorbonne université, Paris, France; Laboratoire PIMM, arts et métiers Paris Tech, Paris, France
| | - P Meria
- Service d'urologie, hôpital Saint-Louis, AP-HP, centre université Paris Cité, Paris, France
| | - C Almeras
- UroSud, clinique La Croix du Sud, Quint-Fonsegrives, France.
| |
Collapse
|
24
|
Shrestha A, Adhikari B, Panthier F, Baidya S, Gauhar V, Traxer O. Flexible ureteroscopy for lower pole calculus: is it still a challenge? World J Urol 2023; 41:3345-3353. [PMID: 37728745 DOI: 10.1007/s00345-023-04606-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 08/28/2023] [Indexed: 09/21/2023] Open
Abstract
PURPOSE Flexible ureteroscopy (fURS) is steadily gaining popularity in the management of renal calculi, including those located in the lower pole (LP). Due to difficulty in accessing to the LP of kidney in minority of cases with fURS and reports of lower stone-free rate (SFR), it is still considered as a challenge in selected cases. The purpose of the review was to analyze the various aspects of fURS for LP stones. METHODS An extensive review of the recent literature was done including different factors such as anatomy, preoperative stenting, stone size, flexible scopes, types of lasers, laser fibers, suction, relocation, stone-free rates, and complications. RESULTS The significance of various lower pole anatomical measurements remain a subject of debate and requires standardization. Recent improvements in fURS such as single-use digital scopes with better vision and flexibility, high power laser, thulium fiber laser, smaller laser fiber, and accessories have significantly contributed to make flexible ureteroscopy more effective and safer in the management of LP stone. The utilization of thulium fiber lasers in conjunction with various suction devices is being recognized and can significantly improve SFR. CONCLUSIONS With the significant advancement of various aspects of fURS, this treatment modality has shown remarkable efficacy and gaining widespread acceptance in management of LP kidney stones. These developments have made the fURS of LP stones less challenging.
Collapse
Affiliation(s)
- Anil Shrestha
- National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal.
- B&B Hospital, Lalitpur, Nepal.
| | | | | | | | | | | |
Collapse
|
25
|
Kwok JL, Ventimiglia E, De Coninck V, Corrales M, Sierra A, Panthier F, Pauchard F, Schmid F, Hunziker M, Poyet C, Daudon M, Traxer O, Eberli D, Keller EX. Pulsed thulium:YAG laser-ready to dust all urinary stone composition types? Results from a PEARLS analysis. World J Urol 2023; 41:2823-2831. [PMID: 37587366 PMCID: PMC10581948 DOI: 10.1007/s00345-023-04549-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 07/23/2023] [Indexed: 08/18/2023] Open
Abstract
PURPOSE To evaluate whether stone dust can be obtained from all prevailing stone composition types using the novel pulsed thulium:YAG (p-Tm:YAG), including analysis of stone particle size after lithotripsy. METHODS Human urinary stones of 7 different compositions were subjected to in vitro lithotripsy using a p-Tm:YAG laser with 270 µm silica core fibers (Thulio®, Dornier MedTech GmbH®, Wessling, Germany). A cumulative energy of 1000 J was applied to each stone using one of three laser settings: 0.1 J × 100 Hz, 0.4 J × 25 Hz and 2.0 J × 5 Hz (average power 10 W). After lithotripsy, larger remnant fragments were separated from stone dust using a previously described method depending on the floating ability of dust particles. Fragments and dust samples were then passed through laboratory sieves to evaluate stone particle count according to a semiquantitative analysis relying on a previous definition of stone dust (i.e., stone particles ≤ 250 µm). RESULTS The p-Tm:YAG laser was able to produce stone dust from lithotripsy up to measured smallest mesh size of 63 µm in all seven stone composition types. Notably, all dust samples from all seven stone types and with all three laser settings had high counts of particles in the size range agreeing with the definition stone dust, i.e., ≤ 250 µm. CONCLUSION This is the first study in the literature proving the p-Tm:YAG laser capable of dusting all prevailing human urinary stone compositions, with production of dust particles ≤ 250 µm. These findings are pivotal for the broader future implementation of the p-Tm:YAG in clinical routine.
Collapse
Affiliation(s)
- Jia-Lun Kwok
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
- Department of Urology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Eugenio Ventimiglia
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Young Academic Urologists (YAU), Endourology and Urolithiasis Working Group, Arnhem, The Netherlands
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Vincent De Coninck
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Young Academic Urologists (YAU), Endourology and Urolithiasis Working Group, Arnhem, The Netherlands
- Department of Urology, AZ Klina, Brasschaat, Belgium
| | - Mariela Corrales
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
| | - Alba Sierra
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Young Academic Urologists (YAU), Endourology and Urolithiasis Working Group, Arnhem, The Netherlands
- Urology Department, Hospital Clinic de Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Frédéric Panthier
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
| | - Felipe Pauchard
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Urology Department, Hospital Naval Almirante Nef, 2520000, Viña del Mar, Chile
| | - Florian Schmid
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Manuela Hunziker
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Cédric Poyet
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Michel Daudon
- CRISTAL Laboratory, Hôpital Tenon, Sorbonne Université, Paris, France
| | - Olivier Traxer
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
| | - Daniel Eberli
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Etienne Xavier Keller
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France.
- Young Academic Urologists (YAU), Endourology and Urolithiasis Working Group, Arnhem, The Netherlands.
| |
Collapse
|
26
|
Panthier F, Solano C, Chicaud M, Kutchukian S, Candela L, Doizi S, Corrales M, Traxer O. Initial clinical experience with the pulsed solid-state thulium YAG laser from Dornier during RIRS: first 25 cases. World J Urol 2023; 41:2119-2125. [PMID: 37414942 DOI: 10.1007/s00345-023-04501-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 06/07/2023] [Indexed: 07/08/2023] Open
Abstract
INTRODUCTION Holmium:yttrium-aluminium-garnet (Ho:YAG) and thulium fiber (TFL) lasers are currently the two laser sources recommended for endocorporeal laser lithotripsy (ELL). Recently, the pulsed-thulium:YAG (Tm:YAG) laser was also proposed for ELL, as an answer to both Ho:YAG and TFL limitations. We aimed to evaluate the efficiency, safety, and laser settings of Tm:YAG laser in ELL during retrograde intrarenal surgery (RIRS). METHODS A prospective study of the first 25 patients with ureteral and renal stones who underwent RIRS using the Thulio (pulsed-Tm:YAG, Dornier©, Germany) was performed in a single center. 272 µm laser fibers were used. Stone size, stone density, laser-on time (LOT) and laser settings were recorded. We also assessed the ablation speed (mm3/s), Joules/mm3 and laser power (W) values for each procedure. Postoperative results, such as stone-free rate (SFR) and zero fragments rate (ZFR) were also recorded. RESULTS A total of 25 patients were analyzed (Table 1). The median (IQR) age was 55 (44-72) years old. Median (IQR) stone volume was 2849 (916-9153)mm3. Median (IQR) stone density was 1000 (600-1174)HU. Median (IQR) pulse energy, pulse rate and total power were 0.6 (0.6-0,8)J, 15(15-20)Hz and 12(9-16)W, respectively. All procedures used "Captive Fragmenting" pulse modulation (Table 2). The median (IQR) J/mm3 was 14,8 (6-21). The median (IQR) ablation rate was 0,75 (0,46-2)mm3/s. One postoperative complications occurred (streinstrasse). SFR and ZFR were 95% and 55%, respectively. CONCLUSION The pulsed-Tm:YAG laser is a safe and effective laser source for lithotripsy during RIRS, using low pulse energy and low pulse frequency.
Collapse
Affiliation(s)
- Frédéric Panthier
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France.
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France.
- PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, 151 bd de l'Hôpital, 75013, Paris, France.
| | - Catalina Solano
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France
- Department of Endourology, Uroclin SAS, Medellin, Colombia
| | - Marie Chicaud
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France
- PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, 151 bd de l'Hôpital, 75013, Paris, France
- Service d'Urologie, CHU Limoges, 87000, Limoges, France
| | - Stessy Kutchukian
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France
- PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, 151 bd de l'Hôpital, 75013, Paris, France
- Department of Urology, Poitiers University Hospital, 2 Rue de la Milétrie, 86000, Poitiers, France
| | - Luigi Candela
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Steeve Doizi
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France
- PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, 151 bd de l'Hôpital, 75013, Paris, France
| | - Mariela Corrales
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France
| | - Olivier Traxer
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France
| |
Collapse
|
27
|
Kutchukian S, Doizi S, Lapouge P, Germain T, Dragos L, Berthe L, Solano C, Candela L, Corrales M, Chicaud M, Traxer O, Panthier F. Ablation rates with Holmium:YAG and Thulium Fiber Laser: Influence of the stone phantom homogeneity. An in vitro study. Prog Urol 2023:S1166-7087(23)00126-4. [PMID: 37442755 DOI: 10.1016/j.purol.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/19/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVES The lithotripsy efficiency (LE) in vitro study requires artificial or human stone samples (AS, HS). With the development of dusting lithotripsy, less ex vivo HS are available. We aimed to compare Thulium Fiber Laser (TFL) and Holmium:YAG (Ho:YAG)'s LE and define the most accurate LE parameter. METHODS Hard and soft homogenous- and heterogenous-AS (Ho-AS, He-AS) were made to reproduce calcium-oxalate monohydrate and uric acid stones, respectively by a rapid or slow brewing of BegostonePlus (Bego) and distilled water. One hundred and fifty and 272μm-laser fibers, connected to 50W-TFL and 30W-HoYAG generators, compared three settings for TFL (FD: 0.15J/100Hz; D: 0.5J/30Hz; Fr: 1J/15Hz) and two for Ho:YAG (D-Fr). An experimental setup consisted in immerged 10mm cubic stone phantoms with a 20 seconds' lasing spiral, in contact mode, repeated four times. Stones were dried, weighted and μ-scanned (ablation weight and volume [AW and AV]). RESULTS With He-AS, dusting AV were four- and three-fold higher with TFL compared to Ho:YAG against hard and soft (P<0.05). In fragmentation, AV were two-fold higher with TFL compared to Ho:YAG against hard (P<0.05) and soft (P<0.05). Experiments with Ho-AS were associated with non-significant differences when comparing TFL-150μm and TFL-272μm. The ablation weight-volume correlation coefficients was higher with Ho-AS than with He-AS (P<0.0001), and with hard than soft AS. If the LE can be estimated by the AW with hard AS, this approximation is not consistent for soft AS. CONCLUSION TFL presented higher ablation rates than Ho:YAG, significant with He-AS. If the AW is acceptable and less expensive for hard Ho-AS, AV are more accurate for He-AS, which are suggested to imitate closely HS.
Collapse
Affiliation(s)
- S Kutchukian
- GRC n(o) 20, Groupe de recherche clinique sur la lithiase urinaire, hôpital Tenon, Sorbonne université, 75020 Paris, France; Service d'urologie, hôpital Tenon, Sorbonne université, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France; PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, 151, boulevard de l'Hôpital, 75013 Paris, France; Service d'urologie, CHU de Poitiers, Poitiers, France
| | - S Doizi
- GRC n(o) 20, Groupe de recherche clinique sur la lithiase urinaire, hôpital Tenon, Sorbonne université, 75020 Paris, France; Service d'urologie, hôpital Tenon, Sorbonne université, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France; PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, 151, boulevard de l'Hôpital, 75013 Paris, France
| | - P Lapouge
- PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, 151, boulevard de l'Hôpital, 75013 Paris, France
| | - T Germain
- GRC n(o) 20, Groupe de recherche clinique sur la lithiase urinaire, hôpital Tenon, Sorbonne université, 75020 Paris, France; Service d'urologie, hôpital Tenon, Sorbonne université, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France
| | - L Dragos
- GRC n(o) 20, Groupe de recherche clinique sur la lithiase urinaire, hôpital Tenon, Sorbonne université, 75020 Paris, France; Department of Urology, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - L Berthe
- PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, 151, boulevard de l'Hôpital, 75013 Paris, France
| | - C Solano
- GRC n(o) 20, Groupe de recherche clinique sur la lithiase urinaire, hôpital Tenon, Sorbonne université, 75020 Paris, France; Service d'urologie, hôpital Tenon, Sorbonne université, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France; Department of Endourology, Uroclin S.A.S., Medellin, Colombia
| | - L Candela
- GRC n(o) 20, Groupe de recherche clinique sur la lithiase urinaire, hôpital Tenon, Sorbonne université, 75020 Paris, France; Service d'urologie, hôpital Tenon, Sorbonne université, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France; Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vital-Salute San Raffaele University, Milan, Italy
| | - M Corrales
- GRC n(o) 20, Groupe de recherche clinique sur la lithiase urinaire, hôpital Tenon, Sorbonne université, 75020 Paris, France; Service d'urologie, hôpital Tenon, Sorbonne université, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France
| | - M Chicaud
- GRC n(o) 20, Groupe de recherche clinique sur la lithiase urinaire, hôpital Tenon, Sorbonne université, 75020 Paris, France; Service d'urologie, hôpital Tenon, Sorbonne université, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France; Service d'urologie, CHU de Limoges, Limoges, France
| | - O Traxer
- GRC n(o) 20, Groupe de recherche clinique sur la lithiase urinaire, hôpital Tenon, Sorbonne université, 75020 Paris, France; Service d'urologie, hôpital Tenon, Sorbonne université, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France
| | - F Panthier
- GRC n(o) 20, Groupe de recherche clinique sur la lithiase urinaire, hôpital Tenon, Sorbonne université, 75020 Paris, France; Service d'urologie, hôpital Tenon, Sorbonne université, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France; PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, 151, boulevard de l'Hôpital, 75013 Paris, France.
| |
Collapse
|
28
|
Panthier F, Pauchard F, Traxer O. Retrograde intra renal surgery and safety: pressure and temperature. A systematic review. Curr Opin Urol 2023; 33:308-317. [PMID: 37140545 DOI: 10.1097/mou.0000000000001102] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
PURPOSE OF REVIEW Retrograde intra renal surgery (RIRS) with laser lithotripsy represents the gold-standard to treat renal stones up to 20 mm. Controlling intraoperative parameters such as intrarenal pressure (IRP) and temperature (IRT) is mandatory to avoid complications. This article reviews advances in IRP and IRT over the last 2 years. RECENT FINDINGS We conducted a PubMed/Embase search and reviewed publications that include temperature and pressure during RIRS. Thirty-four articles have been published which met the inclusion criteria. Regarding IRP, a consensus has emerged to control IRP during RIRS, in order to avoid (barotraumatic and septic) complications. Several monitoring devices are under evaluation but none of them are clinically approved for RIRS. Ureteral access sheath, low irrigation pressure and occupied working channel help to maintain a low IRP. Robotic systems and suction devices would improve IRP intraoperative management and monitoring. IRT determinants are the irrigation flow and laser settings. Low power settings(<20 W) with minimal irrigation flow (5-10 ml/min) are sufficient to maintain low IRT and allows continuous laser activation. SUMMARY Recent evidence suggests that IRP and IRT are closely related. IRP depends on inflow and outflow rates. Continuous monitoring would help to avoid surgical and infectious complications. IRT depends on the laser settings and the irrigation flow.
Collapse
Affiliation(s)
- Frédéric Panthier
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université
- PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, Paris, France
- Progressive Endourological Association for Research and Leading Solutions (PEARLS)
| | - Felipe Pauchard
- Progressive Endourological Association for Research and Leading Solutions (PEARLS)
- Urology Department, Hospital Naval Almirante Nef, Viña del Mar, Chile
| | - Olivier Traxer
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université
- Progressive Endourological Association for Research and Leading Solutions (PEARLS)
| |
Collapse
|
29
|
Emiliani E, Kanashiro A, Angerri O. Lasers for stone lithotripsy: advantages/disadvantages of each laser source. Curr Opin Urol 2023; 33:302-307. [PMID: 36927702 DOI: 10.1097/mou.0000000000001092] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
PURPOSE The purpose of this article was to make a narrative review of the literature in search of all articles regarding thulium:yttrium-aluminium-garnet (YAG), thulium laser fiber (TFL) and holmium:YAG (Ho:YAG) for lithotripsy from 2020 to 2023. A selection of articles of special interest and best evidence was made in order to give a better perspective on their advantages and disadvantages. RECENT FINDINGS New Ho:YAG technologies of as high power, high frequency and pulsed modulations have shown promising results for lithotripsy by reducing retropulsion with good ablation efficiency. High peak power makes it particularly good for percutaneous nephrolithotomy. High intrarenal temperatures and correct setting are still concerning points.TFL has arrived to be one of the main players in flexible ureteroscopy. Being highly efficient and quick, and by producing micro-dusting the laser is quickly heading to become a gold standard. The new pulsed Thulium YAG is the newest laser. For now, only in-vitro studies show promising results with efficient lithotripsy. As the peak power lies between Ho:YAG and TFL it may be able to adequately perform when needing and low power lithotripsy. SUMMARY Several new technologies have been developed in the last years for stone lithotripsy. All being efficient and safe if well used. Different advantages and disadvantages of each laser must be taken into consideration to give each laser the proper indication.
Collapse
Affiliation(s)
- Esteban Emiliani
- Fundació Puigvert. Autonomous University of Barcelona. Barcelona, Spain
| | | | | |
Collapse
|
30
|
Delbarre B, Baowaidan F, Culty T, Khelfat L, Brassier M, Ferragu M, Magnier A, Secourgeon A, Tariel F, Lebdai S, Bigot P. Prospective Comparison of Thulium and Holmium Laser Lithotripsy for the Treatment of Upper Urinary Tract Lithiasis. EUR UROL SUPPL 2023; 51:7-12. [PMID: 37187726 PMCID: PMC10175723 DOI: 10.1016/j.euros.2023.02.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2023] [Indexed: 05/17/2023] Open
Abstract
Background Lithotripsy with holmium:yttrium-aluminum-garnet (Ho:YAG) laser is the current gold standard for treating stones of the upper urinary tract (UUT). The recently introduced thulium fiber laser (TFL) has the potential to be more efficient and as safe as Ho:YAG. Objective To compare the performance and complications between Ho:YAG and TFL for UUT lithotripsy. Design setting and participants This was a prospective single-center study of 182 patients treated between February 2021 and February 2022. In a consecutive approach, laser lithotripsy was performed via ureteroscopy with Ho:YAG for 5 mo, and then with TFL for 5 mo. Outcome measurements and statistical analysis Our primary outcome was stone-free (SF) status at 3 mo after ureteroscopy with Ho:YAG versus TFL lithotripsy. Secondary outcomes were complication rates and results regarding the cumulative stone size. Patients were followed at 3 mo with abdominal imaging (ultrasound or computed tomography). Results and limitations The study cohort comprised 76 patients treated with Ho:YAG laser and 100 patients treated with TFL. Cumulative stone size was significantly higher in the TFL than in the Ho:YAG group (20.4 vs 14.8 mm; p = 0.01). SF status was similar in both groups (68.4% vs 72%; p = 0.06). Complication rates were comparable. In subgroup analysis, the SF rate was significantly higher (81.6% vs 62.5%; p = 0.04) and the operative time was shorter for stones measuring 1-2 cm, whereas the results were similar for stones <1 cm and >2 cm. The lack of randomization and single-center design are the main limitations of the study. Conclusions TFL and Ho:YAG lithotripsy are comparable in terms of the SF rate and safety for the treatment of UUT lithiasis. According to our study, for a cumulative stone size of 1-2 cm, TFL is more effective than Ho:YAG. Patient summary We compared the efficiency and safety of two laser types for the treatment of stones in the upper urinary tract. We found that stone-free status at 3 months did not significantly differ between the holmium and thulium lasers.
Collapse
Affiliation(s)
- Bertrand Delbarre
- Corresponding author. Department of Urology, Angers University Hospital, 4 rue Larrey, 49000 Angers, France.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Tissue thermal effect during lithotripsy and tissue ablation in endourology: a systematic review of experimental studies comparing Holmium and Thulium lasers. World J Urol 2023; 41:1-12. [PMID: 36515722 DOI: 10.1007/s00345-022-04242-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 12/02/2022] [Indexed: 12/15/2022] Open
Abstract
PURPOSE We looked into the Thulium: yttrium-aluminum-garnet (TM:YAG), Thulium Fibre laser (TFL) and Holmium: yttrium-aluminum-garnet (Ho:YAG) thermal laser tissue effect during lithotripsy and tissue ablation. METHODS We performed a PubMed, Scopus, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) search. RESULTS During lithotripsy, the Ho:YAG generated temperatures from 24 to 68.7 °C at powers < 20 W, the Tm:YAG from 43.7 °C at 30 W to 68 °C at powers < 20 W, and the TFL from 33 to 40.46 °C. During ablation, the Ho:YAG and continuous wave (cw) Tm:YAG tissue incision depths ranged from 0.08 to 2.26 mm, and from 0.28 to 3.22 mm. The Ho:YAG and Tm:YAG vaporization areas ranged from 0.044 to 0.078 mm2 and from 0.050 to 0.078 mm3 and their coagulation zones were 0.075 mm2 and 0.125 mm3 respectively. Ho:YAG and Tm:YAG laser damage zones ranged from 0.093 to 2.6 mm3 and from 0.207 to 0.98 mm3 respectively. The TFL incision depth ranged from 0.04 to 5.7 mm. The cw and SuperPulsed (SP) vaporization volumes ranged from 8 to 28.2 mm3/s and from 4 to 11 mm3/s. TFL coagulation depth and coagulation zone ranged from zero to 1.1 mm, 2.2 to 5.1 mm3 in SP mode and from 7.7 to 18.1 mm3 in cw mode. CONCLUSION During lithotripsy all lasers caused similar temperature changes and had a safe temperature profile at < 40 W. During tissue ablation, Ho:YAG has a deeper incision depth, while cwTm:YAG and cwTFL have broader coagulation and total laser areas.
Collapse
|
32
|
Laser Efficiency and Laser Safety: Holmium YAG vs. Thulium Fiber Laser. J Clin Med 2022; 12:jcm12010149. [PMID: 36614950 PMCID: PMC9821183 DOI: 10.3390/jcm12010149] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 11/28/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022] Open
Abstract
(1) Objective: To support the efficacy and safety of a range of thulium fiber laser (TFL) pre-set parameters for laser lithotripsy: the efficiency is compared against the Holmium:YAG (Ho:YAG) laser in the hands of juniors and experienced urologists using an in vitro ureteral model; the ureteral damage of both lasers is evaluated in an in vivo porcine model. (2) Materials and Methods: Ho:YAG laser technology and TFL technology, with a 200 µm core-diameter laser fibers in an in vitro saline ureteral model were used. Each participant performed 12 laser sessions. Each session included a 3-min lasering of stone phantoms (Begostone) with each laser technology in six different pre-settings retained from the Coloplast TFL Drive user interface pre-settings, for stone dusting: 0.5 J/10 Hz, 0.5 J/20 Hz, 0.7 J/10 Hz, 0.7 J/20 Hz, 1 J/12 Hz and 1 J/20 Hz. Both lasers were also used in three in vivo porcine models, lasering up to 20 W and 12 W in the renal pelvis and the ureter, respectively. Temperature was continuously recorded. After 3 weeks, a second look was done to verify the integrity of the ureters and kidney and an anatomopathological analysis was performed. (3) Results: Regarding laser lithotripsy efficiency, after 3 min of continuous lasering, the overall ablation rate (AR) percentage was 27% greater with the TFL technology (p < 0.0001). The energy per ablated mass [J/mg] was 24% lower when using the TFL (p < 0.0001). While junior urologists performed worse than seniors in all tests, they performed better when using the TFL than Ho:YAG technology (36% more AR and 36% fewer J/mg). In the in vivo porcine model, no urothelial damage was observed for both laser technologies, neither endoscopically during lasering, three weeks later, nor in the pathological test. (4) Conclusions: By using Coloplast TFL Drive GUI pre-set, TFL lithotripsy efficiency is higher than Ho:YAG laser, even in unexperienced hands. Concerning urothelial damage, both laser technologies with low power present no lesions.
Collapse
|
33
|
Abstract
Objective The holmium:yttrium-aluminium-garnet laser (Ho:YAG) has been the gold standard for laser lithotripsy over the last three decades. After demonstrating good in vitro efficacy, the thulium fiber laser (TFL) has been recently released in the market and the initial clinical results are encouraging. This article aims to review the main technology differences between the Ho:YAG laser and the TFL, discuss the initial clinical results with the TFL as well as the optimal settings for TFL lithotripsy. Methods We reviewed the literature focusing on the technological aspects of the Ho:YAG laser and TFL as well as the results of in vitro and in vivo studies comparing both technologies. Results In vitro studies show a technical superiority of TFL compared to the Ho:YAG laser and encouraging results have been demonstrated in clinical practice. However, as TFL is a new technology, limited studies are currently available, and the optimal settings for lithotripsy are not yet established. Conclusion TFL has the potential to be an alternative to the Ho:YAG laser, but more reports are still needed to determine the optimal laser for lithotripsy of urinary tract stones when considering all parameters including effectiveness, safety, and costs.
Collapse
|
34
|
Thulium Fiber Laser Behavior on Tissue During Upper- and Lower-Tract Endourology. Curr Urol Rep 2022; 23:271-278. [PMID: 36178569 DOI: 10.1007/s11934-022-01117-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW To present the latest evidence on thulium fiber laser (TFL) effects on tissue, during lithotripsy and ablation, emphasizing on generated temperatures, thermal damage thresholds, incision depths, areas of coagulation, and laser damage. RECENT FINDINGS Lasers are frequently utilized during endoscopic treatment of different urological conditions. The holmium:yttrium-aluminum-garnet (Ho:YAG) is most frequently used for various types of stones and soft tissue. The TFL has been recently introduced, offering several advantages. However, its activity on tissue during upper and lower tract endourology is poorly understood. At equivalent power settings, TFL and Ho:YAG generate similar temperature changes during lithotripsy. TFL has a shallow incision depth during tissue ablation. Compared to SP TFL, (cw) TFL results in a broader coagulation zone, whereas SP TFL gives of Ho:YAG-similar incision, and (cw) TFL offers a quick, precise cut with more carbonization.
Collapse
|
35
|
Traxer O, Sierra A, Corrales M. Which Is the Best Laser for Lithotripsy? Thulium Fiber Laser. EUR UROL SUPPL 2022; 44:15-17. [PMID: 36043194 PMCID: PMC9420494 DOI: 10.1016/j.euros.2022.05.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Olivier Traxer
- Sorbonne University GRC Urolithiasis no. 20, Tenon Hospital, F-75020 Paris, France. Tel. +33 684 479 763.
| | | | | |
Collapse
|
36
|
|
37
|
Li J, Huang Y, Cao D, Wei Q. Re: Øyvind Ulvik, Mathias Sørstrand Æsøy, Patrick Juliebø-Jones, Peder Gjengstø, Christian Beisland. Thulium Fibre Laser Versus Holmium:YAG for Ureteroscopic Lithotripsy: Outcomes from a Prospective Randomised Clinical Trial. Eur Urol. 2022;82:73-79: The Thulium Fibre Laser in Ureteroscopic Lithotripsy: Prospect and Risk Coexist? Eur Urol 2022; 82:e71. [PMID: 35715364 DOI: 10.1016/j.eururo.2022.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 05/17/2022] [Indexed: 02/05/2023]
Affiliation(s)
- Jinze Li
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China; West China School of Clinical Medicine, Sichuan University, Chengdu, China
| | - Yin Huang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China; West China School of Clinical Medicine, Sichuan University, Chengdu, China
| | - Dehong Cao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Qiang Wei
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China.
| |
Collapse
|
38
|
Yaghoubian AJ, Khusid JA, Gupta M. Re: Øyvind Ulvik, Mathias Sørstrand Æsøy, Patrick Juliebø-Jones, Peder Gjengstø, Christian Beisland. Thulium Fibre Laser versus Holmium:YAG for Ureteroscopic Lithotripsy: Outcomes from a Prospective Randomised Clinical Trial. Eur Urol. 2022;82:73-9. Eur Urol 2022; 82:e43-e44. [PMID: 35661627 DOI: 10.1016/j.eururo.2022.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 04/06/2022] [Indexed: 11/20/2022]
Affiliation(s)
- Alan J Yaghoubian
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Johnathan A Khusid
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mantu Gupta
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
39
|
Sierra A, Corrales M, Kolvatzis M, Traxer O. Initial clinical experience with the thulium fiber laser from Quanta System: First 50 reported cases. World J Urol 2022; 40:2549-2553. [PMID: 35861860 DOI: 10.1007/s00345-022-04096-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 07/07/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To evaluate the new thulium fiber laser (TFL) from Quanta System (Fiber Dust™) in terms of efficiency, safety, and laser settings in laser lithotripsy during retrograde intrarenal surgery (RIRS). METHODS A prospective study of the first 50 patients with ureteral and renal stones who underwent RIRS using the new Fiber Dust (TFL from Quanta System, Italy) was performed in a single center. 200 µm and 150 µm laser fibers were used. Stone size, stone density, laser-on time (LOT) and laser settings were recorded. We also assessed the ablation speed (mm3/s), Joules/mm3 and laser power (W) values for each procedure. RESULTS A total of 50 patients were analyzed. The median (IQR) age was 54.5 (43-65) years old. Median (IQR) stone volume was 347 (147-1800) mm3 and 1125 (294-4000) mm3 for ureteral and renal stones, respectively. Median (IQR) stone density was 900 (400-1500) HU for ureteral stones and 950 (725-1125) HU for renal stones. Median (IQR) pulse energy was 0.6 (0.5-1) J and 0.6 (0.5-0.9) J for ureteral and renal stones, respectively. Median (IQR) frequency for ureteral stones was 10 (10-20) Hz and for renal stones, 15 (10-20) Hz. All procedures used short pulse. There were no statistically significant differences in pulse energy, frequency, laser power or LOT in both groups. The median (IQR) J/mm3 was 8.7 (4.8-65.2) for ureteral stones vs 14.3 (7.8-24.7) for renal stones. The median (IQR) ablation rate was 0.3 (0.2-1.3) mm3/s for ureteral stones vs 0.7 (0.4-1.2) mm3/s for renal stones. Neither of those results reached the significance threshold. Overall complication rate was low in both groups, and none was related to TFL. CONCLUSION According to our results, the new TFL laser is safe and effective for lithotripsy during RIRS, using low pulse energy and low pulse frequency.
Collapse
Affiliation(s)
- Alba Sierra
- Sorbonne University, GRC Urolithiasis No. 20 Tenon Hospital, 75020, Paris, France.,Department of Urology AP-HP, Sorbonne University, Tenon Hospital, 75020, Paris, France
| | - Mariela Corrales
- Sorbonne University, GRC Urolithiasis No. 20 Tenon Hospital, 75020, Paris, France.,Department of Urology AP-HP, Sorbonne University, Tenon Hospital, 75020, Paris, France
| | - Merkourios Kolvatzis
- Sorbonne University, GRC Urolithiasis No. 20 Tenon Hospital, 75020, Paris, France.,Department of Urology AP-HP, Sorbonne University, Tenon Hospital, 75020, Paris, France
| | - Olivier Traxer
- Sorbonne University, GRC Urolithiasis No. 20 Tenon Hospital, 75020, Paris, France. .,Department of Urology AP-HP, Sorbonne University, Tenon Hospital, 75020, Paris, France.
| |
Collapse
|