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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: 4.0] [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.
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Sánchez-Puy A, Bravo-Balado A, Diana P, Baboudjian M, Piana A, Girón I, Kanashiro AK, Angerri O, Contreras P, Eisner BH, Balañà J, Sánchez-Martín FM, Millán F, Palou J, Emiliani E. New Generation Pulse Modulation in Holmium:YAG Lasers: A Systematic Review of the Literature and Meta-Analysis. J Clin Med 2022; 11:jcm11113208. [PMID: 35683595 PMCID: PMC9181640 DOI: 10.3390/jcm11113208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/23/2022] [Accepted: 06/01/2022] [Indexed: 12/04/2022] Open
Abstract
(1) Background: New pulse modulation (PM) technologies in Holmium:YAG lasers are available for urinary stone treatment, but little is known about them. We aim to systematically evaluate the published evidence in terms of their lithotripsy performance. (2) Methods: A systematic electronic search was performed (MEDLINE, Scopus, and Cochrane databases). We included all relevant publications, including randomized controlled trials, non-randomized comparative and non-comparative studies, and in-vitro studies investigating Holmium:YAG lithotripsy performance employing any new PM. (3) Results: Initial search yielded 203 studies; 24 studies were included after selection: 15 in-vitro, 9 in-vivo. 10 In-vitro compared Moses with regular PM, 1 compared Quanta’s, 1 Dornier MedTech’s, 2 Moses with super Thulium Fiber Laser, and 1 compared Moses with Quanta PMs. Six out of seven comparative studies found a statistically significant difference in favor of new-generation PM technologies in terms of operative time and five out of six in fragmentation time; two studies evaluated retropulsion, both in favor of new-generation PM. There were no statistically significant differences regarding stone-free rate, lasing and operative time, and complications between Moses and regular PM when data were meta-analyzed. (4) Conclusions: Moses PM seems to have better lithotripsy performance than regular modes in in-vitro studies, but there are still some doubts about its in-vivo results. Little is known about the other PMs. Although some results favor Quanta PMs, further studies are needed.
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Affiliation(s)
- Antoni Sánchez-Puy
- Department of Urology, Fundació Puigvert IUNA, 08017 Barcelona, Spain; (A.P.); (I.G.); (A.K.K.); (O.A.); (J.B.); (F.M.S.-M.); (F.M.); (J.P.)
- Department of Surgery, Universistat Autònoma de Barcelona, 08193 Barcelona, Spain
- Correspondence: (A.S.-P.); (A.B.-B.); (P.D.); (E.E.); Tel.: +34-626413540 (A.S.P.)
| | - Alejandra Bravo-Balado
- Department of Urology, Fundació Puigvert IUNA, 08017 Barcelona, Spain; (A.P.); (I.G.); (A.K.K.); (O.A.); (J.B.); (F.M.S.-M.); (F.M.); (J.P.)
- Correspondence: (A.S.-P.); (A.B.-B.); (P.D.); (E.E.); Tel.: +34-626413540 (A.S.P.)
| | - Pietro Diana
- Department of Urology, Fundació Puigvert IUNA, 08017 Barcelona, Spain; (A.P.); (I.G.); (A.K.K.); (O.A.); (J.B.); (F.M.S.-M.); (F.M.); (J.P.)
- Correspondence: (A.S.-P.); (A.B.-B.); (P.D.); (E.E.); Tel.: +34-626413540 (A.S.P.)
| | - Michael Baboudjian
- Department of Urology and Kidney Transplantation, Aix-Marseille University, APHM, Conception Academic Hospital, 13005 Marseille, France;
| | - Alberto Piana
- Department of Urology, Fundació Puigvert IUNA, 08017 Barcelona, Spain; (A.P.); (I.G.); (A.K.K.); (O.A.); (J.B.); (F.M.S.-M.); (F.M.); (J.P.)
| | - Irene Girón
- Department of Urology, Fundació Puigvert IUNA, 08017 Barcelona, Spain; (A.P.); (I.G.); (A.K.K.); (O.A.); (J.B.); (F.M.S.-M.); (F.M.); (J.P.)
| | - Andrés K. Kanashiro
- Department of Urology, Fundació Puigvert IUNA, 08017 Barcelona, Spain; (A.P.); (I.G.); (A.K.K.); (O.A.); (J.B.); (F.M.S.-M.); (F.M.); (J.P.)
| | - Oriol Angerri
- Department of Urology, Fundació Puigvert IUNA, 08017 Barcelona, Spain; (A.P.); (I.G.); (A.K.K.); (O.A.); (J.B.); (F.M.S.-M.); (F.M.); (J.P.)
| | - Pablo Contreras
- Department of Urology, Hospital Alemán de Buenos Aires, Buenos Aires C1118 AAT, Argentina;
| | - Brian H. Eisner
- Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA;
| | - Josep Balañà
- Department of Urology, Fundació Puigvert IUNA, 08017 Barcelona, Spain; (A.P.); (I.G.); (A.K.K.); (O.A.); (J.B.); (F.M.S.-M.); (F.M.); (J.P.)
| | - Francisco M. Sánchez-Martín
- Department of Urology, Fundació Puigvert IUNA, 08017 Barcelona, Spain; (A.P.); (I.G.); (A.K.K.); (O.A.); (J.B.); (F.M.S.-M.); (F.M.); (J.P.)
| | - Félix Millán
- Department of Urology, Fundació Puigvert IUNA, 08017 Barcelona, Spain; (A.P.); (I.G.); (A.K.K.); (O.A.); (J.B.); (F.M.S.-M.); (F.M.); (J.P.)
| | - Joan Palou
- Department of Urology, Fundació Puigvert IUNA, 08017 Barcelona, Spain; (A.P.); (I.G.); (A.K.K.); (O.A.); (J.B.); (F.M.S.-M.); (F.M.); (J.P.)
- Department of Surgery, Universistat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - Esteban Emiliani
- Department of Urology, Fundació Puigvert IUNA, 08017 Barcelona, Spain; (A.P.); (I.G.); (A.K.K.); (O.A.); (J.B.); (F.M.S.-M.); (F.M.); (J.P.)
- Correspondence: (A.S.-P.); (A.B.-B.); (P.D.); (E.E.); Tel.: +34-626413540 (A.S.P.)
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Mahajan AD, Mahajan SA. Thulium fiber laser versus holmium:yttrium aluminum garnet laser for stone lithotripsy during mini-percutaneous nephrolithotomy: A prospective randomized trial. Indian J Urol 2022; 38:42-47. [PMID: 35136294 PMCID: PMC8796767 DOI: 10.4103/iju.iju_331_21] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 10/31/2021] [Accepted: 12/06/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION We aimed to evaluate the effectiveness and safety of the newly launched thulium fiber laser (TFL) with holmium laser lithotripsy in the miniaturized percutaneous nephrolithotomy (Miniperc) procedure for renal stones. METHODS The prospective study included patients with renal stones of size >1 cm to ≤3 cm. The patients who opted for extracorporeal shock wave lithotripsy, retrograde intrarenal surgeries, and stones >3 cm were excluded from the study. Demographics such as patient's age, sex, stone volume, and hardness were evaluated. The patients were randomized into holmium and TFL group for stone lithotripsy. Both the procedures were evaluated for stone disintegration time, operative time, hospital stay, intra- and postoperative complications, and stone-free rate. RESULTS A total of 125 patients with renal stones who underwent Miniperc were included in this study. The average size of the stone was comparable in both the groups (P = 0.053). The median stone disintegration time with holmium laser was 20 min 45 s and with TFL, it was 11 min 19 s (P < 0.001). The most common complications were Clavien grade I and II complications (P = 0.128). Prolonged postoperative hematuria was observed in the Thulium fiber laser group, which was conservatively managed. The stone-free rate with TFL (94.9%) was better than Holmium lithotripsy (90.9%). CONCLUSIONS The TFL has significant less stone disintegration time which effectively reduced the operative time of Miniperc procedure. The stone-free rate is better, but the incidence of self-limiting hematuria is higher with TFL as compared to Holmium laser.
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Affiliation(s)
- Abhay Dinkar Mahajan
- Department of Urology, Sai Urology Hospital, Aurangabad, Maharashtra, India,E-mail:
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Ryan JR, Nguyen MH, Linscott JA, Nowicki SW, James E, Jumper BM, Ordoñez M, Ingimarsson JP. Ureteroscopy with thulium fiber laser lithotripsy results in shorter operating times and large cost savings. World J Urol 2022; 40:2077-2082. [PMID: 35729369 PMCID: PMC9213046 DOI: 10.1007/s00345-022-04037-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 05/03/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Prolonged ureteroscopy (URS) is associated with complications including ureteral perforation, stricture, and urosepsis. As laser lithotripsy is one of the most common urologic procedures, small cost savings per case can have a large financial impact. This retrospective study was designed to determine if Thulium fiber laser (TFL) lithotripsy decreases operative time and costs compared to standard Holmium:YAG (Ho:YAG) lithotripsy without pulse modulation. METHODS A retrospective review of URS with laser lithotripsy was conducted for 152 cases performed from August 2020 to January 2021. Variables including cumulative stone size, location, chemical composition, prior ureteral stenting, and ureteral access sheath use were recorded for each case. A cost benefit analysis was performed to show projected cost savings due to potentially decreased operative times. RESULTS Compared to Ho:YAG, use of TFL resulted in an average decrease of 12.9 min per case (p = .021, 95% CI [2.03-23.85]). In subgroup analysis of cases with cumulative stone diameter less than 15 mm, the difference was 14.0 min (p = .007, CI [3.95-23.95]). For cases less than 10 mm, the mean difference was 17.3 min in favor of TFL (p = .002, 95% CI [6.89-27.62]). This ~ 13 min reduction in operative time resulted in saving $440/case in direct operating room costs giving our institution a range of $294,000 to $381,900 savings per year. CONCLUSIONS TFL has a significantly shorter operative time and decreased cost when compared to the standard Ho:YAG for equivalent kidney stone and patient characteristics. Longer term follow up is needed to see if recurrence rates are affected.
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Affiliation(s)
- James R. Ryan
- Tufts University School of Medicine, 145 Harrison Ave, Boston, MA 02111 USA
| | - Mitchell H. Nguyen
- Division of Urology, Maine Medical Center, 100 Brickhill Ave, South Portland, ME 04106 USA
| | - Joshua A. Linscott
- Division of Urology, Maine Medical Center, 100 Brickhill Ave, South Portland, ME 04106 USA
| | - Samuel W. Nowicki
- Tufts University School of Medicine, 145 Harrison Ave, Boston, MA 02111 USA
| | - Evelyn James
- Brown School of Public Health, 121 South Main Street, Providence, RI USA
| | - Brian M. Jumper
- Division of Urology, Maine Medical Center, 100 Brickhill Ave, South Portland, ME 04106 USA
| | - Maria Ordoñez
- Division of Urology, Maine Medical Center, 100 Brickhill Ave, South Portland, ME 04106 USA
| | - Johann P. Ingimarsson
- Division of Urology, Maine Medical Center, 100 Brickhill Ave, South Portland, ME 04106 USA
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Abstract
Laser technology has been a breakthrough in urology. The new era in endocorporeal laser lithotripsy has recently begun in mid-2020, where promising technologies tested in vitro have reached their approval for clinical use and, in that way, have made it possible to confirm their safety and advantages in the real world, for the patient and for the urologist.
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Affiliation(s)
- Olivier Traxer
- Sorbonne University, GRC Urolithiasis no. 20, Tenon Hospital, Paris F-75020, France; Sorbonne University, Department of Urology AP-HP, Tenon Hospital, Paris F-75020, France.
| | - Mariela Corrales
- Sorbonne University, GRC Urolithiasis no. 20, Tenon Hospital, Paris F-75020, France; Sorbonne University, Department of Urology AP-HP, Tenon Hospital, Paris F-75020, France
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Kraft L, Yilmaz M, Petzold R, Gratzke C, Suarez-Ibarrola R, Miernik A. Dusting Efficiency of a Novel Pulsed Thulium:Yttrium Aluminum Garnet Laser vs a Thulium Fiber Laser. J Endourol 2021; 36:259-265. [PMID: 34693738 DOI: 10.1089/end.2021.0441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Holmium:yttrium aluminum garnet laser (Ho:YAG) is still considered the gold standard in laser lithotripsy. There is a large body of literature comparing the capabilities of Ho:YAG and thulium fiber lasers (TFLs). The novel, pulsed thulium:yttrium aluminum garnet laser (p-Tm:YAG) evaluation model has only been compared with Ho:YAG in terms of its dusting performance to date. It was this study's aim to compare the p-Tm:YAG's dusting efficiency with that of a chopped TFL. Materials and Methods: During the laser ablation procedure, while the laser device was emitting light, the laser fiber was spiraled across the surface of a uniform kidney stone model via software. We relied on the stone model's difference in weight before and after the dusting procedure to assess the dusting efficiency and assessed each laser device's dusting efficiency at various preset laser configurations and laser fiber-motion speeds. We compared both laser devices' laser configurations, which were identical in pulse energy and frequency, while keeping in mind that the pulse duration differed significantly. In addition, we tested each laser device's capability. Results: The average ablated weight across all laser configurations was 0.61 g (standard deviation [SD] = 0.44 g) for p-Tm:YAG and 0.76 g (SD = 0.51 g) for TFL. After statistical analysis, we found no significant difference in ablated weight between the laser devices (U = 1715.5, p-value = 0.11). The maximum permissible frequency configuration for TFL was 1600 Hz, which resulted in the worst overall dusting output. Conclusions: We observed that the p-Tm:YAG's dusting efficiency resembled that of TFL in the identical pulse energy and frequency laser configurations. The ablation efficiency did not seem to be affected by the laser devices' differences in pulse duration. Slower laser fiber-motion speeds resulted in more efficient ablation. When using the maximum preset frequency and power configuration, TFL's dusting efficiency appeared to be inefficient.
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Affiliation(s)
- Lea Kraft
- Department of Urology, Faculty of Medicine, Medical Centre, University of Freiburg, Freiburg, Germany
| | - Mehmet Yilmaz
- Department of Urology, Faculty of Medicine, Medical Centre, University of Freiburg, Freiburg, Germany
| | - Ralf Petzold
- Department of Urology, Faculty of Medicine, Medical Centre, University of Freiburg, Freiburg, Germany
| | - Christian Gratzke
- Department of Urology, Faculty of Medicine, Medical Centre, University of Freiburg, Freiburg, Germany
| | - Rodrigo Suarez-Ibarrola
- Department of Urology, Faculty of Medicine, Medical Centre, University of Freiburg, Freiburg, Germany
| | - Arkadiusz Miernik
- Department of Urology, Faculty of Medicine, Medical Centre, University of Freiburg, Freiburg, Germany
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Multisensorial Assessment of Laser Effects on Shellac Applied on Wall Paintings. SENSORS 2021; 21:s21103354. [PMID: 34065913 PMCID: PMC8150335 DOI: 10.3390/s21103354] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/07/2021] [Accepted: 05/08/2021] [Indexed: 11/17/2022]
Abstract
The assessment of five different laser treatments in the conservation of wall paintings was devised on the basis of the surface temperature monitoring by infrared thermography (IRT), ultraviolet-induced fluorescence-visible (UV-VIS) imaging, and optical coherence tomography (OCT). A series of yttrium-aluminum-garnet (YAG) lasers were tested for removal of shellac layers from wall painting mock-ups. The mock-ups were realized as buon fresco with different mineral based pigments (earths and iron oxide) on a lime- and sand-based mortar. After the carbonatation process, all the samples were treated with shellac (5% in ethanol). The effects of neodymium (Nd):YAG, holmium (Ho):YAG, and erbium (Er):YAG laser sources, in different operative modes, on average temperature of the surface, color, and morphology were inspected with complementary sensors. The results show the necessity to adopt a combined approach in establishing safe laser operating conditions to avoid any undesired effects induced on the artefacts by the laser treatments. We demonstrate, for the first time, the performance of the Ho:YAG laser in the removal of a conservation treatment.
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Kronenberg P, Hameed BMZ, Somani B. Outcomes of thulium fibre laser for treatment of urinary tract stones: results of a systematic review. Curr Opin Urol 2021; 31:80-86. [PMID: 33470684 PMCID: PMC7879830 DOI: 10.1097/mou.0000000000000853] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Lasers have become a fundamental aspect of stone treatment. Although Holmium:Yttrium-Aluminum-garnet (Ho:YAG) laser is the current gold-standard in endoscopic laser lithotripsy, there is a lot of buzz around the new thulium fibre laser (TFL). We decided to evaluate the latest data to help create an objective and evidence-based opinion about this new technology and associated clinical outcomes. RECENT FINDINGS Sixty full-text articles and peer-reviewed abstract presentations were included in the qualitative synthesis of this systematic review performed over the last 2 years. Current super pulsed TFL machines are capable of achieving peak powers of 500W and emit very small pulse energies of 0.025 Joules going up to 6 Joules, and capable of frequency over 2000 Hz. This makes the TFL ablate twice as fast for fragmentation, 4 times as fast for dusting, more stone dust of finer size and less retropulsion compared to the Ho:YAG laser. Because of the smaller laser fibres with the TFL, future miniaturization of instruments is also possible. SUMMARY Based on the review, the TFL is a potential game-changer for kidney stone disease and has a promising role in the future. However larger multicentric prospective clinical studies with long-term follow-up are needed to establish the safety and efficacy of the TFL in endourology.
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Affiliation(s)
| | - BM Zeeshan Hameed
- Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Bhaskar Somani
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
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