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A historical comparison of thulium fiber laser systems for stone lithotripsy: navigating toward safe and effective parameters

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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.

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Authors and Affiliations

  1. Department of Urology, Hospital Clinic, University of Barcelona, Barcelona, Spain

    Alba Sierra

  2. Department of Urology AP-HP, Sorbonne University GRC Urolithiasis No. 20 Tenon Hospital, F-75020, Paris, France

    Alba Sierra, Eugenio Ventimiglia, Mariela Corrales, Catalina Solano, Luigi Candela & Olivier Traxer

  3. Division of Experimental Oncology/Unit of Urology, URI; IRCCS Ospedale San Raffaele, Università Vita-Salute San Raffaele, Milan, Italy

    Eugenio Ventimiglia & Luigi Candela

Authors
  1. Alba Sierra
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  2. Eugenio Ventimiglia
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  3. Mariela Corrales
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  4. Catalina Solano
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  5. Luigi Candela
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  6. Olivier Traxer
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Contributions

AS: manuscript writing. EV: manuscript editing. MC: data analysis, manuscript writing. CS: data management. LC: data management. OT: project development, manuscript editing.

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Correspondence to Olivier Traxer.

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Sierra, A., Ventimiglia, E., Corrales, M. et al. A historical comparison of thulium fiber laser systems for stone lithotripsy: navigating toward safe and effective parameters. World J Urol 42, 145 (2024). https://doi.org/10.1007/s00345-024-04789-6

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