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Minimally invasive percutaneous nephrolithotomy with SuperPulsed Thulium-fiber laser

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Abstract

We aimed to assess the efficacy and safety of minimally invasive percutaneous nephrolithotomy (PCNL) with SuperPulsed Thulium-fiber laser (SP TFL) using different frequency settings. 125 patients with solitary kidney calculi of up to 55 mm in the maximum diameter underwent mini-PCNL with the SP TFL. Stone-free rate, laser-on time, ablation efficacy, energy consumption, ablation speed and complications were all analyzed. Negative low-dose computed tomography scan or asymptomatic patients with stone fragments < 2 mm were the criteria for assessing the stone-free status. In 36 patients (28.8%) low frequency regimens were used (LF: 3–19 Hz—0.5–6 J), in 75 patients (60%) high frequency regimens were chosen (HF: 20–49 Hz—0.2–2 J) and in 14 (11.2%) patients higher frequency (HRF: 50–200 Hz—0.1–0.5 J) regimens were preferred. The mean age was 52 ± 1.8 years. Median stone diameter and median stone volume were larger at low frequency regimens compared to high frequency regimens. Ablation efficacy (J/mm3) was lower at low rather than at high frequency regimens. Ablation speed (mm3/sec) was higher at low compared to high frequency regimens. Surgeons reported minimal and absent retropulsion at higher frequency regimens. The best visibility was observed at high frequency regimens. The overall stone free rate (SFR) at 3 months was 85%. The majority of the postoperative complications were classified between Clavien grades I–II. SP TFL is an effective and safe tool for performing mini-PCNL regardless of the laser settings.

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Abbreviations

SP TFL:

SuperPulsed Thulium-fiber laser

PCNL:

Percutaneous nephrolithotomy

LF:

Low frequency

HF:

High frequency

HRF:

Higher frequency

HU:

Hounsfield units

CT:

Computed tomography

LOT:

Laser-on time

SD:

Standard deviation

IQR:

Interquartile range

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Authors and Affiliations

  1. Institute for Urology and Reproductive Health, Sechenov University, 2/1 Bolshaya Pirogovskaya St, Moscow, 119991, Russia

    Dmitry Korolev, Gagik Akopyan, Dmitry Tsarichenko, Stanislav Ali, Denis Chinenov, Mark Taratkin & Dmitry Enikeev

  2. International School “Medicine of the Future”, Sechenov University, Moscow, Russia

    Anastasia Shpikina

  3. GRC #20 Lithiase Urinaire, Sorbonne University, Hôpital Tenon, Paris, France

    Mariela Corrales & Olivier Traxer

Authors
  1. Dmitry Korolev
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  2. Gagik Akopyan
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  3. Dmitry Tsarichenko
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  4. Anastasia Shpikina
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  5. Stanislav Ali
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  6. Denis Chinenov
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  7. Mariela Corrales
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  8. Mark Taratkin
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  9. Olivier Traxer
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  10. Dmitry Enikeev
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Contributions

DK: manuscript writing, protocol development. GA: protocol development. DT: protocol development. AS: manuscript writing/editing, data collection and analysis. SA: manuscript editing, data collection. DC: protocol development. MC: manuscript editing. MT: manuscript writing/editing, data analysis. OT: manuscript editing, management. DE: manuscript editing, protocol development, management.

Corresponding author

Correspondence to Dmitry Enikeev.

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Conflict of interest

Olivier Traxer is a consultant for Coloplast, Rocamed, Olympus, EMS, Boston Scientific and IPG.

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The study was approved by the Sechenov University (Moscow, Russia) institutional review board.

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Informed consent was obtained from all individual participants included in the study.

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Korolev, D., Akopyan, G., Tsarichenko, D. et al. Minimally invasive percutaneous nephrolithotomy with SuperPulsed Thulium-fiber laser. Urolithiasis 49, 485–491 (2021). https://doi.org/10.1007/s00240-021-01258-2

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  • DOI: https://doi.org/10.1007/s00240-021-01258-2

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