To investigate the thermal effects, stone retropulsion and ablation rate of SuperPulse Thulium-fiber laser (SP TFL) with two different surgical fibers of 200 and 150 μm in diameter.
SP TFL (NTO IRE-Polus, Fryazino, Russia) performance with 200 and 150 μm fibers (NTO IRE-Polus, Fryazino, Russia) was evaluated. Before each test, the laser fiber was cleaved, and the power measurement was taken to verify the actual laser output power. To compare the laser fibers in well-controlled environments, a number of setups were used to assess retropulsion, ablation efficacy, fiber burnback, energy transmission, and safety.
Power measurements performed before each test revealed a 4.7% power drop for a 200 μm fiber SP TFL (14.3 ± 0.5 W) and 7.3% power drop for a 150 μm fiber SP TFL (13.9 ± 0.5 W) versus the nominally indicated power (15.0 W). Retropulsion with the TFL was minimal and comparable between fibers. We found no clinically relevant temperature differences between SP TFL with either 200 or 150 μm fibers. The ablation efficacy tended to be comparable under most parameters. Yet, we did observe a decreased diameter of residual fragments after the ablation with a 150 μm fiber.
The smaller fiber (150 μm) is not inferior to 200 μm fiber in terms of fiber burnback, retropulsion, safety, and ablation rate. Moreover, it has the potential to decrease the diameter of fragments during lithotripsy, which may facilitate dusting during RIRS.
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Scott NJ, Cilip CM, Fried NM (2009) Thulium fiber laser ablation of urinary stones through small-core optical fibers. IEEE J Sel Top Quantum Electron 15(2):443–440
Blackmon RL, Hutchens TC, Hardy LA, Wilson CR, Irby PB, Fried NM (2014) Thulium fiber laser ablation of kidney stones using a 50-μm-core silica optical fiber. Opt Eng 54(1):011004
Traxer O, Keller EX (2020) Thulium fiber laser: the new player for kidney stone treatment? A comparison with Holmium:YAG laser. World J Urol 38(8):1883–1894
Wilson CR, Kennedy JDD, Irby PB, Fried NM (2018) Miniature ureteroscope distal tip designs for potential use in thulium fiber laser lithotripsy. J Biomed Opt 23(7):076003
Andreeva V, Vinarov A, Yaroslavsky I, Kovalenko A, Vybornov A, Rapoport L et al (2020) Preclinical comparison of superpulse thulium fiber laser and a holmium:YAG laser for lithotripsy. World J Urol 38(2):497–503
Taratkin M, Laukhtina E, Singla N, Kozlov V, Abdusalamov A, Ali S et al (2020) Temperature changes during laser lithotripsy with Ho:YAG laser and novel Tm-fiber laser: a comparative in-vitro study. World J Urol 38(12):3261–3266. https://doi.org/10.1007/s00345-020-03122-1
Hein S, Petzold R, Schoenthaler M, Wetterauer U, Miernik A (2018) Thermal effects of Ho: YAG laser lithotripsy: real-time evaluation in an in vitro model. World J Urol 36(9):1469–1475
Wollin DA, Carlos EC, Tom WR, Simmons WN, Preminger GM, Lipkin ME (2018) Effect of laser settings and irrigation rates on ureteral temperature during holmium laser lithotripsy, an in vitro model. J Endourol 32:59–63
Peplinski B, Faaborg D, Miao E, Alsyouf M, Myklak K, Kelln W et al (2016) The effect of laser fiber cleave technique and lithotripsy time on power output. J Endourol 30(6):678–684
Panthier F, Doizi S, Lapouge P, Chaussain C, Kogane N, Berthe L et al (2020) Comparison of the ablation rates, fissures and fragments produced with 150 µm and 272 µm laser fibers with superpulsed thulium fiber laser: an in vitro study. World J Urol 39(6):1683–1691
Taratkin M, Laukhtina E, Singla N, Tarasov A, Alekseeva T, Enikeev M et al (2020) How Lasers Ablate Stones: In Vitro Study of Laser Lithotripsy (Ho:YAG and Tm-Fiber Lasers) in Different Environments. J Endourol 35(6):931–936
Marguet CG, Sung JC, Springhart WP, L’Esperance JO, Zhou S, Zhong P et al (2005) In vitro comparison of stone retropulsion and fragmentation of the frequency doubled, double pulse Nd:YAG laser and the holmium:YAG laser. J Urol 173(5):1797–1800
White MD, Moran ME, Calvano CJ, Borhan-Manesh A, Mehlhaff BA (1998) Evaluation of retropulsion caused by holmium:YAG laser with various power settings and fibers. J Endourol 12(2):183–186
Lee H, Ryan RT, Teichman JMH, Kim J, Choi B, Arakeri NV et al (2003) Stone retropulsion during holmium:YAG lithotripsy. J Urol 169(3):881–885
Bader MJ, Pongratz T, Khoder W, Stief CG, Herrmann T, Nagele U et al (2015) Impact of pulse duration on Ho:YAG laser lithotripsy: fragmentation and dusting performance. World J Urol 33(4):471–477
Enikeev D, Shariat SF, Taratkin M, Glybochko P (2020) The changing role of lasers in urologic surgery. Curr Opin Urol 30(1):24–29
Blackmon RL, Irby PB, Fried NM (2011) Comparison of holmium:YAG and thulium fiber laser lithotripsy: ablation thresholds, ablation rates, and retropulsion effects. J Biomed Opt 16(7):071403
Hardy LA, Wilson CR, Irby PB, Fried NM (2014) Thulium fiber laser lithotripsy in an in vitro ureter model. J Biomed Opt 19(12):128001
Mues AC, Teichman JMH, Knudsen BE (2009) Quantification of holmium: yttrium aluminum garnet optical tip degradation. J Endourol 23(9):1425–1428
Khemees TA, Shore DM, Antiporda M, Teichman JMH, Knudsen BE (2013) Evaluation of a new 240-μm single-use holmium:YAG optical fiber for flexible ureteroscopy. J Endourol 27(4):475–479
Hutchens TC, Blackmon RL, Irby PB, Fried NM (2013) Hollow steel tips for reducing distal fiber burn-back during thulium fiber laser lithotripsy. J Biomed Opt 18(7):078001
Enikeev D, National Library of Medicine (U.S.) (2020) Comparison of SP TFL and Ho:YAG for RIRS using 145 µm and 200 µm fibers. Identifier NCT04346485. Available from: https://clinicaltrials.gov/ct2/show/NCT04346485https://clinicaltrials.gov/ct2/show/NCT04346485
Fried NM (2018) Recent advances in infrared laser lithotripsy [invited]. Biomed Opt Express 9(9):4552
To NTO-IRE Polus/IPG Photonics for providing equipment and to Viktoriya Andreeva and Ilya Yaroslavsky for discussing results.
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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The authors declare that there is no conflict of interest.
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Below is the link to the electronic supplementary material.
Setup for stone ablation assessment. Supplementary file 1 (PNG 849 KB)
Setup for retropulsion assessment. Supplementary file 2 (PNG 2203 KB)
Setup for temperature assessment Supplementary file 3 (PNG 1561 KB)
Retropulsion curves for two types of laser fibers. Supplementary file 4 (PNG 38 KB)
Flexible ureteroscope with 200 and 150 mcm fibers at maximal curvature. No changes in curvature depending on fiber are observed. Supplementary file 5 (PNG 336 KB)
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Taratkin, M., Azilgareeva, C., Corrales, M. et al. Superpulse thulium fiber laser lithotripsy: an in vitro comparison of 200 μm and 150 μm laser fibers. World J Urol (2021). https://doi.org/10.1007/s00345-021-03800-8
- In vitro
- Kidney stones
- Thermal effects
- Thulium fiber laser