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Initial clinical experience with the pulsed solid-state thulium YAG laser from Dornier during RIRS: first 25 cases

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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.

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References

  1. Traxer O, Keller EX (2019) Thulium fiber laser: the new player for kidney stone treatment? A comparison with Holmium:YAG laser. World J Urol. 38:1883

    Article  PubMed  PubMed Central  Google Scholar 

  2. Johnson DE, Cromeens DM, Price RE (1992) Use of the holmium:YAG laser in urology. Lasers Surg Med 12(4):353–363

    Article  CAS  PubMed  Google Scholar 

  3. Gupta PK (2007) Is the holmium:YAG laser the best intracorporeal lithotripter for the ureter? A 3-year retrospective study. J Endourol Mars 21(3):305–309

    Article  Google Scholar 

  4. Urofrance | Recommandations de bonne pratique pour la prise en charge des calculs et de la lithiase urinaires: diagnostic, traitement, suivi et prévention secondaire - Argumentaire - Urofrance [Internet]. [cité 17 nov 2022]. Disponible sur: https://www.urofrance.org/recommandation/recommandations-de-bonne-pratique-pour-la-prise-en-charge-des-calculs-et-de-la-lithiase-urinaires-diagnostic-traitement-suivi-et-prevention-secondaire-argumentaire/

  5. 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 juill 16(7):071403

    Article  Google Scholar 

  6. Ventimiglia E, Doizi S, Kovalenko A, Andreeva V, Traxer O (2020) Effect of temporal pulse shape on urinary stone phantom retropulsion rate and ablation efficiency using holmium:YAG and super pulse thulium fiber lasers. BJU Int. 126:159

    Article  CAS  PubMed  Google Scholar 

  7. Petzold R, Miernik A, Suarez-Ibarrola R (2021) In vitro dusting performance of a new solid state thulium laser compared to holmium laser lithotripsy. J Endourol févr 35(2):221–225

    Article  Google Scholar 

  8. Petzold R, Miernik A, Suarez-Ibarrola R (2021) Retropulsion force in laser lithotripsy-an in vitro study comparing a Holmium device to a novel pulsed solid-state thulium laser. World J Urol. 39:3651

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Petzold R, Suarez-Ibarrola R, Miernik A (2021) Temperature assessment of a novel pulsed thulium solid-state laser compared with a holmium:yttrium-aluminum-garnet laser. J Endourol juin 35(6):853–859

    Article  Google Scholar 

  10. Kraft L, Yilmaz M, Petzold R, Gratzke C, Suarez-Ibarrola R, Miernik A (2022) Dusting efficiency of a novel pulsed thulium: yttrium aluminum garnet laser vs a thulium fiber laser. J Endourol févr 36(2):259–265

    Article  Google Scholar 

  11. Kraft L, Petzold R, Suarez-Ibarrola R, Miernik A (2022) In vitro fragmentation performance of a novel, pulsed Thulium solid-state laser compared to a Thulium fibre laser and standard Ho:YAG laser. Lasers Med Sci avr 37(3):2071–2078

    Article  Google Scholar 

  12. Brisbane W, Bailey MR, Sorensen MD (2016) An overview of kidney stone imaging techniques. Nat Rev Urol 13(11):654–662

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Fedorov A, Beichel R, Kalpathy-Cramer J, Finet J, Fillion-Robin JC, Pujol S et al (2012) 3D Slicer as an image computing platform for the quantitative imaging network. Magn Reson Imaging 30(9):1323–1341

    Article  PubMed  PubMed Central  Google Scholar 

  14. Panthier F, Traxer O, Yonneau L, Lebret T, Berthe L, Illoul L et al (2021) Evaluation of a free 3D software for kidney stones’ surgical planning: kidney stone calculator a pilot study. World J Urol. 39:3607

    Article  PubMed  PubMed Central  Google Scholar 

  15. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg août 240(2):205–213

    Article  Google Scholar 

  16. Thulio® [Internet]. Dornier MedTech. [cité 19 mai 2023]. Disponible sur: https://www.dornier.com/products-item/dornier-thulio/

  17. Sierra A, Corrales M, Piñero A, Traxer O (2022) Thulium fiber laser pre-settings during ureterorenoscopy: Twitter’s experts’ recommendations. World J Urol. 40:1529

    Article  PubMed  Google Scholar 

  18. Sierra A, Corrales M, Piñero A, Kolvatzis M, Somani B, Traxer O (2022) Glossary of pre-settings given by laser companies: no consensus! World J Urol 40(9):2313–2321

    Article  CAS  PubMed  Google Scholar 

  19. Weiss B, Shah O (2016) Evaluation of dusting versus basketing—can new technologies improve stone-free rates? Nat Rev Urol 13(12):726–733

    Article  CAS  PubMed  Google Scholar 

  20. Keller EX, De Coninck V, Doizi S, Daudon M, Traxer O (2020) What is the exact definition of stone dust? An in vitro evaluation. World J Urol. 39:187

    Article  PubMed  Google Scholar 

  21. Ventimiglia E, Pauchard F, Gorgen ARH, Panthier F, Doizi S, Traxer O (2020) How do we assess the efficacy of Ho:YAG low-power laser lithotripsy for the treatment of upper tract urinary stones? Introducing the Joules/mm3 and laser activity concepts. World J Urol. 39:891

    Article  PubMed  Google Scholar 

  22. Petzold R, Suarez-Ibarrola R, Miernik A (2021) Gas bubble anatomy during laser lithotripsy: an experimental in vitro study of a pulsed solid-state tm:yag and ho:yag device. J Endourol juill 35(7):1051–1057

    Article  Google Scholar 

  23. Panthier F, Doizi S, Gorny C, Berthe L, Traxer O (2020) Impact of laser fiber diameter and irrigation fluids on induced bubble stream dynamics with superpulsed thulium fiber laser : an in vitro study. J Endourol. 35:1883

    Article  PubMed  Google Scholar 

  24. Hardy LA, Kennedy JD, Wilson CR, Irby PB, Fried NM (2017) Analysis of thulium fiber laser induced bubble dynamics for ablation of kidney stones. J Biophotonics 10(10):1240–1249

    Article  CAS  PubMed  Google Scholar 

  25. Ulvik Ø, Æsøy MS, Juliebø-Jones P, Gjengstø P, Beisland C. Thulium Fibre Laser versus Holmium:YAG for Ureteroscopic Lithotripsy: Outcomes from a Prospective Randomised Clinical Trial. Eur Urol [Internet]. 14 mars 2022 [cité 16 mars 2022];0(0). Disponible sur: https://www.europeanurology.com/article/S0302-2838(22)01669-4/fulltext

  26. 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. 39:1683

    Article  PubMed  Google Scholar 

  27. Sierra A, Corrales M, Kolvatzis M, Traxer O (2022) Initial clinical experience with the thulium fiber laser from Quanta System: First 50 reported cases. World J Urol 40(10):2549–2553

    Article  PubMed  Google Scholar 

  28. Corrales M, Traxer O (2021) Initial clinical experience with the new thulium fiber laser: first 50 cases. World J Urol. 39:3945

    Article  CAS  PubMed  Google Scholar 

  29. Professionals SO. EAU Guidelines: Urolithiasis [Internet]. Uroweb. [cité 21 sept 2020]. Disponible sur: https://uroweb.org/guideline/urolithiasis/

  30. Louters MM, Dau JJ, Hall TL, Ghani KR, Roberts WW (2022) Laser operator duty cycle effect on temperature and thermal dose: in-vitro study. World J Urol 40(6):1575–1580

    Article  CAS  PubMed  Google Scholar 

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Funding

No funding to declare for this study.

Author information

Authors and Affiliations

  1. GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France

    Frédéric Panthier, Catalina Solano, Marie Chicaud, Stessy Kutchukian, Luigi Candela, Steeve Doizi, Mariela Corrales & Olivier Traxer

  2. Service d’Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France

    Frédéric Panthier, Catalina Solano, Marie Chicaud, Stessy Kutchukian, Luigi Candela, Steeve Doizi, Mariela Corrales & Olivier Traxer

  3. PIMM, UMR 8006 CNRS-Arts et Métiers ParisTech, 151 bd de l’Hôpital, 75013, Paris, France

    Frédéric Panthier, Marie Chicaud, Stessy Kutchukian & Steeve Doizi

  4. Department of Endourology, Uroclin SAS, Medellin, Colombia

    Catalina Solano

  5. Service d’Urologie, CHU Limoges, 87000, Limoges, France

    Marie Chicaud

  6. Department of Urology, Poitiers University Hospital, 2 Rue de la Milétrie, 86000, Poitiers, France

    Stessy Kutchukian

  7. Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy

    Luigi Candela

Authors
  1. Frédéric Panthier
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  2. Catalina Solano
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  3. Marie Chicaud
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  4. Stessy Kutchukian
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  5. Luigi Candela
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  6. Steeve Doizi
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  7. Mariela Corrales
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  8. Olivier Traxer
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Contributions

FP: protocol development, data collection and management, data analysis, manuscript writing and editing. CS: data collection and management. SD: protocol development, manuscript writing and editing. SK: data collection and management. MC: manuscript writing and editing. LC: manuscript writing and editing. MC: manuscript writing and editing. OT: protocol development, data analysis, manuscript writing and editing.

Corresponding author

Correspondence to Frédéric Panthier.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest but: Olivier Traxer has declared as consultant for Karl Storz, Coloplast, IPG photonics, Ambu, Quanta System and Rocamed. Steeve Doizi has declared as consultant for Boston Scientific Corporation and Coloplast.

Research involving human participants or animals

Approval was obtained from the ethics committee of the French Association of Urology. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

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Verbal and written informed consent were obtained prior to the surgery.

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The authors affirm that human research participants provided informed consent for publication of the supplementary videoclip.

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Panthier, F., Solano, C., Chicaud, M. et al. Initial clinical experience with the pulsed solid-state thulium YAG laser from Dornier during RIRS: first 25 cases. World J Urol 41, 2119–2125 (2023). https://doi.org/10.1007/s00345-023-04501-0

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