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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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Funding

No funding to declare for this study.

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Authors and Affiliations

Authors

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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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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