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Thulium-Doped Fiber Laser and Its Application in Urinary Lithotripsy

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Abstract

Purpose

Thulium-doped fiber laser (TFL)-based urological lithotripsy has emerged as a promising technology for treating urological stones in new era of endourological options. The objective of this review is to provide a comprehensive summary of the characteristics of TFL application for lithotripsy and to analyze the research progress of two crucial TFL light sources, quasi-continuous (QCW) TFL and main oscillation power amplification (MOPA) TFL.

Methods

The data about the potential efficiency of TFL in clinical applications and the status of pulsed TFL studies were gathered through a manual search of TFL-related literature in the SCI, SSCI, A&HCI, IE, PubMed databases to assess the performance issues associated with application of thulium laser for urinary tract stone surgery.

Results

TFLs can ablate stones mainly through photothermal and micro-explosive effects. In clinical trials, thulium laser has been established to be superior to holmium laser in terms of lithotripsy efficiency, tissue damage, lithotripsy retreating effect, thermal effect, intraoperative visualization, and postoperative lithotripsy-free rate, which is more widely used currently. Among the various pulsed TFLs, QCW TFL provides flexible beam waveform, high electro-optical conversion efficiency, high heat dissipation performance, and low material maintenance requirements. MOPA TFL can flexibly affect the morphology of the output pulse within a wide range while significantly increasing the output power.

Conclusion

TFL represents a safer, more effective and comprehensive tool for the treatment of urinary stone. Although QCW TFL is currently the mainstream laser source for lithotripsy, we anticipate that MOPA technology has the potential to offer number of advantages while it has not yet received sufficient attention. Further studies are still needed to optimize the performance of pulsed TFLs to facilitate the development of thulium laser lithotripsy.

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Fig. 1

Reproduced from Kronenberg [21]

Fig. 2

Reproduced from Ulvik [27]

Fig. 3
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Data Availability

The authors declare that all data supporting the findings of this study are available within the paper. Additional review data can be shared upon request in Covidence.

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Acknowledgements

The authors would like to thank all the reviewers who participated in the review, as well as MJEditor (www.mjeditor.com) for providing English editing services during the preparation of this manuscript.

Funding

This work was supported by the National Natural Science Foundation of China (62075200), the Fundamental Research Funds for the Central Universities (2042023kf0113, 2042022gf0004), Key Research and Development Program of Hubei province (2023BCB001), the Translational Medicine and Multidisciplinary Research Project of Zhongnan Hospital of Wuhan University (ZNJC202217, ZNJC202232), the Science Fund for Distinguished Young Scholars of Hubei Province (2021CFA042).

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Authors and Affiliations

  1. The Institute of Technological Sciences, Wuhan University, #299, Bayi Road, Wuhan, 430072, Hubei, China

    Runyan Gu, Cheng Lei & Du Wang

  2. Department of Urology, Zhongnan Hospital of Wuhan University, #169, East Lake Road, Wuhan, 430072, Hubei, China

    Zhilong Li, Sheng Li & Xinghuan Wang

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  1. Runyan Gu
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All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by RG, ZL, and DW. The first draft of the manuscript was written by RG and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Du Wang or Xinghuan Wang.

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Gu, R., Li, Z., Lei, C. et al. Thulium-Doped Fiber Laser and Its Application in Urinary Lithotripsy. J. Med. Biol. Eng. 43, 351–361 (2023). https://doi.org/10.1007/s40846-023-00813-z

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