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A clinical experience of thulium fibre laser in miniperc to dust with suction: a new horizon

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Abstract

Purpose

To report safety and efficacy of mini-PCNL with suction attached to sheath combined with high-power Thulium Fibre laser (TFL). The secondary aim was to evaluate optimal laser settings for maximum stone dusting.

Materials and methods

Prospective, single arm study was conducted from June 2019–December 2019 using miniPCNL with suction and TFL in 54 patients with renal stones < 3 cm. Stone fragments for each laser setting were independently retrieved and segregated according to size(< 1 mm,1-3 mm, > 3 mm) and weighed. Xray/CT scan imaging was performed in all patients within 48 h and 30 days to assess stone clearance. Optimal laser settings were evaluated for maximum dusting.

Results

Mean stone size was 18.32 ± 6.37 mm, volume was 2337.75 ± 1996.84mm3 and stone density was 1300.55 ± 435.32 HU. Total operative time was 39.85 ± 20.52 min, laser time was 10.08 ± 7.41 min and stone fragmentation rate was 5.02 ± 3.93 mm3/s. The procedure was completely tubeless in 37.04%, nephrostomy tube in 37.04% and DJ stent placed in 25.92%. Postoperatively, three patients had urinary infection (Clavien 2). Complete stone clearance at 48 h was achieved in 35 (64.8%) cases. 19 patients (35.2%) who had residual fragments at 48 h, had 100% clearance at one month on CT/Xray KUB.

Conclusions

MiniPCNL using a nephrostomy sheath with suction along with high power Thulium Fibre Laser is safe and effective modality for lithotripsy. An initial laser setting of 0.2 J and 125–200 Hz was optimal for maximum dusting and simultaneous aspiration. Randomized comparative studies with other energy sources are being considered.

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Acknowledgements

Mr Nitiraj Shete for statistical analysis. Mr Suresh Patel for imaging, Mr Harshad Pandya and Mr Mahesh Patel for laser settings and maintenance, Mr Kalpesh Desai for technical support.

Funding

Nil.

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Authors and Affiliations

  1. Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India

    Darshit Shah, Abhijit Patil, Naveen Reddy, Abhishek Singh, Arvind Ganpule, Ravindra Sabnis & Mahesh Desai

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  1. Darshit Shah
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  2. Abhijit Patil
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  3. Naveen Reddy
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  4. Abhishek Singh
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  7. Mahesh Desai
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Contributions

DNS: protocol/project development, data collection or management, data analysis, manuscript writing/editing. APP: protocol/project development, data analysis, manuscript writing/editing. NMKR: protocol/project development, data collection or management, manuscript, writing/editing. AGS: data analysis, manuscript writing/editing. APG: data analysis, manuscript writing/editing. RBS: data analysis, manuscript writing/editing. MRD: protocol/project development, operating surgeon, data collection or management, data analysis, manuscript writing/editing.

Corresponding author

Correspondence to Mahesh Desai.

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The authors declare that they have no conflict of interest.

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This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Muljibhai Patel Society for Research in Nephro-Urology (MPSRNU).

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

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Shah, D., Patil, A., Reddy, N. et al. A clinical experience of thulium fibre laser in miniperc to dust with suction: a new horizon. World J Urol 39, 2727–2732 (2021). https://doi.org/10.1007/s00345-020-03458-8

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  • DOI: https://doi.org/10.1007/s00345-020-03458-8

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