Managing Urolithiasis with Thulium Fiber Laser: Updated Real-Life Results-A Systematic Review.

Olivier Traxer,Mariela Corrales

doi:10.3390/jcm10153390

Abstract

Thirty-three years ago, pulsed lasers marked the beginning of a new era in endoscopic lithotripsy, and the one that was highlighted because of its potential was the Holmium: YAG laser, which became and still is the gold standard in endourology. Recently, a new laser technology has been accepted for clinical use in lithotripsy: the thulium fiber laser (TFL), showing appealing characteristics not seen before in several preclinical studies. A review of the literature was performed and all relevant in vitro studies and clinical trials until April 2021 were selected. The search came back with 27 clinical experiences (7 full-text clinical trials and 20 peer-reviewed abstracts) and 33 laboratory studies (18 full-text articles and 15 peer-reviewed abstracts). The clinical experiences confirmed the clinical safety of using the wide parameter range of the TFL. This technology demonstrated the performance at a higher ablation speed, the higher ablation efficiency, and the better dust quality of the TFL, as well as reduced stone retropulsion, thus helping to maintain an optimal visibility. No thermal or radiation damage was found. Given the current evidence, we may be facing the future gold standard laser in endoscopic lithotripsy.

Highlights

There is no doubt that the way urolithiasis is managed nowadays has changed substantially
A new laser technology for endoscopic lithotripsies has emerged for clinical use: the thulium fiber laser (TFL) [6]
Different searches were conducted with the following Medical Subject Heading (MeSH) terms and keywords: “thulium”, “laser”, “fiber”, “lithiasis”, “kidney”, “ureter”, “lithotripsy”, “endourology”, “stones”, and “lithotripter”

Summary

Introduction

There is no doubt that the way urolithiasis is managed nowadays has changed substantially. Pulsed lasers are the only lasers suitable for a safe endoscopic lithotripsy [1,2], and of these, the one that showed early clinical potential was the Holmium: yttrium aluminum garnet (Ho: YAG) laser [3], which is the current gold standard laser in endourology [4,5]. The first clinical trial was developed in Russia in 2018, making it the only country with clinical approval given by the Ministry of Health of the Russian Federation [9]. It was only in June 2020 that this technology was approved worldwide with incredible results [6]. Could it be possible that the Ho: YAG era is approaching its final days?

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Conclusion