PD45-06 DUSTING EFFICIENCY FOR THULIUM FIBER LASER: WHEN IT COMES TO FREQUENCY, LESS IS MORE

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You have accessJournal of UrologyCME1 Apr 2023PD45-06 DUSTING EFFICIENCY FOR THULIUM FIBER LASER: WHEN IT COMES TO FREQUENCY, LESS IS MORE Francois Soto Palou, Robert Medairos, Junqin Chen, Jodi Antonelli, Michael Lipkin, Glenn Preminger, and Pei Zhong Francois Soto PalouFrancois Soto Palou More articles by this author , Robert MedairosRobert Medairos More articles by this author , Junqin ChenJunqin Chen More articles by this author , Jodi AntonelliJodi Antonelli More articles by this author , Michael LipkinMichael Lipkin More articles by this author , Glenn PremingerGlenn Preminger More articles by this author , and Pei ZhongPei Zhong More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003358.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Data from Holmium laser studies has taught us that optimal dusting generally require low energy and high frequency settings. In assessing thulium fiber laser (TFL) technology urologists have often relied on “traditional” dusting settings obtained from Holmium laser trials and experiments. However, these two platforms are fundamentally different in their pulse profile and energy (Ep) delivery. Clinical TFL platforms have an energy range of 0.025J-6J and a frequency (F) range of 1Hz-2400Hz. With the seemingly endless combination of settings and lack of scientific evidence to support one over the other, we aim to provide guidance to the practicing urologists and assess the efficiency of the TFL platform in an automated in vitro “dusting model”. METHODS: All tests were conducted using an IPG Photonics TLR-50W TFL system and a 200μm fiber on “soft” (5:2) Begostone phantoms. We selected the most popular dusting settings (Figure 1) among endourologists familiar with TFL1 and tested each combination of Ep and F settings at four different standoff distances (SD) (0.2mm, 0.5mm 1mm, 2mm) and at clinically significant scanning speeds of 1mm/sec or 2mm/sec, under the same total laser energy delivered to the stone (i.e., 40 J). All pulses were adjusted to maximum peak power and the corresponding pulse duration. The laser fiber was scanned in a 15mm straight line with a 3D positioning system across a polished and submerged Begostone surface. Ablation volumes were quantified by optical coherence tomography (OCT). RESULTS: The maximum stone ablation was achieved at the combination of high energy and low frequency settings (p<0.005). Overall, the settings that produced the greatest ablation volume were 1J/10Hz (2.51mm3) and 1J/20Hz (2.55mm3). For the rectangular pulse profile typically used in TFL, as SD increased ablation volume decreased. CONCLUSIONS: The most efficient dusting settings for dusting using the current TFL occur at high energy, low frequency, and at a short SD of 0.2mm. Further studies are warranted to compare dusting efficiency produced by these settings using human kidney stones. Reference: 1. Sierra A, Corrales M, Piñero A, Traxer O. Thulium fiber laser pre-settings during ureterorenoscopy: Twitter's experts' recommendations. World J Urol. 2022;40(6):1529-1535. doi:10.1007/s00345-022-03966-9 Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1164 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Francois Soto Palou More articles by this author Robert Medairos More articles by this author Junqin Chen More articles by this author Jodi Antonelli More articles by this author Michael Lipkin More articles by this author Glenn Preminger More articles by this author Pei Zhong More articles by this author Expand All Advertisement PDF downloadLoading ...