V03-02 FIRST CLINICAL STUDY ON SUPERPULSE THULIUM FIBER LASER FOR LITHOTRIPSY

Abstract

You have accessJournal of UrologyUrolithiasis & Endourology1 Apr 2018V03-02 FIRST CLINICAL STUDY ON SUPERPULSE THULIUM FIBER LASER FOR LITHOTRIPSY Olivier Traxer, Leonid Rapoport, Dmitry Tsarichenko, Alim Dymov, Dmitry Enikeev, Nikolay Sorokin, Stanislav Ali, Gagik Akopyan, Dmitry Korolev, Alexandra Proskura, Vladimir Lekarev, and Roman Klimov Olivier TraxerOlivier Traxer More articles by this author , Leonid RapoportLeonid Rapoport More articles by this author , Dmitry TsarichenkoDmitry Tsarichenko More articles by this author , Alim DymovAlim Dymov More articles by this author , Dmitry EnikeevDmitry Enikeev More articles by this author , Nikolay SorokinNikolay Sorokin More articles by this author , Stanislav AliStanislav Ali More articles by this author , Gagik AkopyanGagik Akopyan More articles by this author , Dmitry KorolevDmitry Korolev More articles by this author , Alexandra ProskuraAlexandra Proskura More articles by this author , Vladimir LekarevVladimir Lekarev More articles by this author , and Roman KlimovRoman Klimov More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.827AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Ho:YAG laser wavelength of 2.1 μm is off the peak of water absorption and the efficiency of stone fragmentation can be improved by using a laser with wavelength matching peak water absorption at 1.94 μm, where water absorbs 4.5 times more efficiently than at 2.1 μm. Previous in vitro studies have shown that thulium (Tm) fiber laser operating at wavelength 1.94 μm can be effective for stone fragmentation. Recently, we have evaluated in vitro performance of Super-Pulse Tm fiber laser prototype and found its efficiency to be higher than the leading Ho:YAG laser for fragmentation (x1.7 times) and dusting (x2.3 to 4 times) for equal energy and rep rate settings. This is pilot clinical evaluation of the first commercially available Super-Pulse Tm fiber laser system for lithotripsy. METHODS The Super-Pulse Tm fiber laser device has been cleared for clinical use by the Ministry of Health of Russian Federation and the protocol has been approved by the institutional Ethical Review committee. We prospectively analyzed 40 patients who underwent Super-Pulse Tm fiber laser lithotripsy for renal (n=29), ureteral (n=9), and bladder stones (n=2) with various laser settings. Size of the stone, its density, operation time, “laser on” time were measured. Based on surgeon’s feedback, retropulsion and intraoperative visibility were assessed. Post–operative parameters were recorded. RESULTS For renal stones, the average size was 15.6 mm (5.5 – 27 mm), for ureteral stones – 9.6 mm (5 – 13 mm), for bladder stones – 28 mm (15 – 42 mm). The average stone density for renal stones was 1217 HU (524 – 2053 HU), for ureteral stones - 1262.2 HU (700 – 1782 HU), for bladder stones – 839.5 HU (779 – 900 HU). The average time to complete renal stone fragmentation (to dust or small fragments and their washing out) was 30.2 min (10 – 50 min), for ureteral stones – 19.2 min (10 – 28 min), for bladder stones – 23 min (21 – 25 min). The retropulsion during miniPCNL and URS in the vast majority of cases was insignificant especially when using dusting mode with energy level less than 0.5 J. Visibility was estimated as optimal by surgeons in most cases. Fragmentation mode with energy level 2 to 6 J and repetition rate 5-10 Hz was most suitable for bladder stone disintegration. CONCLUSIONS Our preliminary data indicate high efficiency and safety of the novel Super-Pulse Tm fiber laser lithotripter with wavelength 1.94 μm for urinary stone disintegration. Wide range of settings (0.05 to 6 J; 5 to 2000 Hz) available for this laser allows efficient destruction of stones of any composition and location in both dusting and fragmentations modes. Further studies will confirm those results. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e321-e322 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Olivier Traxer More articles by this author Leonid Rapoport More articles by this author Dmitry Tsarichenko More articles by this author Alim Dymov More articles by this author Dmitry Enikeev More articles by this author Nikolay Sorokin More articles by this author Stanislav Ali More articles by this author Gagik Akopyan More articles by this author Dmitry Korolev More articles by this author Alexandra Proskura More articles by this author Vladimir Lekarev More articles by this author Roman Klimov More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...