Русский
Retrograde intrarenal surgery using a 1.94 μm superpulsed thulium fiber laser
DOI: https://dx.doi.org/10.18565/urology.2021.1.28-32
R.E. Klimov, V.Yu. Lekarev, D.G. Tsarichenko, A.M. Dymov, G.N. Akopyan, D.V. Chinenov, D.O. Korolev, S.H. Ali, A.N. Gerasimov, L.M. Rapoport, P.V. Glybochko
1) FGAOU VO I.M. Sechenov First Moscow State Medical University, Moscow, Russia; 2) Department of Medical Informatics and Statistics of FGAOU VO I.M. Sechenov First Moscow State Medical University, Moscow, Russia
Introduction: surgical treatment of urinary stone disease plays an important role in urological practice. Stone fragmentation can be performed using various lithotripters, from which Holmium fiber laser (Ho: YAG) has currently taken the main place. According to the current literature, a superpulsed thulium fiber laser with a wavelength of 1.94 μm and a maximum power output of 40 W showed in vitro higher efficiency compared to Ho: YAG, while having the same safety profile. The use of a thulium fiber laser with a pulse energy of 0.025-6 J and a high repetition rate (up to 1600 Hz) allows to most effectively perform stone dusting during retrograde intrarenal surgery (RIRS).
Aim: to improve the performance of RIRS using the 1.94μm superpulsed thulium fiber laser.
Materials and methods: a total of 152 patients with renal stones who were treated during the period from February 2018 to July 2019 were included in the study. The analysis of the laser settings, their effect on retropulsion and visibility when performing RIRS using a superpulsed thulium fiber laser with a wavelength of 1.94 μm and a maximum power output of 40 W, a peak power of 500 W, as well as an assessment of the stone-free rate the first postoperative day and 3 months after the procedure was done.
Results. The most frequently used settings were as following: 0.5 J, 30 Hz, 15 W (No. 1), 0.15 J, 200 Hz, 30 W (No. 2), 0.8 J, 31.25 Hz, 25 W (No. 3), 0.8 J, 37.5 Hz, 30 W (No. 4). The statistical analysis of the influence of the settings on the quality of endoscopic imaging and retropulsion was carried out. In addition, the features of each settings were analyzed. The stone-free rate on the first postoperative day was evaluated using low-dose CT.
Conclusion. A superpulsed thulium fiber laser with a wavelength of 1.94 μm and a maximum power of 500 W has shown high efficiency in clinical practice when performing RIRS, since it allows to have good endoscopic imaging, minimal retropulsion, and to perform stone dusting, which had a positive effect on the stone-free rate. Optimization of the settings of thulium fiber lithotripsy may improve the results of surgical treatment of urinary stone disease.
Aim: to improve the performance of RIRS using the 1.94μm superpulsed thulium fiber laser.
Materials and methods: a total of 152 patients with renal stones who were treated during the period from February 2018 to July 2019 were included in the study. The analysis of the laser settings, their effect on retropulsion and visibility when performing RIRS using a superpulsed thulium fiber laser with a wavelength of 1.94 μm and a maximum power output of 40 W, a peak power of 500 W, as well as an assessment of the stone-free rate the first postoperative day and 3 months after the procedure was done.
Results. The most frequently used settings were as following: 0.5 J, 30 Hz, 15 W (No. 1), 0.15 J, 200 Hz, 30 W (No. 2), 0.8 J, 31.25 Hz, 25 W (No. 3), 0.8 J, 37.5 Hz, 30 W (No. 4). The statistical analysis of the influence of the settings on the quality of endoscopic imaging and retropulsion was carried out. In addition, the features of each settings were analyzed. The stone-free rate on the first postoperative day was evaluated using low-dose CT.
Conclusion. A superpulsed thulium fiber laser with a wavelength of 1.94 μm and a maximum power of 500 W has shown high efficiency in clinical practice when performing RIRS, since it allows to have good endoscopic imaging, minimal retropulsion, and to perform stone dusting, which had a positive effect on the stone-free rate. Optimization of the settings of thulium fiber lithotripsy may improve the results of surgical treatment of urinary stone disease.
Keywords: wavelength 1.94 μm, superpulse thulium fiber laser, retropulsion, thulium lithotripsy, lithotripsy, laser, urolithiasis
About the Autors
Corresponding author: R.E. Klimov – Ph.D. student at the Institute of Urology and Reproductive Health, FGAOU VO I.M. Sechenov First Moscow State Medical University, Moscow, Russia; e-mail: dr.romanklimov@gmail.com
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