A clinical experience of thulium fibre laser in miniperc to dust with suction: a new horizon
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ORIGINAL ARTICLE
A clinical experience of thulium fibre laser in miniperc to dust with suction: a new horizon Darshit Shah1 · Abhijit Patil1 · Naveen Reddy1 · Abhishek Singh1 · Arvind Ganpule1 · Ravindra Sabnis1 · Mahesh Desai1 Received: 5 May 2020 / Accepted: 10 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
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 2 cm non-lower calyceal and 10–20 mm lower calyceal renal stones [1]. Innovations in optics, energy delivery and accessories has led to miniaturization of PCNL (miniPCNL) [2]. MiniPCNL is associated with significantly lower blood loss, but with significantly longer operative time.[1] This problem was circumvented by transition from low to high power laser. The high power laser leads to dusting of stone [3] which can be suctioned out simultaneously during lasing by addition of suction to the nephrostomy sheath. The integration of active suction to the sheath during stone fragmentation is referred in literature as super-miniPCNL [4]. Holmium: YAG (Ho:YAG) is currently the standard of care for laser lithotripsy [1] Ho:YAG has transitioned from low to high power and now with many advancements including “Moses technology”, “Stabilization Mode”, “Vapor Tunnel”, “Virtual Basket Technology” or “Burst technology” [5,
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6]. TFL, although recently available, has been evaluated in many in-vitro studies. TFL has an electronically controlled multiple laser diodes. They pump photons through a very thin and long silica fibre (10–20 µm core diameter, 10–30 m long) which are chemically doped with Thulium ions. They emit laser beam of 1940 nm wavelength and can be either continuous or pulsed mode. It has wide range of pulse energy, frequency and pulse modulation [7].In-vitro studies have shown that TFL has more stone ablation rates [8, 9], produces symmetrical square waveform leading to less retropulsion [10, 11], more quality and quantity of dust [12]. TFL is light weight, durable and more energy efficient due to better laser beam dynamics and need for only air-cooling system as against water cooling required for Ho:YAG [7]. We combined two technologies—TFL with super-miniPCNL in this prospective study to assess safety and efficacy of TFL in clinical setting. There are many in-vitro studies on TFL. But data is lacking on TFL and its impact on various laser energy settings for distribution of fragment size in clinical setting. The ability to aspirate and retrieve all stone fragments using suction sheath, allowed us to define optimal laser settings for maximum dusting. We herein report the initial clinical series using the suction sheath combined with high power TFL and report stone-free
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