(UroToday.com) The 2022 WCET annual meeting included a “Clinical stones: PCNL and ureteroscopy” session with work presented by Dr. Eric Edison comparing the cost analysis of the thulium fiber laser (TFL) versus the holimium:YAG (HoYAG) laser. Newer literature suggests that the new TFL is of particular efficacy for laser lithotripsy in terms of dusting larger stones and also energy efficiency. As a new laser, the TFL is under scrutiny and has great promise for replacing the HoYAG as a standard of treatment.
Dr. Edison and colleagues conducted a retrospective analysis of ureterorenoscopies from May 2021 to December 2021 in order to highlight operating room metrics and differences between patients that had laser lithotripsy conducted via the TFL and the HoYAG lasers. Specific metrics that were studied included operating time and the use of consumables, such as baskets, during the procedure. Operating speed of the surgeon was calculated by dividing the volume of renal stone burden cleared by the total time of the operation, as mm3/min.
The operating speed, in mm3/min, is shown below in Fig. 1 for the two types of lasers used to ablate “large” stones and “small” stones. In the study, large stones were defined as those with volume > 200mm3, and small stones were defined as having a volume less than this.
The researchers also studied how many retrospective cases used a basket to retrieve additional stone burden during the laser lithotripsy. These results are displayed in Fig. 2 below, showing the breakdown with the two types of lasers used for large and small stones.
Dr. Edison concluded his presentation with the following statements:
- TFL was faster than Ho overall, and nearly twice as fast for larger stones. Baskets were used nearly half as frequently with TFL in larger stones. This translates to a gross saving of £1283 per case.
- Compared to Ho:YAG, TFL is cost effective for dusting of large stones.
Presented by: Eric Edison, MA, MBBS, MRCS, Honorary Clinical Fellow at University College Hospital, London
Written by: Allen Rojhani, BS - MD Candidate at the Drexel University College of Medicine and 2022-2023 LIFT Research Fellow at the University of California, Irvine Department of Urology during the 39th World Congress of Endo urology and Uro-Technology (WCET), Oct 1 - 4, 2022, San Diego, California.