(UroToday.com) The 2022 WCET Annual meeting included stone equipment and medical management session, where Dr. Sierra and colleagues evaluated the Thulium fiber laser (TFL) from Quanta System (Fiber Dust™). They reviewed the system with regard to efficiency, safety, and laser settings during retrograde intrarenal surgery (RIRS). In seeking to investigate the use of the new TFL in stone management, Dr. Sierra et al. aimed to analyze the safety and efficacy of the TFL system.
The study prospectively analyzed 50 patients that underwent RIRS (Table 1), consisting of 10 ureteral and 40 renal stones, using the novel TFL, Fiber Dust, Quanta System. Both 200 µm and 150 µm laser fibers were utilized. The ablation speed (mm3/s), Joules/mm3, and laser power (w) of each endocorporeal laser lithotripsy (ELL) was assessed, each using the shortest pulse. Additionally, stone size, stone density, laser settings, and laser-on time (LOT) were recorded.
Between all 50 patients, the median (IQR) age of the study population was 54.5. 60% of the renal stone patients were male, while 40% were female. 50% of ureteral stone patients were male, and the other 50% were female. The median (IQR) stone volume was 347 mm3 for ureteral stones and 1125 mm3 for renal stones. Median (IQR) density of renal stones 950 (725-1125) HU, and 900 (400-1500) HU for ureteral stones. The median pulse energy of renal stones was 0.6 (0.5-0.9) J, and 0.6 (0.5-1) for ureteral stones. For renal stones, the median (IQR) frequency was 15 (10-20) Hz, and 10 (10-20) Hz. Overall, there were no statistically significant differences between both groups in LOT, laser power, frequency, and pulse energy. Median (IQR) I/mm3 for renal stones was 14.3 (7.8-24.7) and 8.7 (4.8-65.2) for ureteral stones. For renal stones the median (IQR) ablation rate was 0.7 (0.4-1.2) mm3/s, and 0.3 (0.2-1.3) mm3/s for ureteral stones. Neither of these results surpassed the threshold of significance. In total, complication rates remained low in both groups, unrelated to TFL. Further outcomes and peri-operatory complications were as follows:
Through this prospective study, Dr. Sierra concluded her presentation on the initial clinical experience with the thulium fiber laser from Quanta system with the following statements:
- TFL laser is safe and effective modality for lithotripsy of renal and ureteral stones during RIRS with minimal complication rates, according to stone type and localization.
- These results show the efficacy of low pulse energy and low pulse frequency
Presented by: Alba Sierra, MD, Tenon Hospital, Paris, France
Written by: Mariah Hernandez, Junior Research Specialist, Department of Urology, University of California, Irvine, @mariahch00 on Twitter during the 39th World Congress of Endo urology and Uro-Technology (WCET), Oct 1 - 4, 2022, San Diego, California.