Several preclinical studies about a novel pulsed-thulium:yttrium-aluminum-garnet (p-Tm:YAG) device have been published, demonstrating its possible clinical relevance.
We systematically reviewed the reality and expectations for this new p-Tm:YAG technology. A PubMed, Scopus and Embase search were performed. All relevant studies and data identified in the bibliographic search were selected, categorized, and summarized.
Tm:YAG is a solid state diode-pumped laser that emits at a wavelength of 2013 nm, in the infrared spectrum. Despite being close to the Ho:YAG emission wavelength (2120 nm), Tm:YAG is much closer to the water absorption peak and has higher absorption coefficient in liquid water. At present, there very few evaluations of the commercially available p-Tm:YAG devices. There is a lack of information on how the technical aspects, functionality and pulse mechanism can be maximized for clinical utility. Available preclinical studies suggest that p-Tm:YAG laser may potentially increase the ablated stone weight as compared to Ho:YAG under specific condition and similar laser parameters, showing lower retropulsion as well. Regarding laser safety, a preclinical study observed similar absolute temperature and cumulative equivalent minutes at 43° C as compared to Ho:YAG. Finally, laser-associated soft-tissue damage was assessed at histological level, showing similar extent of alterations due to coagulation and necrosis when compared with the other clinically relevant lasers.
The p-Tm:YAG appears to be a potential alternative to the Ho:YAG and TFL according to these preliminary laboratory data. Due to its novelty, further studies are needed to broaden our understanding of its functioning and clinical applicability.
World journal of urology. 2023 Sep 08 [Epub ahead of print]
Eugenio Ventimiglia, Daniele Robesti, Luigi Bevilacqua, Elena Tondelli, Isabella Oliva, Luca Orecchia, Patrick Juliebø-Jones, Amelia Pietropaolo, Vincent De Coninck, Francesco Esperto, Thomas Tailly, Stefania Ferretti, Vineet Gauhar, Bhaskar Somani, Luca Villa, Etienne Xavier Keller, Andrea Salonia, Olivier Traxer, Ioannis Kartalas Goumas
Division of Experimental Oncology/Unit of Urology, URI-Urological Research Institute, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Via Olgettina 60, 20132, Milan, Italy. ., Division of Experimental Oncology/Unit of Urology, URI-Urological Research Institute, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Via Olgettina 60, 20132, Milan, Italy., Department of Urology, Istituto Clinico Beato Matteo, Vigevano, Italy., Young Academic Urologists (YAU), Urolithiasis and Endourology Working Party, Arnhem, The Netherlands., Department of Urology, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium., Urology Department, Hospital and University of Modena, Modena, Italy., Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore., Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, UK., Sorbonne Universite, 27063, GRC#20 Lithiase Urinaire, Hôpital Tenon, Paris, Île-de-France, France., Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France.