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01-12-2024 | Laser | Original Article

How much energy do we need to ablate 1 cubic millimeter of stone during Thulium Fiber Laser lithotripsy? An in vitro study

Authors: Frédéric Panthier, Marie Chicaud, Steeve Doizi, Stessy Kutchukian, Pierre Lapouge, Catalina Solano, Luigi Candela, Michel Daudon, Laurent Berthe, Mariela Corrales, Olivier Traxer

Published in: World Journal of Urology | Issue 1/2024

Abstract

Introduction

Both Holmium:yttrium–aluminium–garnet (Ho:YAG) laser and Thulium Fiber Laser (TFL) can effectively treat all urinary stone types. This in vitro study evaluated the ablation volume per pulse (AVP) and required energy needed to ablate 1mm³ (RE, J/mm³) of various stone types at different laser settings with TFL.

Methods

272-µm core-diameter laser fibers (Boston Scientific^©) were connected to a 50 Watts TFL generator (IPG^®). An experimental setup immerged human stones of calcium oxalate monohydrate (COM), uric acid (UA), and cystine (CYS) with a single pulse lasing emission (0.5/0.8/1 J), in contact mode. Stones were dried out before three-dimensional scanning to measure AVP and deduce from the pulse energy (PE) and AVP the RE. A direct comparison with known Ho:YAG’s AVP and RE was then carried out.

Results

AVP for COM stones was significantly greater than those for CYS stones and similar to UA stones (p = 0.02 and p = 0.06, respectively). If AVP increased with PE against COM and UA stones, AVP decreased against CYS stones. 1 J PE resulted in a threefold lower RE compared with other PE for COM stones. On the contrary, RE for CYS increased with PE, whereas PE did not had influence on RE for UA. TFL was associated with greater AVP for COM, but lower for UA and CYS stones compared to Ho:YAG laser.

Conclusion

This in vitro study firstly describes the ablation volume per pulse and required energy to treat a cubic millimeter of three frequent human stone types, and suggest TFL could not be suited for cystine. Therefore, stone composition could be considered when choosing the laser source for lithotripsy.

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Title: How much energy do we need to ablate 1 cubic millimeter of stone during Thulium Fiber Laser lithotripsy? An in vitro study
Authors: Frédéric Panthier
Marie Chicaud
Steeve Doizi
Stessy Kutchukian
Pierre Lapouge
Catalina Solano
Luigi Candela
Michel Daudon
Laurent Berthe
Mariela Corrales
Olivier Traxer
Publication date: 01-12-2024
Publisher: Springer Berlin Heidelberg
Keyword: Laser
Published in: World Journal of Urology / Issue 1/2024
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-023-04761-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

How much energy do we need to ablate 1 cubic millimeter of stone during Thulium Fiber Laser lithotripsy? An in vitro study

Abstract

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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