Thulium fiber laser vs Ho:YAG in RIRS: a prospective randomized clinical trial assessing the efficacy of lasers and different fiber diameters (150 µm and 200 µm)

Mark Taratkin, Camilla Azilgareeva, Vladislav Petov, Andrey Morozov, Stanislav Ali, Diana Babaevskaya, Vincent De Coninck, Dmitry Korolev, Gagik Akopyan, Cesare Marco Scoffone, Denis Chinenov, Alexander Androsov, Harun Fajkovic, David Lifshitz, Olivier Traxer, Dmitry Enikeev*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: The aims of the study: (1) to compare the Super Pulse Thulium Fiber Laser (SP TFL) and the holmium: yttrium–aluminium-garnet (Ho:YAG) lasers in retrograde intrarenal surgery (RIRS); (2) to compare the efficacy of SP TFL laser fibers of different diameters (150 μm and 200 μm). Methods: A prospective randomized single-blinded trial was conducted. Patients with stones from 10 to 20 mm were randomly assigned RIRS in three groups: (1) SP TFL (NTO IRE-Polus, Russia) with fiber diameter of 150 μm; (2) SP TFL with 200-μm fiber; and (3) Ho:YAG (Lumenis, USA) with 200-μm fiber. Results: Ninety-six patients with kidney stones were randomized to undergo RIRS with SP TFL using a 150-μm fiber (34 patients) and a 200-μm fiber (32 patients) and RIRS with Ho:YAG (30 patients). The median laser on time (LOT) in the 200-μm SP TFL group was 9.2 (6.2–14.6) min, in 150-μm SP TFL—11.4 (7.7–14.9) min (p = 0.390), in Ho:YAG—14.1 (10.8–18.1) min (p = 0.021). The total energy consumed in 200-μm SP TFL was 8.4 (5.8–15.2) kJ; 150-μm SP TFL − 10.8 (7.3–13.5) kJ (p = 0.626) and in Ho:YAG—15.2 (11.1–25.3) kJ (p = 0.005). Conclusions: Irrespective of the density, RIRS with SP TFL laser has proven to be both a safe and effective procedure. Whilst the introduction of smaller fibers may have the potential to reduce the duration of surgery, SP TFL results in a reduction in the LOT and total energy for stone ablation in RIRS compared with Ho:YAG.

Original languageEnglish
Pages (from-to)3705-3711
Number of pages7
JournalWorld Journal of Urology
Volume41
Issue number12
DOIs
StatePublished - Dec 2023

Keywords

  • Ho:YAG
  • RIRS
  • Thulium fiber laser

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