Presented by: Julio Chong MD
Colorado Urology

Introduction

High-powered lasers have been marketed by many major device companies that support endourological procedures. The newest high-powered lasers include improvements on the 120-watt holmium laser (HPH-M, MOSES 2.0, Lumenis) and the thulium fiber laser (TFL, Soltive, Olympus). With its reduced sheath size, miniature percutaneous nephrolithotomy (mPCNL) can be an optimal delivery modality of these lasers in stone treatment that still require the power of percutaneous stone extraction. Previous randomized studies have only compared TFL to lower wattage holmium lasers and little data exists comparing TFL vs HPH-M in a mPCNL setting.

Materials

A retrospective analysis of mPCNL procedures done by one surgeon from August 2021 to May 2023 was performed. mPCNL with TFL (n=23) and mPCNL with HPH-M (n=15) were identified. All fibers used were 200 micron (um). Treatment specific parameters such as laser energy, treatment/laser times and laser efficiency were compared using a two-tailed paired t-test.

Results

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There were no differences in patient and stone demographics such as age (52.3 vs 53.7, p=0.891), sex, procedure side, stone size (14.3 vs 17.93 mm, p=0.093), or stone locations between TFL and HPH-M groups. Stone location and stone predominant type were similar in both groups. Treatment time (all manipulation required to clear stones, 13.87 vs 20.47 min, p=0.165), operative time (71.48 vs 78.47 min, p=0.345), laser time (293 vs 328 sec, p=0.725), laser total energy (4.53 vs 4.65 kJ, p=0.95) and treatment efficiency (laser time/treatment time, 0.39 vs 0.3, p=0.305) tended to favor the TFL group but were not statistically significant. Stone-free rates on a renal ultrasound six weeks post-operatively were also similar between groups (82.6 vs 86.7%, p=0.112). One patient in the TFL arm required post-operative oxygen needing admission and one patient in the HPH-M arm had stent migration that necessitated stent exchange. No complications related to laser usage were noted in either arms.

Conclusion

200 um TFL and HPH-M fibers perform similarly in a mPCNL setting. Both laser types result in good stone-free rates, even in complex mPCNL cases. There were no laser related complications noted in this study. A surgeon performing mPCNL should expect to achieve excellent stone clearance in a safe manner with either high powered lasers.

Funding

None