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Enhanced thulium fiber laser lithotripsy using micro-pulse train modulation.

Richard L Blackmon¹, Pierce B Irby, Nathaniel M Fried

¹University of North Carolina at Charlotte, Department of Physics and Optical Science, 9201 University City Avenue, Charlotte, North Carolina 28223-0001, USA.

Journal of Biomedical Optics

|April 3, 2012

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The thulium fiber laser (TFL) shows promise for kidney stone treatment. Operating TFL in a micro-pulse train mode significantly increased stone ablation rates compared to standard modes, with minimal stone movement.

Area of Science:

Urology
Laser Physics
Biomedical Engineering

Background:

The holmium:YAG (Ho:YAG) laser is the standard for laser lithotripsy.
The thulium fiber laser (TFL) is an emerging alternative with potential advantages.
TFL's electronic modulation allows for variable pulse parameters, enabling optimization for stone ablation.

Purpose of the Study:

To investigate the influence of micro-pulse train (MPT) mode on TFL stone ablation rates.
To compare TFL MPT mode with conventional TFL operation for lithotripsy.
To assess stone retropulsion and fiber degradation under TFL MPT conditions.

Main Methods:

TFL operated at 1908 nm, 35-mJ pulse energy, 500-μs pulse duration in MPT mode (5 micro-pulses) at 10 Hz.
Conventional TFL operation at 10-50 Hz was used for comparison.

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Human uric acid (UA) and calcium oxalate monohydrate (COM) stones were ablated; mass removal, OCT, and microscopy analyzed craters. Stone retropulsion and fiber burnback were also measured.

Main Results:

TFL MPT mode achieved a twofold increase in ablation rates: 414 ± 94 μg/s (UA) and 122 ± 24 μg/s (COM).
Conventional TFL at 50 Hz yielded rates of 182 ± 69 μg/s (UA) and 60 ± 14 μg/s (COM).
Stone retropulsion was minimal (<2 mm) for both modes; fiber burnback was significant and higher for COM stones.

Conclusions:

TFL operation in MPT mode significantly enhances stone ablation efficiency.
Further optimization of TFL MPT parameters may yield clinical results comparable to Ho:YAG laser lithotripsy.
TFL MPT mode offers a promising advancement in laser lithotripsy technology.