Thulium laser-based hemostasis during percutaneous nephrolithotomy: a prospective observational multicentric study

Area of Science:

• Urology
• Minimally Invasive Surgery
• Nephrolithiasis Management

Background:

• Percutaneous nephrolithotomy (PNL) is a critical procedure for large kidney stones but carries a risk of significant intraoperative bleeding.
• Effective hemostasis during PNL is essential to minimize complications and ensure patient safety.

Purpose of the Study:

• To evaluate the safety and efficacy of using pulsed mode thulium laser for hemostasis during percutaneous nephrolithotomy (PNL).
• To assess the impact of thulium laser hemostasis on PNL outcomes and complications.

Main Methods:

• A prospective observational study included 733 adult patients undergoing PNL for kidney stones (≥20 mm).
• Patients requiring hemostasis for bleeding spurters were managed with thulium laser, forming Group A; others formed Group B.
• Outcomes, complications, and glomerular filtration rate were compared between groups.

Main Results:

• Eighty-eight patients (12%) required thulium laser hemostasis for various bleeding sources.
• No statistically significant differences in outcomes or complications were observed between patients who received thulium laser hemostasis and those who did not.
• Postoperative kidney function, assessed by glomerular filtration rate, remained comparable between the groups.

Conclusions:

• Thulium laser-based hemostasis is a safe and effective method for managing intraoperative bleeding during percutaneous nephrolithotomy.
• The use of thulium laser for hemostasis during PNL does not adversely affect patient outcomes or renal function.