Pulsed solid-state thulium: YAG laser compared to holmium: YAG laser during mini-PCNL

Area of Science:

• Urology
• Laser Lithotripsy
• Minimally Invasive Surgery

Background:

• Holmium: YAG (Ho: YAG) lasers are standard for urinary stone fragmentation.
• Limitations of Ho: YAG have driven research into alternatives like thulium lasers.
• This study compares a novel pulsed solid-state Thulium: YAG (Tm: YAG) laser with Ho: YAG in Mini-PCNL.

Purpose of the Study:

• To compare the efficacy and safety of a novel Tm: YAG laser versus the standard Ho: YAG laser for renal calculi fragmentation during Mini-PCNL.
• To evaluate differences in operative time, laser-on-time, stone-free rates, and complications.

Main Methods:

• A prospective comparative study involving 100 patients undergoing Mini-PCNL.
• Fifty patients treated with Tm: YAG (prospectively) were compared to fifty patients treated with Ho: YAG (retrospectively).
• Data collected included patient demographics, stone characteristics, operative details, and complications, followed by statistical analysis.

Main Results:

• Both groups showed comparable demographics and stone characteristics.
• The Tm: YAG group had significantly shorter laser-on-time (7.20 min) and operative time (32.6 min) than the Ho: YAG group (10.46 min and 41.2 min, respectively; p < 0.05).
• Stone-free rates at 24 h (92% for Tm: YAG vs. 90% for Ho: YAG) and intraoperative complication rates were similar between the groups (p > 0.999).

Conclusions:

• The novel pulsed solid-state Tm: YAG laser demonstrates superior efficiency in laser-on-time and operative time compared to Ho: YAG laser during Mini-PCNL.
• Tm: YAG laser offers comparable stone-free rates and complication profiles to Ho: YAG laser.
• Further trials are recommended to compare Tm: YAG and Ho: YAG lasers in diverse settings and evaluate Tm: YAG against thulium fiber lasers (TFL).