Initial clinical experience with the thulium fiber laser from Quanta System: First 50 reported cases

Objective To evaluate the new thulium fiber laser (TFL) from Quanta System (Fiber Dust (TM)) in terms of efficiency, safety, and laser settings in laser lithotripsy during retrograde intrarenal surgery (RIRS). Methods A prospective study of the first 50 patients with ureteral and renal stones who underwent RIRS using the new Fiber Dust (TFL from Quanta System, Italy) was performed in a single center. 200 mu m and 150 mu m laser fibers were used. Stone size, stone density, laser-on time (LOT) and laser settings were recorded. We also assessed the ablation speed (mm(3)/s), Joules/mm(3) and laser power (W) values for each procedure. Results A total of 50 patients were analyzed. The median (IQR) age was 54.5 (43-65) years old. Median (IQR) stone volume was 347 (147-1800) mm(3) and 1125 (294-4000) mm(3) for ureteral and renal stones, respectively. Median (IQR) stone density was 900 (400-1500) HU for ureteral stones and 950 (725-1125) HU for renal stones. Median (IQR) pulse energy was 0.6 (0.5-1) J and 0.6 (0.5-0.9) J for ureteral and renal stones, respectively. Median (IQR) frequency for ureteral stones was 10 (10-20) Hz and for renal stones, 15 (10-20) Hz. All procedures used short pulse. There were no statistically significant differences in pulse energy, frequency, laser power or LOT in both groups. The median (IQR) J/mm(3) was 8.7 (4.8-65.2) for ureteral stones vs 14.3 (7.8-24.7) for renal stones. The median (IQR) ablation rate was 0.3 (0.2-1.3) mm(3)/s for ureteral stones vs 0.7 (0.4-1.2) mm(3)/s for renal stones. Neither of those results reached the significance threshold. Overall complication rate was low in both groups, and none was related to TFL. Conclusion According to our results, the new TFL laser is safe and effective for lithotripsy during RIRS, using low pulse energy and low pulse frequency.