A clinical experience of thulium fibre laser in miniperc to dust with suction: a new horizon

• DOI: 10.1007/s00345-020-03458-8
• Publication Date: 2020-09-22T15:04:20Z
• Authors: Darshit Shah; Abhijit Patil; Naveen Reddy; Abhishek Singh; Arvind Ganpule; Ravindra Sabnis; Mahesh Desai
• Keywords: Adult; Male; Nephrolithotomy, Percutaneous; Middle Aged; Suction; Combined Modality Therapy; Kidney Calculi; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Thulium; Humans; Female; Laser Therapy; Prospective Studies

To report safety and efficacy of mini-PCNL with suction attached to sheath combined with high-power Thulium Fibre laser (TFL). The secondary aim was to evaluate optimal laser settings for maximum stone dusting.Prospective, single arm study was conducted from June 2019-December 2019 using miniPCNL with suction and TFL in 54 patients with renal stones < 3 cm. Stone fragments for each laser setting were independently retrieved and segregated according to size(< 1 mm,1-3 mm, > 3 mm) and weighed. Xray/CT scan imaging was performed in all patients within 48 h and 30 days to assess stone clearance. Optimal laser settings were evaluated for maximum dusting.Mean stone size was 18.32 ± 6.37 mm, volume was 2337.75 ± 1996.84mm3 and stone density was 1300.55 ± 435.32 HU. Total operative time was 39.85 ± 20.52 min, laser time was 10.08 ± 7.41 min and stone fragmentation rate was 5.02 ± 3.93 mm3/s. The procedure was completely tubeless in 37.04%, nephrostomy tube in 37.04% and DJ stent placed in 25.92%. Postoperatively, three patients had urinary infection (Clavien 2). Complete stone clearance at 48 h was achieved in 35 (64.8%) cases. 19 patients (35.2%) who had residual fragments at 48 h, had 100% clearance at one month on CT/Xray KUB.MiniPCNL using a nephrostomy sheath with suction along with high power Thulium Fibre Laser is safe and effective modality for lithotripsy. An initial laser setting of 0.2 J and 125-200 Hz was optimal for maximum dusting and simultaneous aspiration. Randomized comparative studies with other energy sources are being considered.