Category: Stones: Ureteroscopy

VS1-1 - Thulium fiber laser for lithotripsy of large renal stones: initial experience

Fri, Sep 21
10:00 AM - 12:00 PM

Introduction & Objective :

The Thulium fiber laser may present as a valuable alternative to Holmium laser for lithotripsy. Its operating wavelength is near the water absorption peak, which results in a higher ablation efficiency at low pulse energy compared to Holmium lithotripsy. Pulsed energy can be delivered through silica fibers as small as 50 microns, which may allow for miniaturization of the endourological instruments. Also, pulse shape can easily be modulated, because the Thulium fiber laser is pumped by a diode laser, which in turn can be electronically modulated to adapt its temporal beam profile. In this video we present the applicability of Thulium fiber laser for lithotripsy of large renal stones.


Methods : Three cases operated with the SuperPulse Thulium fiber laser at the Martov's Clinic in Moscow, Russia were included in this video. Local ethical committee approval was warranted.


Results : For the first case, it took a total of 40 minutes of operative time for lithotripsy of five stones between 6 to 12 mm. For the second case, it took a total of 24 minutes of operative time for lithotripsy of a 15 mm renal stone. For the third case, it took 23 minutes for stone dusting and 14 minutes for pop-corning, resulting in a total operative time of 37 minutes for lithotripsy of a 30 millimeters renal stone.


Conclusions :

From this initial experience, we conclude that the SuperPulse Thulium fiber laser is applicable for lithotripsy of large renal stones in humans. At low pulse energy, it achieves effective stone dusting. Operative time for lithotripsy was less than one hour, including a case with a 30 mm stone and a case with multiple stones up 10 mm. Future studies are warranted to define optimal lithotripsy settings and further detail safety profile of the SuperPulse Thulium fiber laser.

Etienne X. Keller

Fellow of the ES
Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, AP-HP, Hôpital Tenon, F-75020 Paris, France
Paris, Ile-de-France, France

Vincent De Coninck

Urologist
AZ Klina
Brasschaat, Antwerpen, Belgium

Vincent De Coninck graduated as a medical doctor from the Free University of Brussels, Belgium (VUB) in 2011. He became a certified urologist in 2017 after a training at the University Hospital of Brussels (Prof. Dr. Dirk Michielsen) and OLV Aalst (Prof. Dr. Alex Mottrie), where he developed a special interest in the minimal invasive treatment of benign and malignant pathologies. In the same year, he became Fellow of the European Board of Urology.
In 2018, he completed a one-year fellowship program of the Endourological Society in Paris, France under the supervision of Prof. Dr. Olivier Traxer. During that fellowship, he also obtained a diploma in urolithiasis, organized by Dr. Michel Daudon at the Sorbonne University in Paris, France. Afterwards, he was trained in HoLEP by Dr. Karin Lehrich in Berlin, Germany.
Currently, he is completing a three-month fellowship under the supervision of Dr. Guido Giusti in Milan, Italy. In December 2018, he will start working as an endourologist in AZ Klina, Brasschaat, Belgium. He will focus on the medical and surgical treatment of kidney stones and benign prostatic obstruction (HoLEP) and he will continue publishing articles relating to the management of patients with renal stone disease.

Paul H.L. Chiron

MD, FEBU
Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, AP-HP, Hôpital Tenon, F-75020 Paris, France
Saint Mandé, Ile-de-France, France

Steeve S. Doizi

Urologist
Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, AP-HP, Hôpital Tenon, F-75020 Paris, France
Paris, Ile-de-France, France

Mirab Guseynov

Federal Medical-Biological Agency of Russian Federation State Institute of Continuous Medical Education, Division of Urology, Moscow, Russia
Moscow, Moskva, Russia

Dmitry V. Ergakov

Associate Professor
Federal Medical-Biological Agency of Russian Federation State Institute of Continuous Medical Education, Division of Urology, Pletnews Municipal Hospital, Moscow, Russia
Moscow, Moskva, Russia

Alexey G. Martov

Head of Urology department
Federal Medical-Biological Agency of Russian Federation State Institute of Continuous Medical Education, Division of Urology, Moscow, Russia
Moscow, Moskva, Russia

Martov Alexey G., MD, PhD, Honored Doctor of Russia
Professor and Chairman, Department of Urology, Federal Medico-biology Agency
Professor of Urology, Russian Medical Academy of Postgraduate Education
Head of Urology Department, Moscow City Hospital № 57
Ph/fax: +7 499 7800853
e-mail: martovalex@mail.ru
www.amartov.ru

1978-1982. First Moscow Medical Institute
1982-1988. Residenship, Institute of Urology, Moscow
1988. Doctorate Thesis «Percutaneous Treatment of Kidney Stones»
1988-2006. Institute of Urology, from Head of Endourology Department to Vice-President
1993. PhD degree, «Endourological Treatment of Upper Urinary Tract Diseases»
2006 – p. t. Head of Urology Department, Moscow City Hospital №57, Professor of Urology, Russian Medical Academy of Postgraduate Education
2012 – p.t. Professor and Chairman Department of Urology, Federal Medico-biology Agency, Russia


Activities
• Founding Member and President of the Russian Endourology and New Urotechnology Society
• Vice-president of the Russian Urology Association
• Co-Editor of Russian Journal “Urology”
• Member of EAU, SIU, AUA, Endourological Society
• CROES, ESUT activity
• Director of Training Center for Endourology, Moscow, Russia
• Honorary member of Russian, Georgian and Azerbaijan Urology Association
Specialisations / Interests
• Endourology
• BPH
• Stone desease
• Urooncology

over 400 scientific publications (PubMed-cited Journals), 15 books, 35 books chapters
3 educational CD for Urologists (Endourology, BPH, Prostate cancer)
Numerous international invitations for live surgery meetings / presentations / workshops / congresses and teaching events in Russia and countries of former Soviet Union, Germany, France, Austria, Switzerland, Turkey, Sweden etc.
Moscow, 2018

Olivier O. Traxer

Professor
Sorbonne Universite, GRC n020 Lithiase Renale, AP-HP, Hospital Tenon, F-75020 Paris, France
Paris, Ile-de-France, France