Netsch Christopher, Gross Andreas J, Herrmann Thomas R W, Becker Benedikt
Department of Urology. Asklepios Hospital Barmbek. Hamburg. Germany.
Department of Urology. Spital Thurgau AG. Kantonsspital Frauenfeld. Frauenfeld. Switzerland.
Arch Esp Urol. 2020 Oct;73(8):682-688.
Thulium lasers operate at wavelengths between1940-2013 nm either in a continuous wave or in a pulsed mode, which enables smooth incisions with fast vaporization or effective laser lithotripsy for urolithiasis. Thulium laser enucleation is a minimally invasive and size-independent treatment for benign prostatic hyperplasia (BPH) with excellent long-term results. Since its introduction, several modifications in the technology and surgical techniques have been proposed such as vaporesection, vaporization and enucleation with regard to BPH treatment. Recent developments in the thulium laser technology include the introduction of a super pulsed thulium fiberlaser. This technique delivers the laser energy through anactive fiber with an absorption maximum in water at awavelength of 1940 μm. Preclinical studies showed asignificantly higher stone fragmentation rate in differentex vivo models compared to the Ho:YAG laser. Another innovative thulium laser that works, as a hybrid laser has yet not been tested clinically, however, will soon be introduced. With the introduction of both new thulium lasers as novel devices, the armamentarium in the field of endourology for lithotripsy and enucleation increases. We here present different thulium lasers and surgical techniques that are possible to perform with each device including the reasons and advantages of each modification.
铥激光以连续波或脉冲模式在1940 - 2013纳米波长下运行，这使得它能够实现平滑切割、快速汽化，或对尿石症进行有效的激光碎石术。铥激光剜除术是一种针对良性前列腺增生（BPH）的微创且与大小无关的治疗方法，具有出色的长期效果。自其问世以来，针对BPH治疗，在技术和手术技巧方面提出了多种改进，如汽化切除术、汽化和剜除术。铥激光技术的最新进展包括引入了一种超脉冲铥光纤激光器。该技术通过一根有源光纤传输激光能量，在波长1940微米处对水的吸收达到最大值。临床前研究表明，与钬激光相比，在不同的体外模型中，铥激光的结石破碎率显著更高。另一种作为混合激光工作的创新铥激光尚未进行临床测试，但很快将会推出。随着这两种新型铥激光作为新型设备的引入，腔内泌尿外科用于碎石术和剜除术的器械库得到了扩充。我们在此介绍不同的铥激光以及使用每种设备可能进行的手术技巧，包括每种改进的原因和优势。
