Hospital CUF Descobertas, Lisbon, Portugal.
Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.
Curr Opin Urol. 2021 Mar 1;31(2):80-86. doi: 10.1097/MOU.0000000000000853.
Lasers have become a fundamental aspect of stone treatment. Although Holmium:Yttrium-Aluminum-garnet (Ho:YAG) laser is the current gold-standard in endoscopic laser lithotripsy, there is a lot of buzz around the new thulium fibre laser (TFL). We decided to evaluate the latest data to help create an objective and evidence-based opinion about this new technology and associated clinical outcomes.
Sixty full-text articles and peer-reviewed abstract presentations were included in the qualitative synthesis of this systematic review performed over the last 2 years. Current super pulsed TFL machines are capable of achieving peak powers of 500W and emit very small pulse energies of 0.025 Joules going up to 6 Joules, and capable of frequency over 2000 Hz. This makes the TFL ablate twice as fast for fragmentation, 4 times as fast for dusting, more stone dust of finer size and less retropulsion compared to the Ho:YAG laser. Because of the smaller laser fibres with the TFL, future miniaturization of instruments is also possible.
Based on the review, the TFL is a potential game-changer for kidney stone disease and has a promising role in the future. However larger multicentric prospective clinical studies with long-term follow-up are needed to establish the safety and efficacy of the TFL in endourology.
目的综述：激光已经成为结石治疗的一个基本手段。虽然钬激光（Ho:YAG）是目前腔内激光碎石术的金标准，但新型掺铥光纤激光（TFL）也备受关注。我们评估了最新的数据，以帮助对这项新技术及其相关临床结果形成客观和基于证据的观点。
最新发现：在过去 2 年进行的这项系统评价的定性综合分析中，共纳入了 60 篇全文文章和同行评审的摘要报告。目前的超脉冲 TFL 机可达到 500W 的峰值功率，发射非常小的 0.025 焦耳脉冲能量，最高可达 6 焦耳，频率可超过 2000Hz。与 Ho:YAG 激光相比，这使得 TFL 的碎石速度快两倍，粉碎速度快四倍，产生的结石粉尘更小，后向推力更小。由于 TFL 采用了更小的激光光纤，未来仪器的小型化也成为可能。
总结：基于这项综述，TFL 可能是肾结石治疗的一个重大变革，在未来具有广阔的应用前景。然而，需要进行更大规模的多中心前瞻性临床研究，以确定 TFL 在腔内泌尿外科中的安全性和疗效。
