Traxer Olivier, Corrales Mariela
Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, F-75020 Paris, France.
Sorbonne Université, Service d'Urologie, AP-HP, Hôpital Tenon, F-75020 Paris, France.
J Clin Med. 2021 Jul 30;10(15):3390. doi: 10.3390/jcm10153390.
Thirty-three years ago, pulsed lasers marked the beginning of a new era in endoscopic lithotripsy, and the one that was highlighted because of its potential was the Holmium: YAG laser, which became and still is the gold standard in endourology. Recently, a new laser technology has been accepted for clinical use in lithotripsy: the thulium fiber laser (TFL), showing appealing characteristics not seen before in several preclinical studies. A review of the literature was performed and all relevant in vitro studies and clinical trials until April 2021 were selected. The search came back with 27 clinical experiences (7 full-text clinical trials and 20 peer-reviewed abstracts) and 33 laboratory studies (18 full-text articles and 15 peer-reviewed abstracts). The clinical experiences confirmed the clinical safety of using the wide parameter range of the TFL. This technology demonstrated the performance at a higher ablation speed, the higher ablation efficiency, and the better dust quality of the TFL, as well as reduced stone retropulsion, thus helping to maintain an optimal visibility. No thermal or radiation damage was found. Given the current evidence, we may be facing the future gold standard laser in endoscopic lithotripsy.
33年前，脉冲激光标志着内镜碎石术新时代的开端，其中因潜力备受瞩目的是钬激光：钇铝石榴石激光（Ho:YAG），它曾是且仍是腔内泌尿外科的金标准。最近，一种新的激光技术已被批准用于临床碎石：铥光纤激光（TFL），在多项临床前研究中展现出前所未有的诱人特性。我们进行了文献综述，并选取了截至2021年4月的所有相关体外研究和临床试验。检索结果有27项临床经验（7项全文临床试验和20篇同行评审摘要）以及33项实验室研究（18篇全文文章和15篇同行评审摘要）。临床经验证实了使用TFL广泛参数范围的临床安全性。这项技术展示了TFL更高的消融速度、更高的消融效率、更好的粉末质量，以及减少的结石反冲，从而有助于保持最佳视野。未发现热损伤或辐射损伤。基于目前的证据，我们可能正面临内镜碎石术中未来的金标准激光。
