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Review
. 2023 Dec;41(12):3437-3447.
doi: 10.1007/s00345-023-04679-3. Epub 2023 Nov 6.

Thulium:YAG laser: a good compromise between holmium:YAG and thulium fiber laser for endoscopic lithotripsy? A narrative review

Marie Chicaud  1   2   3   4 , Mariela Corrales  1   2 , Stessy Kutchukian  1   2   3   5 , Catalina Solano  1   2   6 , Luigi Candela  1   2   7   8 , Steeve Doizi  1   2   3 , Olivier Traxer  1   2 , Frédéric Panthier  9   10   11
Affiliations
Review

Thulium:YAG laser: a good compromise between holmium:YAG and thulium fiber laser for endoscopic lithotripsy? A narrative review

Marie Chicaud et al. World J Urol. 2023 Dec.

Abstract

Purpose: To provide a technological description of the new pulsed solid-state Thulium:YAG laser (Tm:YAG). In addition, current available literature on Tm:YAG lithotripsy is also reviewed.

Materials and methods: Medline, Scopus, Embase, and Web of Science databases were used to search for Tm:YAG operating mode articles.

Results: Tm:YAG technology works with a laser cavity with thulium-doped YAG crystal, pumped by laser diodes. Laser beam operates at 2013 nm, with an adjustable peak power (≥ 1000 W) and the minimal fiber laser diameter is of 200 µm. It has an intermediate water absorption coefficient and peak power-pulse duration. Various pulse modulations are proposed, aiming to minimize stone retropulsion. Multiple comparative in vitro studies suggest that Tm:YAG's ability to fragment stones is similar to the one of the Ho:YAG laser; on the contrary, its ability to dust all stone types is similar to the one of the TFL, with a low retropulsion. A single in vivo study assessed Tm:YAG lithotripsy feasibility.

Conclusions: The new pulsed solid-state thulium:YAG laser could represent a safe and effective compromise between Ho:YAG laser and TFL for endoscopic lithotripsy, either in retrograde intra-renal surgeries or in percutaneous nephrolithotomy.

Keywords: Holmium:YAG; Laser; Lithotripsy; Thulium YAG; Thulium fiber laser; Ureteroscopy.

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