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Proceedings Article

A review of Thulium fiber laser ablation of kidney stones

[+] Author Affiliations
Nathaniel M. Fried

The Univ. of North Carolina at Charlotte (USA) and Johns Hopkins Medical Institutions (USA)

Richard L. Blackmon

The Univ. of North Carolina at Charlotte (USA)

Pierce B. Irby

Carolinas Medical Ctr. (USA)

Proc. SPIE 7914, Fiber Lasers VIII: Technology, Systems, and Applications, 791402 (February 07, 2011); doi:10.1117/12.878001
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From Conference Volume 7914

  • Fiber Lasers VIII: Technology, Systems, and Applications
  • Jay W. Dawson
  • San Francisco, California, USA | January 22, 2011

abstract

The clinical solid-state Holmium:YAG laser lithotripter (λ=2120 nm) is capable of operating at high pulse energies, but its efficient operation is limited to low pulse rates during lithotripsy. The diode-pumped experimental Thulium Fiber Laser (λ=1908 nm) is limited to low pulse energies, but can operate at high pulse rates. This review compares stone ablation threshold, ablation rate, and retropulsion effects for Ho:YAG and TFL. Laser lithotripsy complications also include optical fiber bending failure resulting in endoscope damage and low irrigation rates leading to poor visibility. Both problems are related to fiber diameter and limited by Ho:YAG laser multimode spatial beam profile. This study exploits TFL spatial beam profile for higher power transmission through smaller fibers. A short taper is also studied for expanding TFL beam at the distal tip of a small-core fiber. Stone mass loss, stone crater depths, fiber transmission losses, fiber burn-back, irrigation rates, and deflection through a flexible ureteroscope were measured for tapered fiber and compared with conventional fibers. The stone ablation threshold for TFL was four times lower than for Ho:YAG. Stone retropulsion with Ho:YAG increased linearly with pulse energy. Retropulsion with TFL was minimal at pulse rates < 150 Hz, then rapidly increased at higher pulse rates. TFL beam profile provides higher laser power through smaller fibers than Ho:YAG laser, potentially reducing fiber failure and endoscope damage and allowing greater irrigation rates for improved visibility and safety. Use of a short tapered distal fiber tip also allows expansion of the laser beam, resulting in decreased fiber tip damage compared to conventional fibers, without compromising fiber bending, stone ablation efficiency, or irrigation rates.

© (2011) COPYRIGHT Society of Photo-Optical Instrumentation Engineers (SPIE). Downloading of the abstract is permitted for personal use only.
Citation

Nathaniel M. Fried ; Richard L. Blackmon and Pierce B. Irby
"A review of Thulium fiber laser ablation of kidney stones", Proc. SPIE 7914, Fiber Lasers VIII: Technology, Systems, and Applications, 791402 (February 07, 2011); doi:10.1117/12.878001; http://dx.doi.org/10.1117/12.878001


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