Abstract：
OBJECTIVE: Medical device companies have introduced new TFL machines, including Soltive (Olympus, Japan), Fiber Dust (Quanta System, Italy), and TFLDrive (Coloplast, France). The primary objective of this study is to compare our initial clinical experiences with TFL using those devices. Through this historical comparison of Thulium Fiber Laser systems for stone lithotripsy, we aim to advance our understanding and approach toward achieving safe and effective TFL parameters.
METHODS: The data for this comparative analysis were extracted from three distinct prospective series that were previously published, outlining our initial clinical experience with the Soltive (Olympus, Japan), FiberDust laser (Quanta System, Italy), and TFLDrive laser (Coloplast, France). Parameters such as stone size, stone density, laser-on time (LOT), and laser settings were meticulously recorded. Additionally, we assessed critical variables such as ablation speed (expressed in mm3/s) and Joules/mm3 for each lithotripsy procedure.
RESULTS: A total of 149 patients were enrolled in this study. Among them, 120 patients were subjected to analysis concerning renal stones. Statistically significant differences were observed in the median (IQR) stone volume: 650 (127-6027) mm3 for TFLDrive, 1800 (682.8-2760) mm3 for Soltive, and 1125 (294-4000) mm3 for FiberDust (p: 0.007); while there were no differences regarding stone density among the groups. Significant variations were identified in median (IQR) pulse energy, frequency, and total power. The Soltive group exhibited lower energy levels (0.3 J vs. 0.6 J, p: 0.002) but significantly higher pulse frequency (100 Hz vs. 17.5 Hz, p: 0.003) and total power (24 W vs. 11W, p: 0.001) compared to the other groups. Laser-on time showed no substantial differences across all three groups. Additionally, a statistically significant difference was observed in median J/mm3, with the TFLDrive group using higher values (24 J/mm3, p: 0.001), while the Soltive group demonstrated a higher median ablation speed of 1.16 mm3/s (p: 0.001). The overall complication rate remained low for all groups, with comparable stone-free rates.
CONCLUSIONS: By reducing pulsed frequency, we improved laser efficiency, but smaller volumes lead to decreased efficiency due to increased retropulsion and fragment movement. Further studies are needed to identify and establish the appropriate laser settings for this new technology.
METHODS: The data for this comparative analysis were extracted from three distinct prospective series that were previously published, outlining our initial clinical experience with the Soltive (Olympus, Japan), FiberDust laser (Quanta System, Italy), and TFLDrive laser (Coloplast, France). Parameters such as stone size, stone density, laser-on time (LOT), and laser settings were meticulously recorded. Additionally, we assessed critical variables such as ablation speed (expressed in mm3/s) and Joules/mm3 for each lithotripsy procedure.
RESULTS: A total of 149 patients were enrolled in this study. Among them, 120 patients were subjected to analysis concerning renal stones. Statistically significant differences were observed in the median (IQR) stone volume: 650 (127-6027) mm3 for TFLDrive, 1800 (682.8-2760) mm3 for Soltive, and 1125 (294-4000) mm3 for FiberDust (p: 0.007); while there were no differences regarding stone density among the groups. Significant variations were identified in median (IQR) pulse energy, frequency, and total power. The Soltive group exhibited lower energy levels (0.3 J vs. 0.6 J, p: 0.002) but significantly higher pulse frequency (100 Hz vs. 17.5 Hz, p: 0.003) and total power (24 W vs. 11W, p: 0.001) compared to the other groups. Laser-on time showed no substantial differences across all three groups. Additionally, a statistically significant difference was observed in median J/mm3, with the TFLDrive group using higher values (24 J/mm3, p: 0.001), while the Soltive group demonstrated a higher median ablation speed of 1.16 mm3/s (p: 0.001). The overall complication rate remained low for all groups, with comparable stone-free rates.
CONCLUSIONS: By reducing pulsed frequency, we improved laser efficiency, but smaller volumes lead to decreased efficiency due to increased retropulsion and fragment movement. Further studies are needed to identify and establish the appropriate laser settings for this new technology.
摘要：
目的：医疗器械公司推出了新的TFL机器，包括Soltive(奥林巴斯，Japan),纤维粉尘(量子系统,意大利),和TFLDrive（Coloplast，法国)。这项研究的主要目的是使用这些设备将我们最初的临床经验与TFL进行比较。通过对Thulium光纤激光碎石系统的历史比较，我们的目标是提高我们对实现安全有效的TFL参数的理解和方法。
方法：此比较分析的数据是从先前发表的三个不同的前瞻性系列中提取的，概述了我们在Soltive(Olympus，Japan),纤维粉尘激光器（量子系统，意大利),和TFLDrive激光(Coloplast，法国)。参数，如石头尺寸，石材密度,激光接通时间（LOT），和激光设置被精心记录。此外,我们评估了每个碎石手术的关键变量,如消融速度(以mm3/s表示)和焦耳/mm3.
结果：本研究共纳入149例患者。其中,对120例患者进行了有关肾结石的分析。在中值（IQR）结石体积中观察到统计学上的显着差异：TFLDrive为650（127-6027）mm3，1800(682.8-2760)mm3，用于Soltive，和1125（294-4000）mm3的纤维粉尘（p：0.007）；而各组之间的石头密度没有差异。在中值(IQR)脉冲能量中发现了显著的变化，频率,和总功率。Soltive组表现出较低的能级（0.3Jvs.0.6J,p：0.002），但脉冲频率明显更高（100Hz与17.5Hz,p：0.003）和总功率（24Wvs.11W,p：0.001）与其他组相比。在所有三组中，激光开启时间没有实质性差异。此外,在中位数J/mm3中观察到统计学上的显着差异，TFLDrive组使用较高的值（24J/mm3，p：0.001），而Soltive组的中位消融速度较高，为1.16mm3/s（p：0.001）。所有组的总体并发症发生率仍然很低，具有可比的无石率。
结论：通过降低脉冲频率，我们提高了激光效率，但较小的体积导致效率下降，由于增加的倒退和碎片运动。需要进一步的研究来确定和建立适合这项新技术的激光设置。
方法：此比较分析的数据是从先前发表的三个不同的前瞻性系列中提取的，概述了我们在Soltive(Olympus，Japan),纤维粉尘激光器（量子系统，意大利),和TFLDrive激光(Coloplast，法国)。参数，如石头尺寸，石材密度,激光接通时间（LOT），和激光设置被精心记录。此外,我们评估了每个碎石手术的关键变量,如消融速度(以mm3/s表示)和焦耳/mm3.
结果：本研究共纳入149例患者。其中,对120例患者进行了有关肾结石的分析。在中值（IQR）结石体积中观察到统计学上的显着差异：TFLDrive为650（127-6027）mm3，1800(682.8-2760)mm3，用于Soltive，和1125（294-4000）mm3的纤维粉尘（p：0.007）；而各组之间的石头密度没有差异。在中值(IQR)脉冲能量中发现了显著的变化，频率,和总功率。Soltive组表现出较低的能级（0.3Jvs.0.6J,p：0.002），但脉冲频率明显更高（100Hz与17.5Hz,p：0.003）和总功率（24Wvs.11W,p：0.001）与其他组相比。在所有三组中，激光开启时间没有实质性差异。此外,在中位数J/mm3中观察到统计学上的显着差异，TFLDrive组使用较高的值（24J/mm3，p：0.001），而Soltive组的中位消融速度较高，为1.16mm3/s（p：0.001）。所有组的总体并发症发生率仍然很低，具有可比的无石率。
结论：通过降低脉冲频率，我们提高了激光效率，但较小的体积导致效率下降，由于增加的倒退和碎片运动。需要进一步的研究来确定和建立适合这项新技术的激光设置。
