title: Enhanced thulium fiber laser lithotripsy using micro-pulse train modulation.
abstract: The thulium fiber laser (TFL) is currently being studied as an alternative to the conventional holmium:YAG (Ho:YAG) laser for lithotripsy. The diode-pumped TFL may be electronically modulated to operate with variable parameters (e.g., pulse rate, pulse duration, and duty cycle) for studying the influence of pulse train mode on stone ablation rates. The TFL under study was operated at 1908 nm, 35-mJ pulse energy, and 500-μs pulse duration, in a train of 5 micro-pulses, with macro-pulse rates of 10 Hz, compared with conventional TFL operation at 10 to 50 Hz. TFL energy was delivered through 100-μm-core fibers in contact with human uric acid (UA) and calcium oxalate monohydrate (COM) stones. Mass removal rates, optical coherence tomography, and light microscopy were used to analyze the ablation craters. Stone retropulsion and fiber tip degradation studies also were conducted for these laser parameters. TFL operation in micro-pulse train (MPT) mode resulted in a factor of two increase in the ablation rate of 414 ± 94 μg/s and 122 ± 24 μg/s for the UA and COM stones, respectively, compared to 182 ± 69 μg/s and 60 ± 14 μg/s with standard pulse trains delivered at 50 Hz (P<0.05). Stone retropulsion remained minimal (<2 mm after 1200 pulses) for both pulse modes. Fiber burnback was significant for both pulse modes and was higher for COM stones than UA stones. TFL operation in MPT mode results in increased stone ablation rates which, with further optimization, may approach levels comparable to Ho:YAG laser lithotripsy in the clinic.
authors.affiliation: University of North Carolina at Charlotte, Department of Physics and Optical Science, 9201 University City Avenue, Charlotte, North Carolina 28223-0001, USA.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Blackmon
authors.forename: Pierce B
authors.initials: PB
authors.lastname: Irby
authors.forename: Nathaniel M
authors.initials: NM
authors.lastname: Fried
mesh_terms: D004867:Equipment Design; D019544:Equipment Failure Analysis; D005336:Fiber Optic Technology / Q000295:instrumentation*; D006801:Humans; D017602:Lithotripsy, Laser / Q000295:instrumentation*; D013932:Thulium; D016896:Treatment Outcome; D014545:Urinary Calculi / Q000628:therapy*
chemical_list: D013932:Thulium