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Objective <p>This study compares the ablation rates of three laser systems—Holmium:YAG (Ho:YAG), Thulium Fiber Laser (TFL), and Pulsed Thulium:YAG (p-Tm:YAG)—for renal stone lithotripsy using a standardized robotic setup.</p> Materials and methods <p>A robotic arm enabled consistent laser application on stone phantoms simulating calcium oxalate monohydrate (hard) and uric acid (soft) stones. Ablation efficiency (mm³/J) was assessed across different laser settings (0.2 J–50&#xa0;Hz, 0.5 J–20&#xa0;Hz, and 1.0 J–10&#xa0;Hz) and fiber diameters (200 and 272&#xa0;μm). Ablated volumes were quantified via micro-CT and 3D segmentation using 3DSlicer. Statistical analysis evaluated differences in performance.</p> Results <p>TFL demonstrated the highest ablation rates for both hard and soft stones, significantly outperforming Ho:YAG in multiple settings. For hard stones, TFL exhibited greater ablation efficiency than Ho:YAG, particularly at 0.5 J–20&#xa0;Hz and 1.0 J–10&#xa0;Hz. The p-Tm:YAG laser also outperformed Ho:YAG at 0.5 J–20&#xa0;Hz. For soft stones, the difference between TFL and Tm:YAG was statistically significant at lower energy settings (0.20 J–50&#xa0;Hz and 0.5 J–20&#xa0;Hz). Compared to Ho:YAG, TFL showed significantly higher ablation rates across all tested settings (<i>p</i> &lt; 0.05). The p-Tm:YAG laser showed intermediate performance, with higher efficiency than Ho:YAG but slightly lower than TFL. Fiber diameter influenced ablation, with 272&#xa0;μm fibers yielding greater efficiency at lower energy settings (<i>p</i> &lt; 0.05 at 0.20&#xa0;J − 50&#xa0;Hz and 0.5&#xa0;J − 20&#xa0;Hz for both stone types); this comparison was limited to p-Tm:YAG, as data for the other lasers are already available in the literature.</p> Conclusion <p>TFL achieved the highest in vitro ablation efficiency. However, p-Tm:YAG represents a promising compromise, offering improved performance over Ho:YAG and a balanced profile between fragmentation and dusting capabilities.</p>

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In vitro ablation rates of Ho:YAG, p-Tm:YAG and TFL lasers

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月10日

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  • A. Quarà,
  • A. Bravo-Balado,
  • S. Moretto,
  • A. Madden,
  • F. Zorzi,
  • L. M. I. Jannello,
  • S. Kutchukian,
  • J. Cabrera,
  • M. Corrales,
  • M. Chicaud,
  • U. Gradilone,
  • L. Candela,
  • C. Gorny,
  • F. Coste,
  • L. Berthe,
  • S. Doizi,
  • F. Panthier,
  • C. Fiori,
  • O. Traxer

摘要

Objective

This study compares the ablation rates of three laser systems—Holmium:YAG (Ho:YAG), Thulium Fiber Laser (TFL), and Pulsed Thulium:YAG (p-Tm:YAG)—for renal stone lithotripsy using a standardized robotic setup.

Materials and methods

A robotic arm enabled consistent laser application on stone phantoms simulating calcium oxalate monohydrate (hard) and uric acid (soft) stones. Ablation efficiency (mm³/J) was assessed across different laser settings (0.2 J–50 Hz, 0.5 J–20 Hz, and 1.0 J–10 Hz) and fiber diameters (200 and 272 μm). Ablated volumes were quantified via micro-CT and 3D segmentation using 3DSlicer. Statistical analysis evaluated differences in performance.

Results

TFL demonstrated the highest ablation rates for both hard and soft stones, significantly outperforming Ho:YAG in multiple settings. For hard stones, TFL exhibited greater ablation efficiency than Ho:YAG, particularly at 0.5 J–20 Hz and 1.0 J–10 Hz. The p-Tm:YAG laser also outperformed Ho:YAG at 0.5 J–20 Hz. For soft stones, the difference between TFL and Tm:YAG was statistically significant at lower energy settings (0.20 J–50 Hz and 0.5 J–20 Hz). Compared to Ho:YAG, TFL showed significantly higher ablation rates across all tested settings (p < 0.05). The p-Tm:YAG laser showed intermediate performance, with higher efficiency than Ho:YAG but slightly lower than TFL. Fiber diameter influenced ablation, with 272 μm fibers yielding greater efficiency at lower energy settings (p < 0.05 at 0.20 J − 50 Hz and 0.5 J − 20 Hz for both stone types); this comparison was limited to p-Tm:YAG, as data for the other lasers are already available in the literature.

Conclusion

TFL achieved the highest in vitro ablation efficiency. However, p-Tm:YAG represents a promising compromise, offering improved performance over Ho:YAG and a balanced profile between fragmentation and dusting capabilities.