Feasibility and efficiency of the use of pulsed thulium: YAG (Thulio) laser for ECIRS: a multicenter evaluation.

INTRODUCTION

The pulsed Thulium: YAG (p-Tm: YAG) laser represents a recent technological advancement in endourology, offering high pulse frequencies and energy levels for efficient lithotripsy. While its efficacy has been demonstrated in retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL), data on its application during endoscopic combined intrarenal surgery (ECIRS) remain limited. This multicenter retrospective study evaluated the safety, efficiency, and clinical performance of the p-Tm: YAG laser during ECIRS.

METHODS

Data were collected from 179 consecutive patients undergoing ECIRS with the p-Tm: YAG laser (Dornier Thulio®, Dornier MedTech Systems GmbH) across three European high-volume centers (September 2023–March 2024). Patient demographics, stone characteristics, peri-operative parameters, laser settings, and outcomes were analyzed. Stone-free rate (SFR) was assessed endoscopically and radiographically (2–6 weeks post-operatively). Complications were recorded.

RESULTS

The median stone volume was 4 050 mm³ (IQR 1 690–6 845) with a median density of 1 138 HU. The mean laser energy consumption was 7.3 J/mm³. Endoscopic and radiographic SFRs were 96.6% and 85.4%, respectively. Only four post-operative complications (2.2%) occurred, including one arteriovenous fistula requiring embolization. Pre-stenting and pre-operative hydronephrosis, higher total applied energy and a large stone burden were significantly associated with higher SFR in univariate model. In a multivariate model, the presence of preoperative hydronephrosis and a potential effect of a larger stone burden contributed to a higher SFR.

CONCLUSION

ECIRS using the p-Tm: YAG laser is a safe and effective technique for managing large and complex renal stones, achieving high SFRs with minimal complications. These findings support the p-Tm: YAG laser as a promising tool in combined endourological surgery, warranting further prospective comparative studies.