Comparing dusting and fragmenting efficiency using the new SuperPulsed thulium fiber laser versus a 120 W Holmium:YAG laser

Purpose: Holmium:YAG laser lithotripsy requires high amperage power and has an upper limit of frequency and a minimal fiber size. The technology utilizing thulium-doped fiber offers low pulse energy settings and high pulse frequencies up to 2,400 Hz. We compared the novel SuperPulsed thulium fiber laser (SOLTIVETM; Olympus) to a commercially available 120 W Ho:YAG laser.Materials and Methods: Bench-top testing was conducted with 125 mm3 standardized BegoStones (Bego USA). Time to ablate the stone into particles <1 mm was recorded for efficiency calculations. Finite energy was delivered, and resulting particle sizes were measured to determine fragmentation (0.5 kJ) and dusting (2 kJ) efficiencies. Remaining mass or number of fragments were measured to compare efficacy.Results: SOLTIVETM was faster at ablating stones to particles <1 mm (2.23 +/- 0.22 mg/s, 0.6 J 30 Hz short pulse) compared to Ho:YAG laser (1.78 +/- 0.44 mg/s, 0.8 J 10 Hz short pulse) (p<0.001). Following 0.5 kJ of energy in fragmentation testing, fewer particles >2 mm remained using SOLTIVETM than Ho:YAG laser (2.10 vs. 7.20 fragments). After delivering 2 kJ, dusting (1.05 +/- 0.08 mg/s) was faster using SOLTIVETM (0.1 J 200 Hz short pulse) than 120 W 0.46 +/- 0.09 mg/s (0.3 J 70 Hz Moses) (p=0.005). SOLTIVETM (0.1 J 200 Hz) produced more dust particles <0.5 mm (40%) compared to 24% produced by the P120 W laser at 0.3 J 70 Hz Moses and 14% at 0.3 J 70 Hz long pulse (p=0.015). Conclusions: The efficacy of SOLTIVETM is superior to the 120 W Ho:YAG laser by producing smaller dust particles and fewer frag-ments. Further studies are warranted.