Comparative study of thulium fiber laser versus holmium:yttrium-aluminum-garnet laser for ureteric stone management with semi-rigid ureteroscopy: A prospective, single-center study

Objective:To compare the efficacy and safety of thulium fiber laser(TFL)and holmium:yttrium-aluminum-garnet(Ho:YAG)laser for ureteric stone management with semi-rigid ureteroscopy.Methods:In a prospective study from January 2020 to December 2021,we compared 40 patients in each group who underwent semi-rigid ureteroscopic lithotripsy with TFL and that with Ho:YAG laser.Stone volume,stone density,stone fragmentation rates,total lasing time,total operative time,endoscopic vision,retropulsion and stone free rates were analyzed in both groups and compared.Results:Mean stone volume was comparable in the TFL group and the Ho:YAG laser group(282.45[standard deviation,SD 139.79]mm3 vs.279.49[SD 312.52]mm3;p=0.964).Mean stone density was also comparable in the TFL group and the Ho:YAG laser group(1135.30[SD 317.04]Hounsfield unit vs.1131.75[SD 283.03]Hounsfield unit;p=0.959).The mean stone fragmentation rates calculated as stone volume divided by lasing time were 25.85(SD 10.61)mm3/min and 21.37(SD 14.13)mm3/min in the TFL group and the Ho:YAG laser group,respectively(p=0.113).The mean total lasing time(10.15[SD]4.69 min vs.11.43[SD 4.56]min;p=0.222),mean operative time(25.13[SD 9.51]min vs.25.54[SD 10.32]min;p=0.866),and mean total hospital stay(2.62[SD 0.77]days vs.2.61[SD 0.84]days;p=0.893)were comparable in the TFL group and in the Ho:YAG group.The vision was better and retropulsion was less in the TFL group.The stone-free rate at 1 month postoperatively was slightly better in the TFL group(100%vs.90%;p=0.095).

Thulium fiber laser lithotripsy:Is it living up to the hype?

Objective:The holmium:yttrium-aluminium-garnet laser(Ho:YAG)has been the gold standard for laser lithotripsy over the last three decades.After demonstrating good in vitro efficacy,the thulium fiber laser(TFL)has been recently released in the market and the initial clinical results are encouraging.This article aims to review the main technology differences between the Ho:YAG laser and the TFL,discuss the initial clinical results with the TFL as well as the optimal settings for TFL lithotripsy.Methods:We reviewed the literature focusing on the technological aspects of the Ho:YAG laser and TFL as well as the results of in vitro and in vivo studies comparing both technologies.Results:In vitro studies show a technical superiority of TFL compared to the Ho:YAG laser and encouraging results have been demonstrated in clinical practice.However,as TFL is a new technology,limited studies are currently available,and the optimal settings for lithotripsy are not yet established.Conclusion:TFL has the potential to be an alternative to the Ho:YAG laser,but more reports are still needed to determine the optimal laser for lithotripsy of urinary tract stones when considering all parameters including effectiveness,safety,and costs.

Two-micron （thulium） laser resection of the prostate- tangerine technique： a new method for BPH treatment

Two-micron （thulium） laser resection of the prostate-tangerine technique （TmLRP-TT） is a transurethral procedure that uses a thulium laser fiber to dissect whole prostatic lobes off the surgical capsule, similar to peeling a tangerine. We recently reported the primary results. Here we introduce this procedure in detail. A 70-W, 2-um （thulium） laser was used in continuous-wave mode. We joined the incision by making a transverse cut from the level of the verumontanum to the bladder neck, making the resection sufficiently deep to reach the surgical capsule, and resected the prostate into small pieces, just like peeling a tangerine. As we resected the prostate, the pieces were vaporized, sufficiently small to be evacuated through the reseetoscope sheath, and the use of the mechanical tissue morcellator was not required. The excellent hemostasis of the thulium laser ensured the safety of TmLRP-TT. No patient required blood transfusion. Saline irrigation was used intraoperatively, and no case of transurethral resection syndrome was observed. The bladder outlet obstruction had clearly resolved after catheter removal in all cases. We designed the tangerine technique and proved it to be the most suitable procedure for the use of thulium laser in the treatment of benign prostatic hyperplasia （BPH）. This procedure, which takes less operative time than standard techniques, is safe and combines efficient cutting and rapid organic vaporization, thereby showing the great superiority of the thulium fiber laser in the treatment of BPH. It has been proven to be as safe and efficient as transurethral resection of the prostate （TURP） during the 1-year follow-up.

Thulium laser treatment for bladder cancer

Recent innovations in thulium laser techniques have allowed application in the treatment of bladder cancer.Laser en bloc resection of bladder cancer is a transurethral procedure that may offer an alternative to the conventional transurethral resection procedure.We conducted a review of basic thulium laser physics and laser en bloc resection procedures and summarized the current clinical literature with a focus on complications and outcomes.Literature evidence suggests that thulium laser techniques including smooth incision,tissue vaporization,and en bloc resection represent feasible,safe,and effective procedures in the treatment of bladder cancer.Moreover,these techniques allow improved specimen orientation and accurate determination of invasion depth,facilitating correct diagnosis,restaging,and reevaluation of the need for a second resection.Nonetheless,large-scale multicentre studies with longer follow-up are warranted for a robust assessment.The present review is meant as a quick reference for urologists.

Generation and evolution of multiple operation states in passively mode-locked thulium-doped fiber laser by using a graphene-covered-microfiber

Using graphene-covered-microfiber （GCM） as a saturable absorber, the generation and evolution of multiple operation states are proposed and demonstrated in passively mode-locked thulium-doped fiber laser. The microfiber was fabricated using the flame brushing method to an interaction length of - 1.2 cm with a waist diameter of -10 μm. Graphene layers were grown on copper foils by chemical vapor deposition and transferred onto the polydimethylsiloxane （PDMS） to form a PDMS/graphene film, which allowed light-graphene interaction via evanescent field. With the increase of the pump power from 1.25 W to 2.15 W, five different lasing regimes, including continuous-wave, conventional soliton mode-locking, multi- soliton mode-locking, a period of transition, and noise-like mode-locking, were achieved in a fiber ring cavity. To the best of our knowledge, it is the first report of the generation and evolution of multiple operation states by covering graphene on the microfiber in the 2-μ.m region. The results demonstrate that GCM can be a promising method for fabricating all fiber SA, and the switchable operation states can provide more portability in complex application domain.

A theoretical and experimental investigation of an in-band pumped gain-switched thulium-doped fiber laser

In this paper, the theoretical rate equation model of an in-band pumped gain-switched thulium-doped fiber （TDF） laser is investigated. The analytical formulations of pump energy threshold, peak power extraction efficiency, and pulse extraction efficiency are derived through analyzing the interaction process between the pump pulse and the laser pulse. They are useful for understanding, designing, and optimizing the in-band pumped TDF lasers in a 1.9 μm-2.1 μm wavelength region. The experiment with an all-fiber gain-switched TDF laser pumped by a 1.558-μm pulse amplifier is conducted, and our experimental results show good agreement with theoretical analysis.

Spectroscopic study of thulium doped transparent glass ceramics

A systematic investigation on fluorescence spectroscopy of trivalent thulium doped in oxyfluoride glass ceramics containing LaF3 nanocrystals has been carried out in a spectral range from 400 to 900 nm under the direct excitation of 1D2 level at a low temperature. Specific optical transitions related to the fluorescence emissions are studied based on experimental measurements in frequency and time domain. Fluorescence emissions from the ions in crystal phase are distinguished from what in glass phase and their spectroscopic properties are explored. The dynamical process shows that the temporal decay of fluorescence emission consists of two parts： a rapid decay from the ions in glass phase and a slower decay from the ions in crystal phase.

Magneto-optical effect of TEB30A liquid crystal doped with thulium oxides

The influences of an external magnetic field on the optical properties of the TEB30A nematic liquid crystal doped with thulium oxides （Gd203, Dy203, Nd203, Y203, and Sm203） are studied. It is shown that a magnetic field applied parallelly to the sample cell surface leads to the rotational orientation of mesogenes. All samples except for the sample doped with Sm203 nanoparticles undergo structural deformations. The behavior of the TEB30A/Sm203 differs from those of the TEB30A liquid crystal doped with other four nanoparticles. The presence of Sm203 nanoparticles in the TEB30A liquid crystal does not cause the structural deformation of the liquid crystal matrix. At the same time, the anchoring type of the liquid crystal molecules on the nanoparticle surface is different. The director n is parallel to the magnetic moment/~ in the TEB30A/Sm203, and inclined to the magnetic moment/~ in the TEB30A/Nd203, and perpendicular to the magnetic moment/~ in each of TEB30A/Gd203, TEB30A/Dy203, and TEB30A/Y203. Besides, the dependence of the structural deformation on the critical magnetic field for the TEB30A is obtained.

An experimental study of hydrolytic behavior of thulium in basic and near-neutral solutions

Hydrolytic equilibria of Tm (III) in KOH solutions were studied at 25°C. A spectrophotometry with m-cresol purple and 2-naphthol as pH indicators was used at an ionic strength of not more than 0.0005. The results indicate that in freshly prepared solutions at pH ranging between 6 and 10 Tm is present as , , and . The stepwise stability constants of hydroxide complexes calculated at zero ionic strength were obtained as coefficient of linear regression equations from the graph of optical densities of the indicators in Tm solutions at varying pH.

Mode-Locked Thulium Ytterbium Co-Doped Fiber Laser with Graphene Oxide Paper Saturable Absorber

A mode-locked thulium ytterbium co-doped fiber laser （TYDFL） is proposed and demonstrated by using a commercial graphene oxide （GO） paper as saturable absorber （SA）. The GO paper is sandwiched between two fiber ferrules and incorporates a ring laser cavity to generate soliton pulse train operating at 1942.0nm at a threshold multimode pump power as low as 1.8 W. The mode-locked TYDFL has a repetition rate of 22.32 MHz and the calculated pulse width of 1.1 ns. Even though the SA has a low damage threshold, the easy fabrication of GO paper should promote its potentiM application in ultrafast photonics.

Feasibility of en bloc thulium laser enucleation of the prostate in a large case series. Are results enhanced by experience?

Objective:To provide the first large single-operator case series of patients who undergo“en bloc”thulium laser enucleation of the prostate(ThuLEP)and to demonstrate an improvement in enucleation efficacy with experience.Methods:We prospectively evaluated a cohort of patients with symptomatic benign prostatic hyperplasia(BPH)who underwent“en bloc”ThuLEP between May 2015 and November 2017.Association between dependent variables(delivered energy and operating time)and independent variables(adenoma volume and experience)were estimated with regression analysis.The experience was calculated as the time interval between the date of the first operation of the series and the date of the operation being considered.Results:A total of 100 patients were registered for the study.Median operative time was 56.5 min(interquartile range[IQR]:40-85 min).Median enucleation time was 17.4 min(IQR:15-21.5 min).Median enucleation index(enucleation time per adenoma gram)was 0.3 min/g(0.2-0.3 min/g).The overall operative time is not influenced by experience,but we registered a significant trend towards a reduction in the total amount of energy delivered energy normalized per adenoma gram(p=0.0148).Conclusion:We believe that further attention is needed for these new“en bloc”prostatic enucleation techniques,which can facilitate some surgical steps,leading to a widespread use of laser technology for BPH surgical treatment.

Analysis of gain distribution in cladding-pumped thulium-doped fiber laser and optical feedback inhibition problem in fiber-bulk laser system

The steady-state gain distribution in cladding pumped thulium-doped fiber laser（TDFL） is analytically and numerically solved based on the rate equations including loss coefficients and cross relaxation effect. With the gain curve, a problem, which is named optical feedback inhibition（OFI） and always occurs in tandem TDFL-Ho：YAG laser system, is analyzed quantitatively. The actual characteristics of output spectra and power basically prove the conclusion of theoretical analysis. Then a simple mirror-deflected L-shaped cavity is employed to restrain the external feedback and simplify the structure of fiber-bulk Ho：YAG laser. Finally, 25 W of 2097-nm laser power and 51.2% of optical-to-optical conversion efficiency are obtained, and the beam quality factor is less than 1.43 obtained by knife-edge method.

Observation of Violet-Light Emission Band for Thulium-Doped Tantalum-Oxide Films Produced by Co-Sputtering

We prepared thulium-doped tantalum (V) oxide (Ta2O5:Tm) thin films using co-sputtering of two Tm2O3 pellets and a Ta2O5 disc, and we observed photoluminescence (PL) peaks not only around a wavelength of 800 nm due to the 3H4→3H6 transition of Tm3+ but also around a wavelength of 400 nm (violet) from the films after annealing for the first time. Comparatively narrow PL peaks around the wavelength of 400 nm were observed from the films annealed at 800°C and 900°C for 20 min. The peak intensity from the film annealed at 900°C was approximately four-times stronger than that from the film annealed at 800°C. The origin of the 400-nm peaks seems to be the same as our non-doped Ta2O5 thin films deposited using radio-frequency sputtering because we observe PL peaks around 400 - 430 nm from the Ta2O5 films. Such a Ta2O5:Tm co-sputtered thin film seems to be used as a multi-functional coating film having both anti-reflection and down-conversion effects for realizing a high-efficiency silicon solar cell.

Photoluminescence Properties of Thulium and Cerium Co-Doped Tantalum-Oxide Films Prepared by Radio-Frequency Co-Sputtering

We prepared thulium and cerium co-doped tantalum-oxide (Ta2O5 :Tm, Ce) thin films by radiofrequency co-sputtering of Tm2O3 and CeO2 pellets on a Ta2O5 disc for the first time, and photoluminescence (PL) properties of the films annealed at 700°C, 800°C, 900°C, or 1000°C for 20 min were evaluated. PL peaks around a wavelength of 800 nm due to Tm3+?were observed for films annealed at 900°C or 1000°C. The peak intensities of films prepared using one Tm2O3 pellet and one CeO2 pellet were much stronger than those of films prepared using one Tm2O3 pellet and two CeO2 pellets or films prepared using two Tm2O3 pellets and one CeO2 pellet. To obtain the strongest PL intensity from the film, the proper Tm concentration was estimated to be around 1.0 mol%, and the proper Ce concentration was estimated to be around 1.3 mol%. Such Ta2O5:Tm, Ce co-sputtered thin films can be used as high-refractive-index materials of autocloned photonic crystals that can be applied to novel light-emitting devices, and they will also be used as anti-reflection and downconversion layers for realizing high-efficiency silicon solar cells.

Thulium Doped Fiber Amplifier (TDFA) for S-band WDM Systems

A comprehensive numerical model based on solving rate equations of a thulium-doped silica-based fiber amplifier is evaluated. The pump power and thulium-doped fiber (TDF) length for single-pass Thulium-Doped Fiber Amplifiers (TDFA) are theoretically optimized to achieve the optimum Gain and Noise Figure (NF) at the center of S-band region. The 1064 nm pump is used to provide both ground-state and excited state absorptions for amplification in the S-band region. The theoretical result is in agreement with the published experimental result.

Passively Q-switched operation of a 1.94μm thulium-doped solid-state laser based on MXeneV_(2)CT_(x)

MXene V_(2)CT_(x) has great practicability because it is not easy to degrade under ambient conditions.In this paper,a V_(2)CT_(x) saturable absorber(SA)was firstly applied to a passively Q-switched(PQS)laser,to the best of our knowledge.The V_(2)CT_(x)-SA was prepared by the spin-coating method.The linear absorption of the V_(2)CT_(x)-SA in the 1000-2200 nm region and the nonlinear absorption near 2μm were studied.With the V_(2)CT_(x)-SA,a typical PQS operation at 1.94μm was realized in a Tm:YAlO3laser.The minimum pulse width produced by the PQS laser was 528 ns,and the peak power,repetition rate,and average output power were 10.06 W,65.9 kHz,and 350 mW,respectively.Meanwhile,the maximum pulse energy was 6.33μJ.This work demonstrates that the V_(2)CT_(x) can be used as an effective SA to obtain nanosecond pulses with high peak power and high repetition rate simultaneously.

Two-micrometer thulium laser resection of the prostate-tangerine technique in benign prostatic hyperplasia patients with previously negative transrectal prostate biopsy

The 2-1μm thulium laser resection of the prostate-tangerine technique （TmLRP-TT） has been introduced as a minimally invasive treatment for benign prostatic hyperplasia （BPH）. This study was undertaken to assess the clinical efficacy and safety of TmLRP-TT for the treatment of BPH patients with previously negative transrectal prostate biopsy. A prospective analysis of 51 patients with previously negative transrectal prostate biopsy who underwent surgical treatment using TmLRP-TT was performed from December 2011 to December 2013. Preoperative status, surgical details, and perioperative complications were recorded. The follow-up outcome was evaluated with subjective and objective tests at I and 6 months. TmLRP-TT was successfully completed in all patients. Mean prostate volume, operative duration, and catheterization time were 93.3 ± 37.9 ml, 69.5 ± 39.5 min, and 6.5 ± 1.3 days, respectively. The mean International Prostate Symptom Score, quality of life score, maximum urinary flow rate, and post-void residual urine volume changed notably at 6-month follow-up （22.5 ± 6.9 vs 6.1 ± 3.2, 4.8 ± 1.3 vs 1.1 ± 0.9, 7.3 ± 4.5 vs 18.9 ± 7.1 ml s^-1, and 148.7 ± 168.7 vs 28.4 ± 17.9 ml）. Two （3.9%） patients required blood transfusion perioperatively, while 3 （5.9%） patients experienced transient hematuria postoperatively, and 2 （3.9%） patients received 3 days recatheterization due to clot retention. TmLRP-TT is a safe and effective minimally invasive technique for patients with previously negative transrectal prostate biopsy during the 6-month follow-up. This promising technology may be a feasible surgical method for previously negative transrectal prostate biopsy in the future.

优路铥激光结合曲安奈德腔内注射治疗尿道吻合术失败病例的疗效观察

目的:探讨优路铥激光结合曲安奈德腔内注射治疗尿道吻合术失败病例的临床经验。方法:回顾性分析2018年1月至2023年12月收治的盆腔骨折尿道牵张性缺损(PFUDD)男性患者。共纳入尿道吻合术失败患者35例,根据内切开能量平台分别为优路铥激光和等离子组。所有患者均在直视下尿道狭窄内切开术,并予以曲安奈德腔内局部注射,记录年龄、狭窄长度、手术时间、术前最大尿流率、术后最大尿流率、术后并发症以及狭窄复发情况。结果:所有患者均顺利完成所有治疗,两组患者在年龄、狭窄长度、手术时间、并发症率及狭窄复发率上均无统计学差异(P>0.05)。铥激光组和等离子组中位随访时间分别为21.0个月(IQR 16.0~24.0)和21.0个月(IQR 17.0~25.0),术前和术后12个月的最大尿流率均有显著差异(P<0.01)。两组无复发生存期无统计学差异(P=0.398)。结论:优路铥激光尿道内切开结合曲安奈德腔内局部注射在短期内可有效维持尿道狭窄瘢痕的稳定,保持良好的尿道通畅性。与传统等离子内切开相比,该策略术后并发症率较低,具有操作简单、安全、并发症少、疗效可靠等特点,可作为PFUDD患者吻合术失败后的补救治疗方法。

“推挑式”铥激光膀胱肿瘤整体剜除术临床疗效研究

目的比较“推挑式”铥激光膀胱肿瘤整体剜除术(TmLRBT)与等离子膀胱肿瘤电切术(TURBT)处理非肌层浸润性膀胱癌(NMIBC)的疗效与安全性。方法分析2018年1月至2020年6月我院99例NMIBC患者的临床资料,其中行“推挑式”TmLRBT 50例,行TURBT 49例,比较两组手术时间、术中出血量、膀胱冲洗时间、保留导尿时间、术后住院时间、术中并发症、尿道狭窄发生及肿瘤复发情况。结果TmLRBT组手术时间(38.56±8.51)min,TURBT组(36.79±9.05)min,差异无统计学意义(P>0.05)。TmLRBT组术中出血量(7.59±3.34)ml,膀胱冲洗时间(1.05±0.82)d,术后留置尿管时间(3.87±2.77)d,术后住院时间(4.96±2.38)d,显著低于TURBT组的(11.84±4.17)ml、(3.23±1.35)d、(5.69±3.01)d、(6.56±2.42)d,差异有统计学意义(P<0.05)。术后TmLRBT组无闭孔神经反射及膀胱穿孔,显著低于TURBT组的14.29%及10.20%(P<0.05);术后发生尿道狭窄两组差异无统计学意义(P>0.05);在12个月肿瘤复发率中,TmLRBT组发生2例(4.00%),TURBT组发生8例(16.33%),差异有统计学意义(P<0.05)。结论TmLRBT与TURBT都是处理NMIBC安全可靠的手术方式,“推挑式”TmLRBT在安全性及疗效上更有优势,值得推广。

Flexible ureteroscopic treatment of kidney stones: How do the new laser systems change our concepts?

Objective: Flexible ureteroscopy (fURS) has become a widely accepted and effective technique for treating kidney stones. With the development of new laser systems, the fURS approach has evolved significantly. This literature review aims to examine the current state of knowledge on fURS treatment of kidney stones, with a particular focus on the impact of the latest laser technologies on clinical outcomes and patient safety.Methods: We conducted a search of the PubMed/PMC, Web of Science Core Collection, Scopus, Embase (Ovid), and Cochrane Databases for all randomized controlled trial articles on laser lithotripsy in September 2023 without time restriction.Results: We found a total of 22 relevant pieces of literature. Holmium laser has been used for intracavitary laser lithotripsy for nearly 30 years and has become the golden standard for the treatment of urinary stones. However, the existing holmium laser cannot completely powder the stone, and the retropulsion of the stone after the laser emission and the thermal damage to the tissue have caused many problems for clinicians. The introduction of thulium fiber laser and Moses technology brings highly efficient dusting lithotripsy effect through laser innovation, limiting pulse energy and broadening pulse frequency.Conclusion: While the holmium:yttrium-aluminum-garnet laser remains the primary choice for endoscopic laser lithotripsy, recent technological advancements hint at a potential new gold standard. Parameter range, retropulsion effect, laser fiber adaptability, and overall system performance demand comprehensive attention. The ablation efficacy of high-pulse-frequency devices relies on precise targeting, which may pose practical challenges.