In 2022, Dornier MedTech launched Dornier Thulio, the pulsed solid-state thulium: yttrium-aluminum-garnet (Tm:YAG) laser for various urological treatments. This cutting-edge laser operates at a wavelength of 2013 nm and boasts a maximum power output of 100 W. The absorption coefficient of the pulsed Tm:YAG laser falls between that of the holmium: YAG (Ho:YAG) laser and the thulium fiber laser (TFL).
The pulsed Tm:YAG laser sets itself apart with unique laser settings, including a pulse energy of up to 2.5 J, a pulse frequency (also known as pulse rate) of up to 300 Hz, and a peak power of up to 3.7 kW. Combining the finest attributes of the gold standard Ho:YAG and TFL in one device, Dornier Thulio, powered by pulsed Tm:YAG technology, represents the optimal middle ground between both technologies and offers a potential breakthrough in the field.
Study: Initial clinical experience with the pulsed solid-state thulium YAG laser from Dornier Thulio during retrograde intrarenal surgery (RIRS): first 25 cases.1
Method:
In a single-center prospective study, 25 patients with ureteral and renal stones underwent RIRS utilizing Dornier Thulio (pulsed-Tm:YAG) laser from Dornier MedTech Laser GmbH, located in Wessling, Germany.
Objective:
The authors aimed to evaluate the efficiency, safety, and laser settings of the pulsed Tm:YAG Dornier Thulio laser in ELL during
retrograde intrarenal surgery (RIRS).
Results: The analysis included 25 patients with a median value and interquartile range (IQR) age of 55 (44–72) years. The stones had a median and IQR volume of 2849 (916–9153) mm³ and a median and IQR density of 1000 (600–1174) HU. 17 patients had stones in the superior or inferior calyx and the pelvis. Five patients had complex stone cases, including two ureteral stones and one bladder stone.
The dusting technique with the pulsed Dornier Thulio Tm:YAG laser is similar to the Ho:YAG laser, but a greater distance between the fiber and stone is required compared to TFL.
Conclusion: Dornier Thulio, the new pulsed-Tm:YAG laser, is a safe and effective source for endocorporeal laser lithotripsy (ELL) during retrograde intrarenal surgery (RIRS) using low pulse energy and low pulse frequency. The study reveals minimal complications and comparable outcomes to thulium fiber laser (TFL). The lasering technique for pulsed-Tm:YAG may differ from TFL, with a slightly longer fiber-to-stone distance. Further clinical trials, particularly comparative studies, are necessary to determine the performance of pulsedTm:YAG in comparison to other laser technologies available for ELL.
