MP29-20: A prospective, single center randomised controlled trial comparing dusting and fragmentation modes of thulium fiber laser in retrograde intrarenal surgery.
Saturday, May 4, 2024 9:30 AM to 11:30 AM · 2 hr. (US/Central)
302B
Abstract
Information
Full Abstract and Figures
Author Block
Niramya J Pathak*, Abhishek Singh, Arvind Ganpule, Ravindra Sabnis, Mahesh Desai, Nadiad, India
Introduction
To compare the dusting versus fragmentation modes with Thulium fibre laser (TFL) in Retrograde Intrarenal Surgery (RIRS) for upper tract stones using the same fixed low power settings in both the arms. There is no study comparing only fragmentation and dusting modes with same fixed low power setting for upper tract stones including proximal ureteral stones. Primary objective was to compare stone free rate and secondary objectives were to compare mean operating times, hospital stay duration, complication rates, need for secondary procedures, laser efficacy.
Methods
A prospective, parallel group, single center, double blind, randomised controlled trial, with patients having proximal ureteral or renal stones of 10-20 mm size and planned for RIRS was done. Total of 60 consecutively admitted patients with signed consent were included for randomization with 30 patients in each arm of dusting and fragmentation modes. TFL company laser (Urolase SP, 35W, IPG Photonics), Ureteral access sheath (UAS), flexible disposable digital ureterorenoscope – Indoscope Sleek with 7.5 Fr outer diameter (bioradmedisysTM), 200 micron fiber were used. Fixed starting power of 10 Watts, laser settings of 0.1 J, 100 Hz for dusting mode and 1 J, 10 Hz for fragmentation modes. If the operating surgeon felt that the stone disintegration was not proper then he had the option of increasing the energy setting up to 0.15 J, 100 Hz for dusting and 1.5 J, 10 Hz for fragmentation modes, 15 watts power. No popcorn mode and no basketing was permissible.
Results
Median age in dusting and fragmentation arms of 41.5 and 45.5 years, median stone size of 10.45 and 12.25 mm, median stone volume of 351.6 and 490.7 mm3 and median stone density of 1263.5 HU in both arms with comparable hospital stay of median of 2 days in both arms. Lasing time was significantly lesser in the Fragmentation group (20.5 min – IQR 15.12-31.62) than in dusting group (34.25 min, IQR 26.62-38.62), p <0.001. Higher ablation speed for fragmentation mode (0.405 mm3/sec, IQR 0.337-0.635) than dusting mode (0.17 mm3/sec, IQR 0.135-0.325), p <0.001. Stone free rates and complication rates were comparable in both the arms.
Conclusions
TFL in fragmentation mode has shorter lasing times and better laser efficacy than dusting mode with comparable minimal complications, stone free rates and hospital stay duration.
Source Of Funding
None
Author Block
Niramya J Pathak*, Abhishek Singh, Arvind Ganpule, Ravindra Sabnis, Mahesh Desai, Nadiad, India
Introduction
To compare the dusting versus fragmentation modes with Thulium fibre laser (TFL) in Retrograde Intrarenal Surgery (RIRS) for upper tract stones using the same fixed low power settings in both the arms. There is no study comparing only fragmentation and dusting modes with same fixed low power setting for upper tract stones including proximal ureteral stones. Primary objective was to compare stone free rate and secondary objectives were to compare mean operating times, hospital stay duration, complication rates, need for secondary procedures, laser efficacy.
Methods
A prospective, parallel group, single center, double blind, randomised controlled trial, with patients having proximal ureteral or renal stones of 10-20 mm size and planned for RIRS was done. Total of 60 consecutively admitted patients with signed consent were included for randomization with 30 patients in each arm of dusting and fragmentation modes. TFL company laser (Urolase SP, 35W, IPG Photonics), Ureteral access sheath (UAS), flexible disposable digital ureterorenoscope – Indoscope Sleek with 7.5 Fr outer diameter (bioradmedisysTM), 200 micron fiber were used. Fixed starting power of 10 Watts, laser settings of 0.1 J, 100 Hz for dusting mode and 1 J, 10 Hz for fragmentation modes. If the operating surgeon felt that the stone disintegration was not proper then he had the option of increasing the energy setting up to 0.15 J, 100 Hz for dusting and 1.5 J, 10 Hz for fragmentation modes, 15 watts power. No popcorn mode and no basketing was permissible.
Results
Median age in dusting and fragmentation arms of 41.5 and 45.5 years, median stone size of 10.45 and 12.25 mm, median stone volume of 351.6 and 490.7 mm3 and median stone density of 1263.5 HU in both arms with comparable hospital stay of median of 2 days in both arms. Lasing time was significantly lesser in the Fragmentation group (20.5 min – IQR 15.12-31.62) than in dusting group (34.25 min, IQR 26.62-38.62), p <0.001. Higher ablation speed for fragmentation mode (0.405 mm3/sec, IQR 0.337-0.635) than dusting mode (0.17 mm3/sec, IQR 0.135-0.325), p <0.001. Stone free rates and complication rates were comparable in both the arms.
Conclusions
TFL in fragmentation mode has shorter lasing times and better laser efficacy than dusting mode with comparable minimal complications, stone free rates and hospital stay duration.
Source Of Funding
None