Can a 60-watt thulium fiber laser machine be used for surgical procedures?

From the Guidelines

No, you cannot safely perform surgical procedures with a 60-watt thulium fiber laser machine, as the power output is insufficient for effective tissue vaporization or enucleation. The most recent and highest quality study, 1, provides guidelines for the surgical treatment of male lower urinary tract symptoms, including recommendations for laser resection of the prostate using Tm:YAG laser. However, the study does not specify the minimum power output required for these procedures. Other studies, such as 1 and 1, discuss the efficacy and safety of various laser procedures, including thulium laser enucleation of the prostate (ThuLEP) and thulium vapoenucleation of the prostate (ThuVEP), but do not provide specific information on the minimum power output required. Given the lack of specific information on the minimum power output required, it is essential to prioritize patient safety and consider alternative treatment modalities or upgrade to a higher-powered laser system. Some key points to consider when evaluating the use of a 60-watt thulium fiber laser machine for surgical procedures include:

• The power output of the laser machine may be insufficient for effective tissue vaporization or enucleation, which could result in incomplete treatment, prolonged operative time, and potentially poor clinical outcomes.
• The shallow penetration depth (0.2mm) and precise cutting abilities of thulium fiber lasers make them suitable for prostate procedures, but the power output is crucial for effective vaporization.
• Enucleation techniques, such as ThuFLEP, can be performed at lower power settings, but vaporization procedures, such as THUVARP, typically require a minimum of 120-150 watts of power.
• Alternative BPH treatment modalities, such as bipolar transurethral resection of the prostate (TURP) or holmium laser enucleation of the prostate (HoLEP), may be more suitable for patients with certain prostate sizes or conditions.

From the Research

Surgical Procedures Using Thulium Fiber Laser

• The use of thulium fiber laser machines in surgical procedures has been studied in various research papers 2, 3, 4, 5, 6.
• These studies have investigated the application of thulium fiber lasers in urological surgery, including lithotripsy and prostate surgery.
• The evidence suggests that thulium fiber lasers can be used for surgical procedures, with studies showing promising results for lithotripsy and prostate surgery 2, 3.

Technical Specifications and Settings

• The technical specifications and settings of the thulium fiber laser machine used in these studies varied, with some studies using a 70-W laser 3, 6 and others using different settings for stone ablation and prostate surgery 2.
• The optimal settings for stone dusting in percutaneous nephrolithotomy (PCNL) were found to be 0.2 J and 125-200 Hz 2.
• For flexible ureteroscopic lithotripsy (FURSL), stone ablation settings ranged from 0.1-4 J, and 7-300 Hz 2.

Comparison with Other Lasers

• Some studies compared the use of thulium fiber lasers with other lasers, such as holmium lasers 5, 6.
• These studies found that thulium fiber lasers and holmium lasers had similar outcomes and effectiveness in relieving lower urinary tract symptoms and improving micturition parameters 5, 6.
• However, the choice of laser may not be as important as the surgeon's experience and technique in achieving good outcomes 5.

Safety and Complications

• The studies also investigated the safety and complications associated with the use of thulium fiber lasers in surgical procedures 3, 4, 5.
• The evidence suggests that thulium fiber lasers are safe and effective, with low rates of complications and adverse events 3, 4, 5.