(UroToday.com) The 2022 WCET annual meeting included a Tuesday morning plenary session during which Dr. Roshan Patel and Dr. Wilson Molina debated the thulium fiber laser. Dr. Molina began the session with a presentation on the thulium fiber laser and argued in agreement with using the thulium fiber laser over the holmium laser.
He spoke about the different generations and advancements of the thulium laser and started his talk by referencing a 2022 study that demonstrated increased incidence of stone free rates and decreased bleeding with the use of a thulium laser (compared to the holmium). Dr. Molina did mention that the study was limited by the fact that only low laser settings were used and that it was only done in a single center. He commented on the fact that there are not enough randomized control trials directly comparing the two modalities. Dr. Molina then proceeded with a comprehensive and fascinating direct comparison of the thulium and holmium lasers on several metrics. Below is a picture from his presentation demonstrating his ratings out of 5 stars for different settings of each laser:
Dr. Molina concluded his talk by saying that he believes there will be many randomized control trials on the horizon for the thulium fiber laser which will prove its superiority. He gave the final score of 4.3/5 stars for the thulium laser and 3.6/5 stars for the holmium laser.
Following this presentation, Dr. Patel came to the podium and opened his talk with a fascinating analogy to the movie, The Matrix. He referenced the scene of having to pick between a red pill and facing the truth or picking the blue pill and remaining in blissful ignorance. In this analogy, he exclaimed that using a holmium laser is like picking the red pill and facing the truth while using a thulium laser is like picking the blue pill and remaining blissfully unaware. To back up his assertions, he noted that in prior studies comparing the two lasers, equal settings were not used and therefore the measurement of stone free rates was an unfair comparison. Dr. Patel also mentioned that stone carbonization, or charring, can occur with the thulium fiber laser. He proceeded to show a recorded video from one of his cases during which the phenomenon was evident and exclaimed that he had to switch to a holmium laser in that instance to break apart the stone. Dr. Patel concluded his talk by saying that the most optimal use of a thulium laser is for dusting stones, and that it is less effective for other instances when fragmentation is required. He remarked that the holmium laser is more versatile and effective for everyday use in laser lithotripsy.
Dr. Molina responded to Dr. Patel by noting that the thulium fiber laser is newer and therefore many improvements will be made to it in future generations. In the next generation, he commented, there will be increased peak power available for the thulium laser. Dr. Patel came to the podium for a second time and offered a rebuttal by comically referencing another Hollywood movie. He spoke about Lord of The Rings and asserted that the thulium laser is similar to the “ring” in that it corrupts the hearts of those who use it (slide presented below). Dr. Patel concluded by saying that the holmium laser is superior because it can be used to treat all stone types and that it is also useful in BPH surgery.
Presented by:
- Wilson Molina, MD - Professor of Urology, University of Kansas Medical Center, Prairie Village, Kansas, United States
- Roshan M. Patel, MD - Vice Chairman and Chief, Division of Endourology. Director, Kidney Stone Center, University of California, Irvine.
Written by: Allen Rojhani, BS - MD Candidate at the Drexel University College of Medicine and 2022-2023 LIFT Research Fellow at the University of California, Irvine Department of Urology, @allenrojhani on twitter, during the 39th World Congress of Endo urology and Uro-Technology (WCET), Oct 1 - 4, 2022, San Diego, California.