Which Laser for RIRS: Thulium Fiber Laser

Yi-Sheng TaiTaiwan Speaker Which Laser for RIRS: Thulium Fiber Laser Thulium Fiber Laser (TFL)is a type of fiber laser, distinct from Thulium laser used for prostate surgey. ​It’ a cutting-edge laser and rapidly gaining traction in urology ​The machine is compact, portable, quiet with air-cooling, and lower power consumption.It employs a thulium-doped silica fiber powered by diode lasers, emitting light at 1940 nm, matching water absorption peaks. ​This results in a high absorption coefficient and shallow penetration (~0.1 mm), enabling precise energy delivery and minimizing tissue damage.​Compared to Holmium lasers, TFL operates at lower energies (down to 25mJ) and higher frequencies (up to 2000Hz) for delicate tissue ablation and fine stone dusting.​ ​ The most notable change is pulse modulation​Ho:YAG lasers has Spike-shaped pulses and indicate greater energy concentration, resulting in higher localized heating, uneven fragmentation, and increased retropulsion.​TFL produces pulses with uniform energy distribution and lower peak power, resulting in consistent ablation with less retropulsion and fewer thermal spikes.​Higher water absorption rapidly forms a vapor channel, enhancing ablation efficiency. But, TFL is not as ideal in surgical scenarios. ​At settings of low pulse energy (0.2 J) and high frequency (100 Hz), it tends to cause troublesome char formation and spark generation, particularly when treating calcium phosphate stones. ​These phenomena, explosive combustion and carbonization can reduce ablation efficiency and increase the risk of thermal damage and fiber degradation. ​Optimizing TFL settings is very important for outcome and safety and ongoing evaluation. ​AI in Medical Imaging – Converting 2D Black & White to 3D and Applications in Mixed Reality (MR) used in RIRS Artificial Intelligence (AI) and Extended Reality (XR) are at the forefront of innovation in modern medicine. In endoscopic surgery, these technologies are increasingly being integrated to enhance procedural precision and intraoperative guidance. One experimental application involves using AI to convert 2D CT scans into 3D visualizations, offering surgeons a more intuitive understanding of anatomical structures. Devices like the Apple Vision Pro may be used to create fully immersive virtual environments, although it is not currently approved as a medical device. In clinical practice, Mixed Reality (MR)—which blends real and virtual environments with real-time interaction—has shown promise. MR has been used during Retrograde Intrarenal Surgery (RIRS) to reduce the risk of missed stones, and in Endoscopic Combined Intrarenal Surgery (ECIRS) to overlay anatomical data, improving puncture accuracy during Percutaneous Nephrolithotomy (PCN). As an emerging field, further advancements will depend on enhanced imaging resolution, improved intrarenal navigation and integration of AI-driven real-time stone detection.