Rapid Thulium Fiber Laser Lithotripsy at Pulse Rates up to 500 Hz Using a Stone Basket

Our laboratory is currently studying the experimental thulium fiber laser (TFL) for ablation of kidney stones. Previous studies have reported increased stone ablation rates with TFL operation at higher pulse rates; however, stone retropulsion remains an obstacle to more efficient stone ablation. This study explores TFL operation at high pulse rates in combination with a stone stabilization device (e.g., stone basket) for improved stone ablation efficiency. A TFL beam with pulse energy of 35 mJ, pulse duration of 500 μs, and pulse rates of 10-500 Hz was delivered through 100-μm-core, low-OH, silica fibers, in contact mode with human uric acid (UA) and calcium oxalate monohydrate (COM) stones, ex vivo. TFL operation at 500 Hz produced mean UA and COM stone ablation rates up to 4.4 and 1.4 mg/s, respectively. High TFL pulse rates produce increased stone ablation rates that may be suitable for future translation into the clinic.