Stone ablation efficacy: a comparison of a thulium fibre laser and two pulse-modulated holmium:YAG lasers.

We present preliminary stone ablation rate results from an automated bench model using two pulse-modulated Ho:YAG lasers and a thulium fibre laser (TFL) in contact and non-contact modes. Ablation rate was assessed using automated apparatus that moved the laser fibre across flat BegoStone phantoms at a constant stone-to-fibre working distance (WD). Pre-soaked and unsoaked stones were used. A range of powers (20-60 W) was tested at WD of up to 3 mm. In pseudocontact, the prototype Ho:YAG laser produced higher ablation than the reference Ho:YAG laser at all powers tested (p < 0.002), and higher ablation than TFL at 20 W and 40 W (p < 0.001). At distance, ablation rates for the prototype were higher than the reference Ho:YAG laser using pre-soaked stones at WD up to 3 mm (p < 0.001). TFL required the laser fibre to be moved faster (5-12 mm/s) for optimal ablation, compared to 1-3 mm/s for the Ho:YAG lasers. TFL was unable to demonstrate ablation with unsoaked BegoStone. At any given power, similar ablation rates were achievable with all three lasers under optimised conditions. Novel pulse-modulation modes demonstrated higher ablation rates than the reference Ho:YAG laser's pulse-modulation at a range of powers and WDs. Ablation rate of Ho:YAG lasers decreased linearly with WD whereas the ablation rate of TFL decreased rapidly beyond 2 mm WD. TFL was more affected by scan speed and pre-soaking of stone than Ho:YAG lasers. Ho:YAG lasers may be more practical in clinical settings because they are less dependent on ablation technique.