Thulium Fiber Laser Versus Holmium:Yag Laser: What Is The Best Choice For Endoscopic Lithotripsy?

Abstract

The use of pulsed lasers was a watershed in endourology. In this scenario, the Holmium:YAG
Laser (Ho:YAG) stood out and is recommended as the gold standard for endoscopic lithotripsy
by several international guidelines. However, new technologies have emerged in urological
surgery, with special emphasis on the Thulium Fiber Laser (TFL), which has demonstrated
encouraging results in initial analyses. OBJECTIVE: To review the available literature on the
application of TFL in endoscopic lithotripsy, in order to evaluate its efficacy, safety and
comparisons with the already established Ho:YAG Laser.
A systematic literature review was carried out using the PubMed/MEDLINE, SciELO and
LILACS databases, with the descriptors “Thulium Fiber Laser”, “Holmium:YAG Laser” and

“Lithotripsy”. The inclusion criteria were: articles in English, Spanish and Portuguese,
complete, with a publication date between 2018 and 2024 and relevance according to the
proposed objectives.
Initially, 54 articles were identified. 39 studies that met the pre-established eligibility criteria
were included in this systematic review. In total, 402 patients participated in the selected
randomized clinical trials. From pre-clinical studies, it is noted that TFL presents superior
characteristics to Ho:YAG in several aspects, such as integration of thinner fibers, more
effective wavelength (closer to the water absorption peak), higher rate stone ablation and
pulverization and different modes of action, which provide a reduction in stone retropulsion.
Preliminary clinical research demonstrates that TFL shows promise in the context of
endoscopic lithotripsy, as well as presenting several advantages compared to Ho:YAG.
However, comparative controlled clinical studies between the two technologies are still scarce.

In this sense, more randomized trials are essential to confirm the efficiency, safety and cost-
benefit of TFL in clinical practice, in order to definitively confirm all the benefits mentioned.

In this way, it will be possible to assess whether TFL can, in fact, consolidate itself as the new
gold standard in endoscopic lithotripsy.