In the field of stone treatment, laser technology continues to evolve.

In recent years, TFL lasers have received widespread attention. It has led to many exciting results. But it also exposed some problems that need to be further solved.

In 2020, some surgeons conducted a study, and they selected 15 patients as research subjects. These patients were treated with URS and the TFL laser was used to treat a single inferior calyceal stone.

Although the scope of the study is limited, its results are worthy of attention. Among them, the largest stone diameter successfully removed reached 3.2 cm.

This shows that TFL lasers showed potential in treating stones at an early stage.

The 2021 study focused on a comparison that analyzed the effectiveness of TFL lasers and holmium lasers in the treatment of ureteral stones in 174 patients, and the relevant literature has been published.

Data comparison shows that with TFL laser treatment, the stone regression rate is 4%; in comparison, with holmium laser treatment, the stone regression rate is as high as 69%, and there is a significant difference between the two.

Observing the stone clearance, follow-up found that patients treated with TFL laser generally achieved stone clearance, while only 94% of patients treated with holmium laser achieved this effect.

In terms of overall complication rate, it was 6%.

Studies have shown that during TFL treatment, the ablation rate of kidney stones can reach 1.16 cubic millimeters per second, which is twice as much as that of holmium laser treatment.

These data clearly point out that in the field of stone treatment, TFL laser shows obvious advantages.

It should be noted that although there are currently no published studies on thermal damage to the ureter, one case of bleeding has occurred in the renal collecting area, which occurred under the coagulation parameters of the laser (1 Joule × 20 Hz).

Niu et al. shared their practical experience in using TFL laser to perform mini-PCNL surgery (15/16F sheath).

After determining the preliminary treatment parameters as "0.2 Joules times 125 to 200 Hz", we found that the effect of powdered gravel and removal of stone powder was the most ideal. At this time, the average laser operation time is only 10.08 minutes.

This suggests that by determining the appropriate parameters for a specific type of surgery, the TFL laser can produce good results.

Each patient's specific situation is different, so various factors must be considered more carefully during clinical promotion.

TFL lasers can theoretically operate at frequencies exceeding 2000Hz, but they face difficulties in clinical application.

For example, when Hardy et al. studied temperature changes at different frequencies, measurements were taken at a distance of 3 mm from the in vitro urinary catheter model to the tip of the laser fiber.

In preparing for TFL laser treatment, consider using lower energy configurations such as 0.4 Joules and 6 Hz.

However, if a high-frequency energy configuration higher than 100Hz is used during surgery, it may cause a blizzard-like effect, thereby interfering with the surgical line of sight.

In clinical applications, reasonable frequency setting of TFL laser is crucial.

In clinical applications, 200 micron laser fiber is more suitable than 150 micron.

The 150-micron laser fiber is more susceptible to damage, but the 200-micron fiber is more convenient to operate and is more convenient to place in the endoscope. These factors play a positive role in the smooth progress of the surgery.

Appropriate laser fibers can enhance the ease of use of TFL lasers during stone treatment.

Although these studies have achieved results so far, they have limitations.

Ideally, these studies would be randomized controlled trials and direct comparisons with holmium lasers.

The follow-up period must be long enough to allow a more comprehensive and accurate assessment of the effectiveness of the TFL laser in stone treatment. Such evaluation results will provide more solid support for the further clinical promotion and application of this laser.

Dear readers, with the advancement of technology, do you think TFL laser will become a common method in the field of stone treatment in the future?