Table 1.
Study details of the included in-vitro studies.
| Author, Year | Laser Used | Pulse Modulation Setting | Laser Setting (Energy J, Frequency Hz) |
Fiber Size (μm) | Fiber-stone Distance (mm) | Stone Composition | Hardness (Plaster: Water) | Experimental Conditions | Compared Variables | Summarized Results |
|---|---|---|---|---|---|---|---|---|---|---|
| King 2021 [22] |
Lumenis Pulse™ 120 H (Lumenis) | SP vs. MD | −1 J single pulse −0.5 J two pulses separated by at least 2 s |
200 | 1 | BegoStone and human COM, MAP and UA | Hard BegoStone (15:3) | Static laser activation for crater formation in: (1) Dry stones in air (2) Wet stones in air (3) Wet stones in water |
-Crater volume -Energy transmission through 1 mm water -Cavitation bubble collapse pressures |
Larger craters with MC and MD than with SP. All PMs had high energy transmission through 1 mm of water. No-Moses PMs generated much higher peak pressures. |
| Aldoukhi 2019 [23] |
Lumenis Pulse™ 120 H (Lumenis) | SP vs. LP vs. MC vs. MD | 1 J, 10 Hz | 230 | 0 0.5 1 2 |
BegoStone | Hard (15:3) for static crater experiment and soft (15:5) for moving laser cut | Static laser activation for crater formation and automatized moving laser-holding arm performing a 2 cm linear cut | -Ablation crater volume -Ablated mass (difference between phantom weight before and after laser action) |
More LSD distance, less ablation. No ablation from 3 mm distance. Greatest ablation was achieved with MD at 1 mm. Greater fragmentation at both 0 and 1 mm compared to other PMs. |
| Winship 2018 [24] | Lumenis Pulse™ 120 H (Lumenis) | SP vs. LP vs. MC vs. MD | 0.4, 70 Hz | 365 | 0 1 2 |
BegoStone | Hard (15:3) and soft (15:6) | Automatized moving laser-holding arm performed square lithotripsy in a spiral motion | -Ablated mass -Fiber tip degradation |
Less LSD, greater ablation regardless of stone composition and pulse modulations. No ablation difference between PMs on hard stones at any distance. In contact with soft stones, MC produced the greatest ablation. At 1 mm from soft stones, MD produced the greatest ablation. No differences in fiber tip degradation. |
| Aldoukhi 2020 [25] |
Lumenis Pulse™ 120 H (Lumenis) | LP vs. MD | 0.5 J, 20/40/80 Hz | 230 | 0 | BegoStone | Soft (15:5) | Automatized moving laser-holding arm cutting phantoms at 1 and 3 mm/s | -Crater depth -Crater area -Ablation volume |
Ablation MD > LP, specially at 3 mm/s MD has deeper craters than LP |
| Elhilali 2017 [16] |
Lumenis Pulse™ 120 H (Lumenis) | Regular Mode * vs. MC and MD | Fragmentation: 0.8 J, 10 Hz and 1.5 J, 10 Hz | 200 365 |
1 for MC 2 for MD |
Plaster of Paris (gypsum) stones and AU 3000 | UA 3000 (4:1) | -Static laser horizontal firing for retropulsion analysis -Automatized moving laser-holding arm performing a linear cut -Human performed RIRS for pyelic stone anesthetized pigs |
-Stone retropulsion -Ablation volume -Surgeon subjective retropulsion |
Less retropulsion and higher ablation volume in MC and MD compared to regular mode. Biggest difference with low energy with high frequencies (stone dusting regimes) together with larger diameter fibers. Less subjective retropulsion with Moses PMs but no differences regarding lasing and procedural times. |
| Dusting: 0.5 J, 50 Hz | ||||||||||
| Black 2020 [26] |
Lumenis Pulse™ 120 H (Lumenis) | SP vs. MD | 1 J, 20 Hz 0.5 J, 40 Hz 1 J, 40 Hz 0.5 J, 80 Hz |
230 | 2 | BegoStone | Hard (15:3) | Static laser pop-corn RIRS model in spherical test tube (repositioning the fiber in the center each 15 s) | -Fragment size distribution -Fragment mass lost in fluid |
At 1 J × 20 Hz, MD created smaller fragments than SP. MD created the smallest fragment size distribution for both 20 W and 40 W settings, except for the high frequency 80 Hz |
| Ibrahim 2018 [27] | Lumenis Pulse™ 120 H (Lumenis) | SP vs. MC | For fragmentation: 0.8 J, 10 Hz |
200 | 0 | UA 3000 | Soft (4:1) | Human performed lower pole RIRS in an artificial urinary trat model | -Subjective stone retropulsion -Time to compete dusting -Lasing time -Number of pedal uses -% laser on vs. Off -Total energy required |
MC: Less procedural time both in fragmentation and pulverization, less subjective retropulsion, reduced number of times the pedal was pressed and higher percentage of time lasing vs. pausing. |
| For dusting 0.4 J, 50 Hz | ||||||||||
| Keller 2018 [9] |
Lumenis Pulse™ 120 H (Lumenis) | LP vs. MC | 0.2 J, 40 Hz | 200 | - | Human COM, COD, UA, CA, MAP CA, MAP, BR and CYS | - | Human performed RIRS model inside a 10 mm diameter glass container | -Morphology of dust and residual fragments | MC: more pronounced disruption of morphological characteristics of COD, MAP and CYS. Areas with hexagonal plate-like surfaces appeared on residual fragments and dust from BR |
| Khajeh 2022 [28] |
Lumenis Pulse™ 120 H (Lumenis) | SP vs. LP vs. MC vs. MD | 0.5 J, 30 Hz | 230 | - | Canine COM stones | - | Human performed RIRS model in a 20 mm inner diameter spherical 3D printed calyceal model | -Residual fragment size distribution -Fiber tip degradation |
No difference between fragments <0.25 mm rate. MC and MD produced a greater mass of fragments <2 mm compared to LP Less fiber tip degradation with MC and MD than with SP. |
| Winship 2019 [29] | Lumenis Pulse™ 120 H (Lumenis) | SP vs. LP vs. MC vs. MD | 0.6 J, 6 Hz 0.8 J, 8 Hz 1 J, 10 Hz 1 J, 20 Hz 0.2 J, 70 Hz |
365 | - | No stone used | - | Static laser activation inside a UAS (URS model) | -Mean temperature change from a baseline adjusted to 37 °C at 1 s and every 5 s -Cumulative equivalent minutes at 43 °C |
At 1/10 Hz no thermal injury threshold was reached. LP generated the greatest temperature increase, but not statistically significant. Only MC at 0.2 J/70 Hz exceed the threshold by a small margin although this was not statistically significant |
| Ventimiglia 2020 [30] |
sTFL (Urolase SP) | Regular | 0.2–2 J, 8–80 Hz ~16 W combinations |
200 | 0 | BegoStone | Hard (15:3) | Static laser crater formation | -Retropulsion -Crater volume -Pulse shape |
Retropulsion: Lowest with sTFL, highest with SP. LP = Moses Stone ablation: sTFL > Ho:YAG. LP = Moses LP had longer pulse and lower peak power than SP SP mode had the shortest pulse width and highest peak power |
| Dual phase | ||||||||||
| Lumenis Pulse™ 120 H (Lumenis) | SP LP MC |
230 | ||||||||
| Jiang 2021 [31] |
sTFL (IPG Photonics) | - | 0.2 J, 80 Hz | 230 | - | Human calcium oxalate stones | - | Human performed pyelic RIRS in a porcine kidney with and without UAS and with or without continuous aspiration | -Stone clearance rate (SCR) -Residual fragment size distribution |
Highest SCR with sTFL with UAS and aspiration. Lowest SCR with Ho:YAG laser without UAS and no aspiration. sTFL resulted in smaller stone remnants compared to Ho:YAG and Ho:YAG-MOSES. All groups had similar proportion of stone remnants <100 microns. The use of UAS improved SCR regardless of the type of laser used or use of aspiration |
| Ho and Nd:YAG VersaPulse PowerSuite™ (Lumenis) | Regular Mode * | 0.4 J, 40 Hz | 420 | |||||||
| Lumenis Pulse™ 30 H (Lumenis) | Moses MP * | 0.2 J, 80 Hz | 408 | |||||||
| Terry 2021 [17] |
Lumenis Pulse™ 120 H (Lumenis) | SP LP MC MD |
0.4 and 1 J, | 272 | 0.5 1 2 |
BegoStone | Soft (15:6) | -Static laser crater formation -Automatized laser-holding moving arm generating a linear cut |
-Crater depth -Crater area -Crater volume -Cut volume -Pulse duration |
Ablation volume was different in all PMs. Lumenis MD had better lithotripsy performance. Lumenis MC was clearly inferior. VT maintains a much greater proportion of its 0.5 mm ablation efficacy once SD increases to 2 mm. |
| Litho 100 High Power (Quanta System) | SP LP VP |
|||||||||
| Ballesta 2021 [32] | Cyber Ho 150 W (Quanta System) | VB | 0.5 J, 20 Hz 1 J, 60 Hz 2 J, 30 Hz |
365 | - | BegoStone | Hard (15:3) and soft (15:6) | Static laser crater formation in saline media | -Ablation rate (difference between stone weight before and after lithotripsy /lithotripsy time -Laser activation time to reach 3 kJ |
Greatest ablation rate combination: VB, 2 J, 30 Hz. Lowest ablation rate: VT in hard stones. Ablation rates for VT and BB improved with increasing laser power. For hard stones, VB and BB had better performance with 2 J × 30 Hz than 1 J × 60 Hz. In low-power lithotripsy (10 W= 0.5 J × 20 Hz) ablation rate was higher with VB than VT |
| VT | 0.5 J, 20 Hz | |||||||||
| BB | 1.2 J, 10 Hz 1.2 J, 50 Hz 2 J, 30 Hz |
|||||||||
| Ho 2021 [33] |
H Solvo 35 W (Dornier MedTech) | FM vs. SM vs. AM | 0.8 J, 10 Hz | 365 | 0.5 1 2 |
Human COM and BegoStone | Hard (hCOM) and soft (BegoStone 15:6) | Static laser crater formation in air and saline media | -Crater volume -Maximum crater depth -Crater area -Dynamic of crater formation and its relation with the bubble formation |
Longer pulse durations (AM) result in greater laser energy delivery to the stone Shortest PM (FM and RM) had higher crater volumes predominantly by wider craters. Crater depths were comparable among PMs |
Abbreviations: SP: short pulse, LP: long pulse, MC: Moses Contact, MD: Moses Distance, RIRS: retrograde intrarenal surgery, URS: ureteroscopy, LSD: laser-stone distance, UAS: ureteral access sheath, BR: brushite, CA: carbapatite, COD: calcium oxalate dihydrate, COM: calcium oxalate monohydrate, CYS: cystine, MAP: magnesium ammonium phosphate, UA: uric acid, FM: Fragmentation Mode (full width at half maximum 75 μs), SM: Standard Mode (FWHM 150 μs,) AM: Advanced Mode (FWHM 200 μs), PM: pulse modes/modulations, VT: Vapor Tunnel, VB: Virtual Basket, BB: Bubble Blast, sTFL: super Thulium Fibre Laser, SD: Stone distance. * Does not specify if short or long pulse.