TY - JOUR
T1 - Experts’ recommendations in laser use for the treatment of upper tract urothelial carcinoma
T2 - a comprehensive guide by the European Section of Uro-Technology (ESUT) and Training Research in Urological Surgery and Technology (T.R.U.S.T.) group
AU - Ortner, Gernot
AU - Somani, Bhaskar Kumar
AU - Güven, Selcuk
AU - Kitzbichler, Gerhard
AU - Traxer, Olivier
AU - Giusti, Guido
AU - Proietti, Silvia
AU - Liatsikos, Evangelos
AU - Kallidonis, Panagiotis
AU - Ulvik, Øyvind
AU - Goumas, Ioannis Kartalas
AU - Duvdevani, Mordechai
AU - Baard, Joyce
AU - Kamphuis, Guido M.
AU - Ferretti, Stefania
AU - Dragos, Laurian
AU - Villa, Luca
AU - Miernik, Arkadiusz
AU - Tailly, Thomas
AU - Pietropaolo, Amelia
AU - Hamri, Saeed Bin
AU - Papatsoris, Athanasios
AU - Gözen, Ali Serdar
AU - Herrmann, Thomas R. W.
AU - Nagele, Udo
AU - Tokas, Theodoros
N1 - Publisher Copyright: © 2023, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2023/11
Y1 - 2023/11
N2 - Purpose: To highlight and compare experts’ laser settings during endoscopic laser treatment of upper tract urothelial carcinoma (UTUC), to identify measures to reduce complications, and to propose guidance for endourologists. Methods: Following a focused literature search to identify relevant questions, a survey was sent to laser experts. We asked participants for typical settings during specific scenarios (ureteroscopy (URS), retrograde intrarenal surgery (RIRS), and percutaneous treatment). These settings were compared among the reported laser types to find common settings and limits. Additionally, we identified preventive measures commonly applied during surgery. Results: Twenty experts completed the survey, needing a mean time of 12.7 min. Overall, most common laser type was Holmium–Yttrium–Aluminum–Garnet (Ho:YAG) (70%, 14/20) followed by Thulium fiber laser (TFL) (45%, 9/20), pulsed Thulium–Yttrium–Aluminum–Garnet (Tm:YAG) (3/20, 15%), and continuous wave (cw)Tm:YAG (1/20, 5%). Pulse energy for the treatment of distal ureteral tumors was significantly different with median settings of 0.9 J, 1 J and 0.45 J for Ho:YAG, TFL and pulsed Tm:YAG, respectively (p = 0.048). During URS and RIRS, pulse shapes were significantly different, with Ho:YAG being used in long pulse and TFL in short pulse mode (all p < 0.05). We did not find further disparities. Conclusion: Ho:YAG is used by most experts, while TFL is the most promising alternative. Laser settings largely do not vary significantly. However, further research with novel lasers is necessary to define the optimal approach. With the recent introduction of small caliber and more flexible scopes, minimal-invasive UTUC treatment is further undergoing an extension of applicability in appropriately selected patients.
AB - Purpose: To highlight and compare experts’ laser settings during endoscopic laser treatment of upper tract urothelial carcinoma (UTUC), to identify measures to reduce complications, and to propose guidance for endourologists. Methods: Following a focused literature search to identify relevant questions, a survey was sent to laser experts. We asked participants for typical settings during specific scenarios (ureteroscopy (URS), retrograde intrarenal surgery (RIRS), and percutaneous treatment). These settings were compared among the reported laser types to find common settings and limits. Additionally, we identified preventive measures commonly applied during surgery. Results: Twenty experts completed the survey, needing a mean time of 12.7 min. Overall, most common laser type was Holmium–Yttrium–Aluminum–Garnet (Ho:YAG) (70%, 14/20) followed by Thulium fiber laser (TFL) (45%, 9/20), pulsed Thulium–Yttrium–Aluminum–Garnet (Tm:YAG) (3/20, 15%), and continuous wave (cw)Tm:YAG (1/20, 5%). Pulse energy for the treatment of distal ureteral tumors was significantly different with median settings of 0.9 J, 1 J and 0.45 J for Ho:YAG, TFL and pulsed Tm:YAG, respectively (p = 0.048). During URS and RIRS, pulse shapes were significantly different, with Ho:YAG being used in long pulse and TFL in short pulse mode (all p < 0.05). We did not find further disparities. Conclusion: Ho:YAG is used by most experts, while TFL is the most promising alternative. Laser settings largely do not vary significantly. However, further research with novel lasers is necessary to define the optimal approach. With the recent introduction of small caliber and more flexible scopes, minimal-invasive UTUC treatment is further undergoing an extension of applicability in appropriately selected patients.
KW - Laser
KW - Percutaneous
KW - RIRS
KW - URS
KW - UTUC
KW - Urothelial cancer
UR - http://www.scopus.com/inward/record.url?scp=85173101726&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s00345-023-04632-4
DO - https://doi.org/10.1007/s00345-023-04632-4
M3 - Article
C2 - 37777981
SN - 0724-4983
VL - 41
SP - 3367
EP - 3376
JO - World Journal of Urology
JF - World Journal of Urology
IS - 11
ER -