The first laser emission obtained from the holmium-doped YAG crystal at 2.1 µm was obtained at liquid nitrogen temperature in 1962 (Johnson and Soden, 1962). There have been many advances in holmium laser technology to better accommodate surgeon preferences, but the core elements, holmium ion and 2. µm have remained constant. Recently, the thulium fiber laser has been introduced for medical use. This laser has been cleared for the treatment of stones and soft tissue. In this article, we will briefly describe the technology, discuss its unique capabilities and features, what is currently available, and what is coming on the near-term horizon.

The Technology & Current Availability

The thulium fiber laser wavelength is approximately 1.9 µm. The current models are offered at 35 watts and 60 watts. Frequencies range from 1 Hz – 2,400 Hz. These devices are table-top and weigh under 90 lbs. The thulium fiber laser is a diode laser that uses a thulium-doped fiber. Currently, there is only one brand available for use in the United States, which is the Soltive laser, manufactured by IPG Photonics for Olympus Corporation.

Unique Capabilities and Features

In the treatment of stones, many surgeons prefer to “dust” rather than crack the stones. To do this requires higher repetition (Hz) rates. This is an area where the thulium fiber excels. Most high-powered holmium lasers have a maximum rate of 60 Hz whereas the thulium fiber is capable of 2,400 Hz. This offers more flexibility in settings, but there is also the potential to have settings that are unsafe in the urinary tract (high heat, less control). Another differentiating feature of the thulium fiber laser is size and weight. High-powered holmium lasers are large and heavy, some weighing 650 lbs. or more. The air-cooled thulium fiber lasers can be much more compact and lighter. Although there is not a lot of experience currently, the thulium fiber laser also has potential in the treatment of BPH. The combination of an effective stone and soft tissue laser has created quite a lot of buzz in the urologic community.

On the Near-Term Horizon

If you are considering purchasing or renting a thulium fiber laser, you may want to wait a few months as there are several new offerings on the near-term horizon. Word is that Lisa Laser (Omniguide), Quanta, and Convergent all have models being introduced before the end of 2021. From what we are hearing, there are a number of feature and price improvements in the works with these new lasers. This technology is new and exciting and offers a lot of promise in the future treatment in urologic and other surgical applications.

                                                                                        ***UPDATE​​​***

The Optica, Convergent's thulium fiber laser is here and now available for purchase or rental! The Optica is a 1940nm wavelength laser capable of dusting stones at very high repetition rates and with enough power to perform prostate enucleations. All of this is in a 95-pound box. Contact us today to get a first-hand look at this awesome new technology

Medworks thanks Darrell Shires for his contribution to this article.