Thulium laser: what it is, applications, advantages and surgical techniques

• Thulium laser is a new technique that can only be performed in selected medical centres.
• Benign prostatic hyperplasia has very good results when performed using the Thulium laser.
• The application of the Thulium laser can be nuanced in different techniques to best suit the specific case of the patient.

The Thulium laser is a relatively new type of surgical laser, with its first documented use in 2005.

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This new type of laser has two fundamental possibilities in its wave modality: continuous or pulsed, where the wavelength can vary from 1.75 to 2.22 μm.

This makes the Thulium laser a type of laser capable of offering great advantages over other types of lasers, such as better quality of the laser beam, the possibility of making a more precise incision and the choice of operating in continuous wave mode or in pulse mode.

The use of the Thulium laser is a very safe technique that provides very good results, as it usually has very few side effects, sometimes none at all. 

For these reasons, the Thulium laser is often replacing other surgical treatments that have been used for years, such as open surgery, and others that have not been used for so long, such as laparoscopic techniques.

Thulium laser is a very innovative technique that is not used in public hospitals due to the high cost of the equipment needed to apply this technique.

Although the Thulium laser is often used to repair benign prostatic hyperplasia, it also has a wide range of possible applications in a multitude of medical specialties:

• In General Surgery: frequently in laparoscopic surgery and tumour removal.
• In Urology: usually in incisions in the neck of the bladder and in condylomas, although its most common use, as mentioned above, is in the operation for BPH.
• In Gynaecology: usually in endometriosis and in the removal of polyps and tumours.
• In Pulmonology: usually in coagulation and malformations.
• In Otolaryngology: frequently in nasal turbinate hyperplasia and tonsillectomy.

In a very short time, the Thulium laser has become the most innovative treatment for the treatment of Benign Prostatic Hyperplasia, providing spectacular advantages over the usual techniques for resolving this problem.

Although the advantages it provides in this type of intervention are common advantages that it usually provides in any of its uses:

• It is a much faster laser than those that have been used up to now, so the time of the intervention is significantly reduced.
• It makes it possible to know how much tissue has been operated on.
• It reduces the possibility of complications, as it is a very effective and safe technique.
• Thulium laser has a great capacity for haemostasis, as part of the heat it emits spreads through the tissue surrounding the area to be operated on, so bleeding is significantly reduced, in some cases to the point of being non-existent.

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This allows for a much shorter hospital stay than with other techniques, which can be as little as 24 hours. It is also an important advantage for patients with specific surgical risks and for those taking anticoagulants.

Thulium laser allows the performance of several different surgical techniques, making it possible to adapt the surgical technique to the specific case of the patient to be operated on.

Vaporisation

The Vaporisation technique using the Thulium laser consists of heating the water inside the cells of the tissue to be operated on, until these cells reach 100 ºC and the water evaporates along with all the material that makes up the cell.

The laser fibre is then removed and a probe is placed to drain the serum and fluid that has been produced during vaporisation. The area is then cleaned.

Vapour Resection

The technique of Vapour-resection using the Tulio laser consists of combining the Vaporisation technique with the aggregation of the tissue resection by means of a laser beam.

This particular technique makes it possible to vaporise and also to obtain fragments of the tissue to be removed for subsequent analysis.

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Due to this advance, this technique becomes a more complex technique than the previous one (Vaporisation).

Vapo-enucleation

The Vapo-enucleation technique using the Thulium laser differs from the two previously described techniques (Vaporisation and Vapo-resection) in that it has the capacity to emit energy continuously, which in the end favours a complete enucleation in a significantly shorter time than would be necessary with other techniques.

In the treatment of benign prostatic hyperplasia, this technique can be used regardless of the prostate volume, so that possible complications are significantly reduced. As a direct consequence, this technique is often very suitable for prostate surgery.