This study investigates the efficacy of high-power Holmium
(HoYAG) and superpulsed thulium fiber laser (TFL) in miniaturized endoscopic combined intrarenal surgery (mini-ECIRS) for kidney stone treatment. Mini-ECIRS combines two techniques—miniaturized percutaneous nephrolithotomy and retrograde intrarenal surgery—in a minimally invasive approach to manage kidney stones of varying sizes and complexities. The study, conducted between August 2021 and May 2023, involved a retrospective cohort of patients undergoing supine mini-ECIRS, excluding those with urinary diversions (such as ileal conduits), multiple laser platform use, other stone fragmentation techniques, or ureteral stones. The lasers compared were the Lumenis Pulse P120H™ HoYAG (120 W, Boston Scientific®) and the Soltive SuperPulsed Thulium Fiber (SPTF) (60 W, Olympus®). Perioperative antibiotic protocols were managed according to EDGE consortium criteria, and stone-free rates (SFR) were assessed via postoperative CT scans, defining stone-free status as the absence of fragments or fragments under 2 mm or 4 mm.
Of 100 patients meeting the criteria, 51 were treated with HoYAG and 49 with SPTF, showing no significant demographic or stone characteristic differences. The HoYAG group required less energy and operating time, achieving higher ablation efficiency and shorter total operative time compared to the TFL group (p<0.05). Despite these intraoperative advantages, there was no significant difference in SFR outcomes between the groups across all fragment categories (no fragments, fragments <2 mm, fragments <4 mm). Overall, while both lasers provided equivalent SFR postoperatively, the HoYAG demonstrated superior efficiency in energy usage and reduced procedure time. This practical comparison highlights that HoYAG may offer enhanced operational efficiency in mini-ECIRS, despite similar postoperative outcomes to TFL.
