Holmium:yttrium‐aluminium‐garnet laser with MOSES technology is more efficient than thulium fibre laser in supine mini‐percutaneous nephrolithotomy

Objectives To address the paucity of literature comparing outcomes achieved with utilisation of the high‐power holmium:yttrium‐aluminium‐garnet (Ho:YAG) laser with MOSES technology vs those achieved with the thulium fibre laser (TFL) in mini‐percutaneous nephrolithotomy (PCNL). Methods A retrospective review was performed of patients undergoing supine mini‐PCNL between August 2021 and May 2023. Exclusion criteria were urinary diversion, simultaneous utilisation of >1 laser platform, use of any other form of fragmentation, and ureteric stones. The Ho:YAG platform (Lumenis Pulse P120H™ with MOSES technology, 120W; Boston Scientific®) and the TFL (Soltive SuperPulsed Thulium Fibre [SPTF], 60W; Olympus®) were compared. Data on stone‐free rate (SFR) were determined by computed tomography performed on the first postoperative day and presented as absence of stone fragments, no fragments larger than 2 mm, or no fragments larger than 4 mm. Results A total of 100 patients met the inclusion criteria, 51 mini‐PCNLs with the Ho:YAG laser and 49 with the SPTF laser. No significant differences in demographics or stone characteristics were detected between the two groups. The Ho:YAG laser utilised less energy and time, resulting in higher ablation efficiency ( P < 0.05) and less total operating time ( P < 0.05). Overall, there was no difference in SFR in any category between the Ho:YAG group and the SPTF group (no fragments: relative risk [RR] 0.81, 95% confidence interval [CI] 0.59–1.12, P = 0.21; fragments <2 mm: RR 0.86, 95% CI 0.67–1.10, P = 0.23; fragments <4 mm: RR 0.96, 95% CI 0.80–1.15, P = 0.67). Conclusions Although we observed an equivalent postoperative SFR, this study supports a shorter operating time and greater intra‐operative laser efficiency with the Ho:YAG laser over the SPTF laser in mini‐PCNL.