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. [ABSTRACT FROM AUTHOR]