Presented by: Crystal Valadon MD, MBA
The University of Kansas Health System

Introduction

Miniaturized endoscopic combined intrarenal surgery (mini-ECIRS) comprises the simultaneous use of two different but complementary surgical techniques to treat kidney stones: miniaturized percutaneous nephrolithotomy and retrograde intrarenal surgery. This study aims to address the literature paucity regarding the outcomes of the utilization of the high-power Holmium:YAG (HoYAG) and the thulium fiber laser (TFL) in mini-ECIRS.

Materials

Data on patients undergoing supine mini-ECIRS was prospectively collected from 08/2021 to 09/2022, regardless of stone size or complexity. Exclusion criteria included patients with urinary diversion (e.g., ileal conduit), simultaneous utilization of > 1 laser platform, cases using any other form of energy fragmentation, and patients with ureteral stones. The utilized HoYAG platform was the Lumenis Pulse P120H™ (120W, Boston Sci®), while the TFL comprised the Soltive SuperPulsed Thulium Fiber (SPTF, 60W, Olympus®). Perioperative antibiotics were managed per EDGE consortium criteria. Stone-free status (SFS) was defined as the absence of stone fragments (i.e., 0% residual fragments) after assessing a CT scan performed on the first postoperative day.

Results

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A total of 74 patients met the study criteria, including 25 patients in the HoYAG and 49 in the SPTF groups. Table 1 exhibits patients’ demographic features and stones characteristics, with no significant differences between groups. HoYAG utilized less energy and time, resulting in higher ablation efficiency and speed (p<.001 and p=.039, respectively), with no reflection on total operative time (p=0.29). Overall, we observed no difference in SFR between HoYAG and SPTF (OR 0.52, CI 95% 0.19 – 1.40, p=0.19) – Table 2.

Conclusion

Although we observed an equivalence in operative time and immediate postoperative SFRs, this study depicts a higher intraoperative laser efficiency of the HoYAG over the SPTF in mini-ECIRS.

Funding

No funding.

Lead Authors

Wilson Molina, MD
The University of Kansas Health System

Co-Authors

Willian Ito, MD
The University of Kansas Health System

Nicholas Choi, BS
University of Kansas School of Medicine

Crystal Valadon, MD
The University of Kansas Health System

Donald Neff, MD
The University of Kansas Health System

David Duchene, MD
The University of Kansas Health System