{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T10:27:42Z","timestamp":1789122462168,"version":"build-2803163510"},"reference-count":24,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:00:00Z","timestamp":1789084800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background &amp; Objectives: Laser lithotripsy is the standard energy source for mini-percutaneous nephrolithotomy (mini-PCNL). Although Holmium:YAG (Ho:YAG), Thulium Fiber Laser (TFL), and pulsed Thulium:YAG (p-Tm:YAG) are currently available for clinical use, direct comparisons among all three laser technologies are lacking. This study aimed to compare the efficacy, safety, and procedural performance of Ho:YAG, TFL, and p-Tm:YAG during mini-PCNL. The primary endpoint was the stone-free rate (SFR). Secondary outcomes included complications, operative time, lasing time, total energy delivered, and laser-related procedural metrics. Methods: Consecutive patients treated with p-Tm:YAG during mini-PCNL for renal stones were prospectively enrolled and compared with two cohorts from our institutional database treated with Ho:YAG or TFL. All procedures were performed using the same mini-PCNL technique and predefined laser settings selected to achieve the closest technically feasible match among the three platforms. Results: Ninety patients were included (30 per group). No significant differences in SFR were observed among Ho:YAG, TFL, and p-Tm:YAG (p = 0.93), or in overall complication rates (p = 0.93). After adjusting for stone volume, density, composition, and location, the laser platform was not independently associated with SFR, whereas stone volume was the only independent predictor of stone-free status. TFL exhibited a significantly longer operative time than Ho:YAG and a longer lasing time than both Ho:YAG and p-Tm:YAG, and was associated with greater total energy delivery, lower ablation efficiency, and lower ablation speed. Conversely, p-Tm:YAG demonstrated a significantly shorter lasing time than TFL and an ablation efficiency similar to that of Ho:YAG, with lasing time and ablation speed values between those observed with Ho:YAG and TFL under the evaluated settings. Laser efficacy did not differ significantly among the three groups. Conclusions: No significant differences in stone-free or safety outcomes were observed among the three laser platforms in mini-PCNL. Although significant differences were observed in lasing time, ablation speed, and energy utilization, p-Tm:YAG demonstrated an intermediate procedural profile under the operating parameters evaluated in this study. Overall, the present findings suggest that p-Tm:YAG represents a feasible treatment option for mini-PCNL, although larger randomized studies are needed before firm conclusions regarding relative platform performance can be drawn.<\/jats:p>","DOI":"10.3390\/jcm15187049","type":"journal-article","created":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T09:09:40Z","timestamp":1789117780000},"page":"7049","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pulsed Thulium:Yag, Thulium Fiber, and Holmium:Yag Lasers in Mini-PCNL: A Three-Arm Comparative Cohort Study"],"prefix":"10.3390","volume":"15","author":[{"given":"Silvia","family":"Proietti","sequence":"first","affiliation":[{"name":"Department of Urology, IRCCS San Raffaele Hospital, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"}]},{"given":"Cristian Axel","family":"Hernandez Gaytan","sequence":"additional","affiliation":[{"name":"Department of Urology, IRCCS San Raffaele Hospital, 20132 Milan, Italy"},{"name":"Department of Urology, Instituto Nacional de Ciencias M\u00e9dicas y Nutrici\u00f3n \u201cSalvador Zubir\u00e1n\u201d, Mexico City 14080, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4150-6978","authenticated-orcid":false,"given":"Jorge Augusto","family":"Alcacio-Mendoza","sequence":"additional","affiliation":[{"name":"Department of Urology, Instituto Nacional de Ciencias M\u00e9dicas y Nutrici\u00f3n \u201cSalvador Zubir\u00e1n\u201d, Mexico City 14080, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"}]},{"given":"Franco","family":"Gaboardi","sequence":"additional","affiliation":[{"name":"Department of Urology, IRCCS San Raffaele Hospital, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]},{"given":"Guido","family":"Giusti","sequence":"additional","affiliation":[{"name":"Department of Urology, IRCCS San Raffaele Hospital, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1376","DOI":"10.1016\/j.euf.2021.07.014","article-title":"Mini versus standard percutaneous nephrolithotomy for the management of renal stone disease: Systematic review and meta-analysis of randomized controlled trials","volume":"8","author":"Sharma","year":"2022","journal-title":"Eur. 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