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A prospective comparative study of mini-PCNL using Trilogy™ or thulium fibre laser with suction



There has been recent introduction of novel lithotripters and high-power lasers for stone disintegration. With miniaturization of PCNL, there is need of effective disintegration and faster stone-clearance. This study aimed to evaluate efficiency of Trilogy™ and Thulium fibre laser (TFL) in mini-percutaneous nephrolithotomy (mini-PCNL).


This is prospective study comparing efficiency and outcomes of Trilogy™ and TFL in mini-PCNL between January 2019 and February 2020. Primary objective was to compare stone fragmentation rates, with secondary objectives beings stone-free rates and complications.


There were 60 mini-PCNL with suction using either Trilogy™ or TFL energy source. Mean stone size and density were 27.60 ± 10.17 mm, 22.04 ± 9.69 mm (p = 0.05) and 1172.9 ± 313.5HU, 1308.9 ± 333.9HU (p = 0.10) for Trilogy™ and TFL, respectively. Using 3D doctor imaging software from CT images, mean stone volumes were 3718.9 ± 3038.7mm3 for Trilogy™ and 3425.9 ± 3096.1mm3 for TFL(p = 0.77). Using probe-activation time or lasing time, stone-fragmentation rate was 5.98 ± 4.25mm3/sec for Trilogy™ and 3.95 ± 1.00mm3/sec for TFL(p = 0.015). Treatment time (puncture to complete clearance) was 32.48 ± 15.39 min for Trilogy™ and 28.63 ± 18.56 min for TFL(p = 0.38). Haemoglobin drop was 1.19 ± 0.76gm/dl for Trilogy™ and 0.99 ± 0.74gm/dl for TFL (p = 0.30). Trilogy™ arm had 96.6% complete clearance and TFL had 76.6% in TFL at 48 h. One patient in Trilogy™ arm required auxiliary RIRS for residual stone. Both arms had complete stone clearance at 1 month follow-up. Trilogy™ arm had 3 Clavien–Dindo grade-II complications while TFL had 2 Clavien–Dindo grade-II complications (UTI requiring antibiotics). There was no blood transfusion in either of arm.


Trilogy™ had significantly better stone fragmentation rate than TFL in managing renal stones. However, stone-free rates and complications were comparable for Trilogy™ and TFL.

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Authors and Affiliations



APP: protocol/project development, data analysis, manuscript writing/editing. RS: data collection or management. DS: data collection or management. AG: data collection or management. AGS: data analysis, manuscript writing/editing. APG: data analysis, manuscript writing/editing. RBS: protocol/project development, operating surgeon, data analysis, manuscript writing/editing. MRD: protocol/project development, operating surgeon, data collection or management, data analysis, manuscript writing/editing.

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Correspondence to Ravindra Sabnis.

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The authors declare that they have no conflict of interest.

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This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Muljibhai Patel Society for Research in Nephro-Urology (MPSRNU).

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Informed consent was obtained from all individual participants included in the study.

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Patil, A., Sharma, R., Shah, D. et al. A prospective comparative study of mini-PCNL using Trilogy™ or thulium fibre laser with suction. World J Urol 40, 539–543 (2022).

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  • Trilogy
  • Mini-PCNL
  • Thulium fibre laser
  • TFL
  • Suction