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complete complex procedures more quickly and effectively. And the shorter operative time, thanks to this energy, is associated with many benefits, taking into consideration the risk of infection and bleeding when treating these complex stones. You have to invest in this energy, if you do a lot of PCNLs. Regarding mini-PCNL, I am not a big fan. Smaller access sheaths often mean longer operative times and difficulty ensuring complete stone clearance. Personally, I don’t believe that there is a difference between the invasiveness of standard and mini-PCNL. For me, safety and stone-free status are priorities, so I generally prefer standard PCNL.
T.S.: You have observed the evolution of flexible ureteroscopy and retrograde intrarenal surgery (RIRS) from their early stages to their current advanced forms. In your opinion, what have been the most significant milestones in this development?
I.K.G: I performed my first flexible ureteroscopy in 2001, with a reusable scope. At that time, scopes had poor vision and weak deflection. The other thing that was missing was the energy, because the only energy that I had available with flexible to go inside the kidney was the electric energy that was producing sparks and which was very dangerous. I think, the first milestone
was the development of more advanced scopes with better deflection and maneuverability. The second was the introduction of digital ureteroscopes around 2007–2008, which provided excellent visualization. Another major milestone was the development of lasers. Without lasers, endourology could not have progressed. More recently, suction-assisted access systems and flexible and navigable access sheaths (FANS) represent a revolution, addressing the problem of residual fragments. Although balancing suction, irrigation, and negative pressure remains a challenge (sometimes you have a collapse of the cavities, sometimes it doesn’t work, etc.), these are important steps forward. It is a working progress, but I think it is a milestone.
T.S.: During ureteroscopy (URS) and RIRS, which laser device and settings do you typically use, and why?
I.K.G: Okay! Very interesting and tricky question! I will go with two lasers. Pulsed Thulium:YAG again, because of the peak power and the high absorption in water. It is also versatile, because it has a peak power that is higher than TFL, so it can be effective for harder stones. But lately, I’m also using Holmium:YAG with a modified duration of the pulse and peak power, it is the Magneto technology. I’m impressed by its
Tεύχος 37 | Σεπτέμβριος - Οκτώβριος 2025
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