There is a dearth of data on the size distribution of laser lithotripsy pieces, stone density, and composition. When compared to bigger pieces (>3 mm), dust (1 mm) and tiny particles (1–3 mm) were too small to be effectively removed using forceps. For a study, researchers sought to describe the size distribution of pieces created during holmium laser lithotripsy. About 110 patients with renal calculi 3 cm underwent miniPCNL using the ClearPetra sheath, which has a controlled irrigation and suction system that reduced fragment dispersion and increased fragment aspiration. For lithotripsy, a Moses holmium laser with predetermined laser energy settings was employed. For the overall cohort, the proportion of fragment size 1 mm was 46.36+16.68%, 1–3 mm was 28.18+10.01%, and greater than 3 mm was 25.19+16.18%. In 77.3% of instances, complete stone removal was accomplished within 48 hours. At the 1-month follow-up CT, the remaining 22.7 % of patients had full clearance.

The majority of pieces generated in all stone density, volume, and composition groups were either 1 mm or 1–3 mm. Only 25% of the fragments were larger than 3 mm and could be suctioned out via the sheath or recovered with forceps. The combination of a high-power holmium laser with suction might aid in total stone clearing by aspirating tiny stone particles and dust while lasing.