Precision in Access: The Laser Direct Alignment Radiation Reduction Technique <i>Versus</i> Conventional Fluoroscopic Renal Access

<b><i>Introduction and Objective:</i></b> The laser direct alignment radiation reduction technique (DARRT) presents a novel approach integrating pulsed low-dose fluoroscopy, ultrasound, direct endoscopic visualization, and laser targeting to minimize fluoroscopy exposure during percutaneous nephrolithotomy (PCNL). This study aims to evaluate the safety and efficacy of laser DARRT in comparison with traditional fluoroscopic PCNL access. <b><i>Methods:</i></b> A retrospective analysis was conducted on patients who underwent PCNL. Patients with pre-existing nephrostomy tubes for access and those who underwent solely ultrasound-guided access were excluded from the study. The primary outcomes of the study were comparing fluoroscopy time used for renal access and total fluoroscopy time between the two groups. Secondary outcomes included relative stone-free rates (SFR) defined as ≤4 mm fragments on postoperative computed tomography scan and complication rates. Continuous variables were compared using an independent-sample <i>t</i> test, whereas categorical variables were compared using the chi-square test, with significance set at <i>p</i> < 0.05. <b><i>Results:</i></b> A total of 292 patients were eligible for the study. The laser DARRT reduced both access fluoroscopy time (10.8 <i>vs</i> 551.7 seconds; <i>p</i> < 0.001) and total fluoroscopy time (21.8 <i>vs</i> 597.7 seconds; <i>p</i> < 0.001). The relative SFR was significantly higher in the laser DARRT group compared with the conventional group (84.1% <i>vs</i> 64.1%; <i>p</i> < 0.001). There was no significant difference in complication rates between the two groups (<i>p</i> > 0.05). <b><i>Conclusions:</i></b> The laser DARRT led to a >95% reduction in access and total fluoroscopy times. By combining the advantages of fluoroscopy, ultrasound, endoscopic vision, and laser guidance, this technique represents a promising option for improving outcomes and minimizing radiation-related risk.