Percutaneous nephrolithotomy (PCNL) is a well established procedure and accepted as the standard of care for the treatment of large renal calculi. Since the introduction of the holmium:yttrium-aluminum-garnet (Ho:YAG) laser into clinical practice in 1990, it has been used successfully to treat various urologic conditions. Today it is the modality of choice for retrograde intracorporeal stone disintegration ureteroscopically, and has also been used successfully for PCNL. One disadvantage when using the Ho:YAG laser for disintegration of renal calculi is the need for graspers to extract fragments and the mobilization of fragments due to the lack of simultaneous suction. We present our experience with a Ho:YAG laser in combination with simultaneous suction in an in-vitro model using a new endourologic technique in comparison to conventional ultrasonic lithotripsy.