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OBJECTIVES • To compare the Cyberwand (Gyrus/ACMI, Southborough, MA, USA), a dual-probe ultrasonic lithotrite, with a single-probe ultrasonic lithotrite. • The Cyberwand incorporates coaxial high-and low-frequency ultrasonic probes that work synergistically. PATIENTS AND METHODS • An institutional review board-approved, multicentre, randomized controlled trial to compare the Cyberwand to the Olympus LUS-II (Olympus America, Inc., Melville, NY, USA) single-probe lithotrite was performed. • Patients undergoing a percutaneous nephrolithotomy (PCNL) with a target stone >2 cm in diameter were eligible for the study. • The primary outcome was the time to removal of the targeted stone. RESULTS • A total of 57 PCNLs were performed after randomization: 25 Cyberwand and 32 LUS-II. • There was no difference (P> 0.05) observed between the two devices for target stone surface area (Cyberwand 526.6 cm 3 vs LUS-II 540.1 cm 3 ), time to clearance of target stone (Cyberwand 15.8 min vs LUS-II 14.2 min) and target stone clearance rate (Cyberwand 61.9 mm 2 /min vs LUS-II 75.8 mm 2 /min). • Of the patients with stone analysis, hard stones (calcium oxalate monohydrate, brushite and cystine) were noted in 14 (56.0%) of the 25 Cyberwand and 18 (62.1%) of the 29 LUS-II patients. • Fifteen of the 25 (60.0%) Cyberwand and 20 of the 32 (62.5%) LUS-II patients were stone-free after the initial PCNL. • Those patients not rendered stone-free went on to receive a secondary PCNL. • Device malfunction occurred in eight of 25(32.0%) Cyberwand and five of 32 (15.6%) LUS II patients. • Complications were similar in both treatment groups. CONCLUSION • No appreciable difference between the dual-probe Cyberwand and the standard ultrasonic Olympus LUS-II lithotrites can be identified.

OBJECTIVE: To traca the history of lithotripsy, marking the start of minimally invasive surgery. Methods: Primary and secondary sources describing the development of lithotripsy as a method to treat common bladder stones were reviewed. Results: To trace the history of lithotripsy, Lithotripsy emerged in the early 19th century as an alternative to the morbid and frequently fatal perineal lithotomy practised for thousands of years to relieve sufferers of bladder stones. Lithotripsy developed in stages, first by learning how to pass a straight hollow sound, then drilling stones to break them up, later by crushing them, followed by means to evacuate the fragments, finally by integrating the lithotrite with the cystoscope, permitting surgery under direct vision. CONCLUSIONS Lithotripsy evolved as the first minimally invasive surgical procedure owing to the ingenuity and skill of our urological forebears.