Holmium laser enucleation of the prostate using Moses 2.0 vs non‐Moses: a randomised controlled trial

Abstract

To compare the enucleation efficiency of Moses 2.0 with non-Moses technology in patients undergoing holmium laser enucleation of the prostate (HoLEP). Patients and MethodsA double-blinded, randomised study of patients undergoing HoLEP at the Mayo Clinic in Arizona, using the Lumenis Pulse TM 120H laser system. Patients were randomised to either right lobe enucleation using Moses 2.0 and left lobe enucleation using non-Moses, or the opposite. The primary outcome was individual lobe enucleation efficiency. Secondary outcomes included individual lobe laser time, laser energy, individual enucleation and haemostasis laser energies, and fibre burn back. Two independent reviewers watched videos of the procedures and provided a subjective evaluation of the technologies. ResultsA total of 27 patients were included in the study. For the entire cohort, Moses 2.0 had less fibre degradation (3.5 vs 16.8 mm, P < 0.01) compared to non-Moses. When HoLEP procedures were performed by an expert, Moses 2.0 resulted in shorter enucleation time (21 vs 36.7 min, P = 0.016) and higher enucleation efficiency (1.75 vs 1.05 g/min, P = 0.05) compared to non-Moses. When HoLEP was performed by trainees, the Moses 2.0 cohort had a shorter haemostasis laser time (4.1 vs 9 min, P = 0.035) compared to the non-Moses. Fibre degradation was lower with Moses 2.0 compared to non-Moses for both experts and trainees. Moses 2.0 received a higher score than the standard technology for the incision sharpness, fibre control, tissue separation, tissue damage, haemostasis, visibility, and charring. The overall inter-observer correlation coefficient was 0.63. ConclusionMoses 2.0 has higher enucleation efficiency compared to non-Moses when used by experts. The subjective evaluation favoured Moses 2.0.

Comparative analysis of MOSES^TM technology versus novel thulium fiber laser (TFL) for transurethral enucleation of the prostate: A single-institutional study

“…Recent evidence suggests that MOSES-TM technology has further revolutionized HoLEP with modulated pulsed energy transmission (9). Enhanced energy delivery is believed to increase efficiency during HoLEP and reduce the operative and catheterization times, as well as blood loss (10). HoLEP performed using MOSES TM technology has been shown to provide faster hemostasis than HoLEP with a standard 100-W holmium laser (9).…”

A Cost Comparison of Holmium Laser Enucleation of the Prostate with and without Moses™

“…13,14 Advancements in laser technology, such as the dual-pedal Lumenis 120H laser 15 and the Moses 2.0 upgrade have led to shorter times to achieve hemostasis and faster enucleation. 7,8 These clinical improvements translated to higher success rates with same-day discharges 16 and same-day catheter removals, 9 even for large glands !175 g. 10 Indeed, in one earlier series assessing the feasibility of outpatient HoLEP without Moses, the authors reported that of patients who were identified preoperatively as suitable for outpatient HoLEP, only 59.5% were able to be discharged. 17 The most common reason for failure of sameday discharge in that study was hematuria.…”

“…In the context of HoLEP, the new version of pulse modulation technology results in improved hemostasis, decreased bleeding, faster enucleation times and therefore, possibly a shorter learning curve. 7,8 We have extensive experience with HoLEP at our institution; nevertheless, after adopting the routine use of Moses 2.0 we were able to consistently achieve same-day discharges and same-day catheter removals. 7,9 Similar excellent outcomes were shown in large prostates !175 cc with the use of Moses 2.0.…”

Holmium: yttrium-aluminum-garnet laser with Moses: does it make a difference?

“…Two more RCTs [37 ▪ ,38 ▪▪ ] compared Moses Technology for HoLEP vs. the standard laser technology. The first one shares a limited sample size (n = 27) and a peculiar design, where each patient was treated with both Moses Technology and standard HoLEP [37 ▪ ], randomizing thus the prostatic lobe to be treated rather than patients themsevels. The second one [38 ▪▪ ] has a more conventional study design, and demostrates shorter operative (68 vs. 80 min, P = 0.03) and hemostasis time (mean: 18 vs. 29 min, P < 0.01) with M-HoLEP, although standard HoLEP patients had larger prostate size (153 vs. 131 g).…”