Moses 2.0 for High-Power Ureteroscopic Stone Dusting: Clinical Principles for Step-by-Step Video Technique

Khajeh, Nikta Rezakahn; Majdalany, Sami E.; Ghani, Khurshid R.

doi:10.1089/end.2021.0682

Cited by 11 publications

(8 citation statements)

References 25 publications

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“…Moses 2.0 ablation speed was slightly faster (0.97 vs. 0.88 mm 3 /s) but had a longer operative time. Rezakahn et al [ 25 ] obtained similar results with the Moses 2.0 only in terms of lasing time and total energy consumed.…”

Section: Discussionmentioning

confidence: 69%

“…There is limited clinical experience with Moses 2.0. We only found three reports, one of which was a single case report [ 23 , 24 , 25 ]. All studies performed ELL in kidney stones and used 230 μm laser fibers.…”

Section: Resultsmentioning

confidence: 99%

“…Finally, Rezakahn et al [ 25 ] performed a study explaining their first experience with Moses 2.0 for stones of around 1 cm. The contact laser lithotripsy used 0.2–0.3 J/100–120 Hz for debulking, and the MD mode with 0.5 J/80 Hz was used once the stone was fragmented.…”

Section: Resultsmentioning

confidence: 99%

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Moses and Moses 2.0 for Laser Lithotripsy: Expectations vs. Reality

Corrales

Sierra

Traxer

2022

JCM

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Moses technology was born with the aim of controlling the Moses effect present in every single Ho:YAG laser lithotripsy. The capacity to divide the energy pulse into two sub-pulses gained popularity due to the fact that most of the energy would be delivered in the second pulse. However, is this pulse modulation technique really better for endocorporeal laser lithoripsy? A review of the literature was performed and all relevant clinical trials of Moses 1.0 and 2.0, as well as the lab studies of Moses 2.0 carried out up to June 2022 were selected. The search came back with 11 clinical experiences (10 full-text clinical trials and one peer-reviewed abstract) with Moses 1.0 and Moses 2.0, and three laboratory studies (peer-reviewed abstracts) with Moses 2.0 only. The clinical experiences confirmed that the MT (1.0) has a shorter lasing time but lower laser efficacy, because it consumes more J/mm3 when compared with the LP Ho:YAG laser (35 W). This gain in lasing time did not provide enough savings for the medical center. Additionally, in most comparative studies of MT (1.0) vs. the regular mode of the HP Ho:YAG laser, the MT did not have a significant different lasing time, operative time or stone-free rate. Clinical trials with Moses 2.0 are lacking. From what has been published until now, the use of higher frequencies (up to 120 Hz) consumes more total energy and J/mm3 than Moses 1.0 for similar stone-free rates. Given the current evidence that we have, there are no high-quality studies that support the use of HP Ho:YAG lasers with MT over other lasers, such as LP Ho:YAG lasers or TFL lasers.

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Section: Discussionmentioning

confidence: 69%

Section: Resultsmentioning

confidence: 99%

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Moses and Moses 2.0 for Laser Lithotripsy: Expectations vs. Reality

Corrales

Sierra

Traxer

2022

JCM

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“…Initial studies of HMM from Ghani et al which included 12 patients showed an improvement in SFRs for renal stones less than 2 cm using HMM [ 23 ]. However, SFRs were not assessed by Ibrahim et al [ 10 ], and while Wang et al and Pietropaolo et al found significant differences [ 14 , 15 ], in our analysis SFRs were not statistically significant.…”

Section: Discussionmentioning

confidence: 99%

Does Moses technology improve the efficiency and outcomes of standard holmium laser lithotripsy? A systematic review and meta-analysis

Riveros

Chalfant

Melchart

et al. 2022

Cent european J Urol

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Introduction Retrograde ureteroscopy with holmium laser lithotripsy (HLL) is a standard treatment for urolithiasis. Moses technology has been shown to improve fragmentation efficiency in vitro; however, it is still unclear how it performs clinically compared to standard HLL. We performed a systematic review and meta-analysis evaluating the differences in efficiency and outcomes between Moses mode and standard HLL. Material and methods We searched the MEDLINE, EMBASE, and CENTRAL databases for randomized clinical trials and cohort studies comparing Moses mode and standard HLL in adults with urolithiasis. Outcomes of interest included operative (operation, fragmentation, and lasing times; total energy used; and ablation speed) and perioperative parameters (stone-free rate and overall complication rate). Results The search identified six studies eligible for analysis. Compared to standard HLL, Moses was associated with significantly shorter average lasing time (mean difference [MD] -0.95, 95% confidence interval [CI] -1.22 to -0.69 minutes), faster stone ablation speed (MD 30.45, 95% CI 11.56–49.33 mm 3 /min), and higher energy used (MD 1.04, 95% CI 0.33–1.76 kJ). Moses and standard HLL were not significantly different in terms of operation (MD -9.89, 95% CI -25.14 to 5.37 minutes) and fragmentation times (MD -1.71, 95% CI -11.81 to 8.38 minutes), as well as stone-free (odds ratio [OR] 1.04, 95% CI 0.73–1.49) and overall complication rates (OR 0.68, 95% CI 0.39–1.17). Conclusions While perioperative outcomes were equivalent between Moses and standard HLL, Moses was associated with faster lasing time and stone ablation speeds at the expense of higher energy usage.

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“…In 1994, the Moses concept was developed to divide a single pulse into two smaller ones, each with a distinct peak strength. Lumenis (Lumenis Ltd., Yokneam, Israel) has recently introduced Moses 2.0, a new version of high-power (HP) laser that can operate at 120 Hz [ 5 ]. Nevertheless, whether this type of technology is superior to the standard low-power Ho:YAG laser remains unknown.…”

Section: Introductionmentioning

confidence: 99%