Moses technology in a stone simulator

Ibrahim, Ahmad; Badaan, Shadie; Elhilali, Mostafa; Andonian, Sero

doi:10.5489/cuaj.4797

Cited by 51 publications

(47 citation statements)

References 12 publications

(19 reference statements)

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“…Laser fiber diameter, method of cleaving and laser technology also play a part in dusting and pop-dusting, and future studies also need to evaluate this aspect [16–18]. The impact of Moses technology in relationship to dusting and pop-dusting is still unclear and perhaps might carry an advantage due to decreased retropulsion, but this aspect needs to be studied further [19].…”

Section: Discussionmentioning

confidence: 99%

Role of ‘dusting and pop-dusting’ using a high-powered (100 W) laser machine in the treatment of large stones (≥ 15 mm): prospective outcomes over 16 months

et al. 2018

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Ureteroscopy and laser stone fragmentation (URSL) has had recent advancements with the more powerful laser systems with the ability to 'dust' and 'pop-dust' the stone. We wanted to look at the outcomes of this method for large stones (≥ 15 mm) using our new 100 W holmium laser. Over a period of 16 months (January 2017-April 2018), 50 patients underwent URSL for minimum cumulative stone size of ≥ 15 mm. Data were collected prospectively on patient and stone demographics and outcomes of URSL. The laser setting used was a power of 0.3-0.6 J and a frequency of 20-50 Hz using a long-pulse setting with a 272-µm fiber. Fifty patients underwent 55 URSL procedures (5 bilateral procedures) using dusting and pop-dusting settings. The mean age was 58 years (range 2-88 years) with a male:female ratio of 35:15. The mean single and overall stone size were 10.3 mm (3-23 mm) and 21 mm (range 15-52 mm) with two-thirds of all patients (65%) having multiple stones. The stone location was in the kidney (n = 65, 78%), in the ureter (n = 19, 22%) and 5 patients had bilateral renal stones. With a mean operating time of 51 min, the initial and final SFR were 93 and 98%, respectively. A pre-operative stent, access sheath and a post-operative stent were present in 29 (53%), 34 (62%) and 51 (93%) procedures, respectively. Over a mean hospital stay of 0.6 days (74% day-case procedures), there was one Clavien IV complication related to urosepsis but without any other major or minor complications. Dusting and pop-dusting techniques achieve an excellent SFR with low risk of complications even for large stones. This might set a new benchmark for treating large stones, bilateral or multiple stones in a single setting, without the need for secondary procedures in most cases.

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Section: Discussionmentioning

confidence: 99%

Role of ‘dusting and pop-dusting’ using a high-powered (100 W) laser machine in the treatment of large stones (≥ 15 mm): prospective outcomes over 16 months

et al. 2018

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“…Laser lithotripsy-related complications such as presence of ureteral mucosal injury and perforation were classified according to the modified Clavien grading system and compared between the two groups. 6 Success rate was assessed using low-dose CT scans at 3 months. Success rate was defined as no ureteral fragments or presence of nonobstructive renal fragments of £4 mm.…”

Section: Methodsmentioning

confidence: 99%

“…4,5 In addition, Moses mode was associated with significantly lower procedural time and significantly improved stone fragmentation efficiency than the regular mode. 6 However, there are no randomized clinical studies evaluating the effectiveness of this new Moses technology in reducing stone retropulsion and improving procedural and/or fragmentation/pulverization times during ureteroscopic Holmium laser lithotripsy. Therefore, the objective of this clinical trial was to compare regular and Moses modes of Holmium laser lithotripsy in terms of stone retropulsion, stone fragmentation/pulverization time, and procedural time during retrograde ureteroscopy in a double-blinded prospective randomized manner.…”

mentioning

confidence: 99%

Double-Blinded Prospective Randomized Clinical Trial Comparing Regular and Moses Modes of Holmium Laser Lithotripsy

Ibrahim

Elhilali

Fahmy

et al. 2020

Journal of Endourology

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Objective: To compare regular and Moses modes of holmium laser lithotripsy during ureteroscopy in terms of fragmentation/pulverization and procedural times in addition to perioperative complications. Patients and Methods: After obtaining ethics approval, a prospective double-blinded randomized trial was conducted for patients undergoing holmium laser lithotripsy during retrograde ureteroscopy. Patients were randomly assigned to either regular or Moses modes. Patients and surgeons were blinded to the laser mode. Lumenis 120W generator with 200 Moses D/F/L fibers were used. Demographic data, stone parameters, perioperative complications, and success rates were compared. The degree of stone retropulsion was graded on a Likert scale from 0-no retropulsion to 3-maximum retropulsion. Results: A total of 72 patients were included in the study (36 per arm). Both groups were comparable in terms of age and preoperative stone size (1.4 cm vs 1.7 cm, p > 0.05). When compared with the regular mode, Moses mode was associated with significantly lower fragmentation/pulverization time (21.1 minutes vs 14.2 minutes; p = 0.03) and procedural time (50.9 minutes vs 41.1 minutes, p = 0.03). However, there were no significant differences in terms of lasing time (7.4 minutes vs 6.1 minutes, p > 0.05) and total energy applied to the stones (11.1 kJ vs 10.8 kJ, p > 0.05). Moses mode was associated with significantly less retropulsion (mean grade was 1.0 vs 0.5, p = 0.01). There were no significant differences between both modes in terms of intraoperative complications (11.1% vs 8.3%, p > 0.05), with one patient requiring endoureterotomy for stricture in the Moses group. Success rate at the end of 3 months was comparable between both groups (83.3% vs 88.4%, p > 0.05). Conclusion: Moses technology was associated with significantly lower fragmentation/pulverization and procedural times. The reduced fragmentation/pulverization time seen using Moses technology could be explained by the significantly lower retropulsion of stones during laser lithotripsy.

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“…Pulse duration is one of the parameters we can work on, and long pulse duration was shown to reduce stone pushback in reproducible experimental conditions . Moses technology in holmium:YAG laser has been shown to significantly reduce retropulsion, in both dusting and fragmentation settings . A case series using the Moses technology for lithotripsy has been shown to decrease stone retropulsion in 18 of 23 procedures, with a trend of better fragmentation rate .…”

Section: Ureteroscopy and Retrograde Intrarenal Surgerymentioning

confidence: 99%

“…159,160 Moses technology in holmium:YAG laser has been shown to significantly reduce retropulsion, in both dusting and fragmentation settings. 161,162 A case series using the Moses technology for lithotripsy has been shown to decrease stone retropulsion in 18 of 23 procedures, with a trend of better fragmentation rate. 163 Cost-effectiveness analysis also showed that the decrease in lasing time achieved by the Moses system does not translate into sufficient cost savings to offset the higher cost of the laser fiber and software.…”

Section: Lithotripsymentioning

confidence: 99%

Updates in endourological management of urolithiasis

Teoh

2018

Int J of Urology

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Urinary stone disease, or urolithiasis, is a very common disease with increasing prevalence and incidence. With the advancement of endoscopic techniques, the treatment outcomes of ureteroscopy (or transureteral lithotripsy) and percutaneous nephrolithotomy are continuously improving. In recent years, there have been many new developments in the field, including new endoscopy design, more effective auxiliary tools, improvement in treatment protocols, introduction of robotic technology, combining both ureteroscopy and percutaneous nephrolithotomy (endoscopic combined intrarenal surgery or transureteral lithotripsy‐assisted percutaneous nephrolithotomy), improvement in laser technology, and so on. All these new inputs will further improve the treatment efficacy and safety of the procedures, thus benefiting our patients. In the present review, we briefly go through the main steps of ureteroscopy and percutaneous nephrolithotomy, with a concise description and application of these new advances.

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Moses technology in a stone simulator

Abstract: Introduction: The objective of this study was to compare fragmentation efficiency of the conventional regular mode of holmium laser to the Moses contact mode on a stone simulator. Methods: The Lumenis ® Pulse TM P120H holmium laser system together with Moses D/F/L

Cited by 51 publications

References 12 publications

Role of ‘dusting and pop-dusting’ using a high-powered (100 W) laser machine in the treatment of large stones (≥ 15 mm): prospective outcomes over 16 months

Role of ‘dusting and pop-dusting’ using a high-powered (100 W) laser machine in the treatment of large stones (≥ 15 mm): prospective outcomes over 16 months

Double-Blinded Prospective Randomized Clinical Trial Comparing Regular and Moses Modes of Holmium Laser Lithotripsy

Updates in endourological management of urolithiasis

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