The Efficiency of Moses Technology Holmium Laser for Treating Renal Stones During Flexible Ureteroscopy: Relationship Between Stone Volume, Time, and Energy

Majdalany, Sami E.; Levin, Brandon A; Ghani, Khurshid R.

doi:10.1089/end.2021.0592

Cited by 30 publications

(29 citation statements)

References 21 publications

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“…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%

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: Resultsmentioning

confidence: 99%

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

Corrales

Sierra

Traxer

2022

JCM

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“…Only Majdalany et al [ 36 ] have investigated Moses 2.0 compared to regular Moses PM (or Moses 1.0). They retrospectively compared the use of Moses 2.0 versus 1.0 in patients that underwent f-URS for solitary stones performed by a single surgeon, showing a SFR of 71% and 90% for Moses 1.0 and 2.0, respectively.…”

Section: Discussionmentioning

confidence: 99%

New Generation Pulse Modulation in Holmium:YAG Lasers: A Systematic Review of the Literature and Meta-Analysis

Sánchez-Puy

Bravo‐Balado

Diana

et al. 2022

JCM

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(1) Background: New pulse modulation (PM) technologies in Holmium:YAG lasers are available for urinary stone treatment, but little is known about them. We aim to systematically evaluate the published evidence in terms of their lithotripsy performance. (2) Methods: A systematic electronic search was performed (MEDLINE, Scopus, and Cochrane databases). We included all relevant publications, including randomized controlled trials, non-randomized comparative and non-comparative studies, and in-vitro studies investigating Holmium:YAG lithotripsy performance employing any new PM. (3) Results: Initial search yielded 203 studies; 24 studies were included after selection: 15 in-vitro, 9 in-vivo. 10 In-vitro compared Moses with regular PM, 1 compared Quanta’s, 1 Dornier MedTech’s, 2 Moses with super Thulium Fiber Laser, and 1 compared Moses with Quanta PMs. Six out of seven comparative studies found a statistically significant difference in favor of new-generation PM technologies in terms of operative time and five out of six in fragmentation time; two studies evaluated retropulsion, both in favor of new-generation PM. There were no statistically significant differences regarding stone-free rate, lasing and operative time, and complications between Moses and regular PM when data were meta-analyzed. (4) Conclusions: Moses PM seems to have better lithotripsy performance than regular modes in in-vitro studies, but there are still some doubts about its in-vivo results. Little is known about the other PMs. Although some results favor Quanta PMs, further studies are needed.

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“…Majdalany et al . [ 20 ] used Moses Technology, P120 laser for a mean stone volume of 290 mm 3 and found the laser efficacy to be 38.2J/mm 3 and the ablation speed to be 0.9 mm 3 /s. In this study, 60W TFL was used for a mean stone volume of 1061.85 mm 3 , and found the laser efficacy was 14.35J/mm 3 and the ablation speed was 0.86 mm 3 /s.…”

Section: Discussionmentioning

confidence: 99%

“…To the best of our knowledge this is the first study focussing on the work efficiency of 60W Superpulse TFL in a clinical setting. The recent clinical studies on Moses laser technology[ 20 ] and TFL[ 15 ] were done on 29 and 40 patients, respectively. This study was done in a larger cohort of patients ( n = 126).…”

Section: Discussionmentioning

confidence: 99%

The clinical efficiency and safety of 60W superpulse thulium fiber laser in retrograde intrarenal surgery

Vaddi¹,

Ramakrishna²,

Ganeshan³

et al. 2022

Indian Journal of Urology

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Introduction: Our aim is to evaluate the clinical efficiency and safety of 60W Thulium fiber laser (TFL) during retrograde intrarenal surgery (RIRS). The performance of the TFL across different ranges of stone volumes and stone densities is assessed. Materials and Methods: Between October 2019 and August 2020, a prospective study was done on 135 patients with < 20 mm renal stones, who underwent RIRS using TFL. Stone parameters, total laser time, total energy delivered (kJ), and fiber burn-back were recorded. Laser efficacy (J/mm3) and ablation speed (mm3/s) were calculated. Results: Data of 126 of 135 patients included in the study were analyzed. The mean patient age was 45.04 ± 12.30 years. Mean stone size was 15.19 ± 4.52 mm, and mean stone volume was 1061.85 ± 806.81 mm3. Mean laser time was 19.78 ± 12.32 min. At higher stone volume (>1000 mm3), J/mm3 decreased significantly from 16.18 ± 5.90 to 10.92 ± 3.21 (P < 0.001) and the ablation speed increased significantly (0.77 ± 0.28–1.04 ± 0.28 mm3/s [P < 0.001]). Stone density did not have a significant influence on the laser efficacy [B = -0.31 (-2.45 to 1.82, p=0.771)] or on the ablation speed [B = -0.06 (-0.17 to 0.05, p=0.278)]. Overall SFR was 93.6%. The complication rate was 16.6% (21/126). Out of the 21, 12 patients had hematuria and 9 had fever, which were of Clavien grades 1–2. Conclusion: Superpulse TFL is efficient and safe. The work efficiency increases for larger volume stones. The work efficiency remains the same across different stone densities. No complication more than Clavien grade 2 was encountered.

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The Efficiency of Moses Technology Holmium Laser for Treating Renal Stones During Flexible Ureteroscopy: Relationship Between Stone Volume, Time, and Energy

Cited by 30 publications

References 21 publications

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

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

New Generation Pulse Modulation in Holmium:YAG Lasers: A Systematic Review of the Literature and Meta-Analysis

The clinical efficiency and safety of 60W superpulse thulium fiber laser in retrograde intrarenal surgery

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