Initial experience in combined ultra-mini percutaneous nephrolithotomy with the use of 120-W laser and the anti-retropulsion “Moses effect”: the future of percutaneous nephrolithotomy?

Leotsakos, Ioannis; Katafigiotis, Ioannis; Lorber, Amitay; Sfoungaristos, Stavros; Sabler, Itay M.; Yutkin, Vladimir; Gofrit, Ofer N.; Duvdevani, Mordechai

doi:10.1007/s10103-020-02986-4

Cited by 12 publications

(7 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Reddy et al [ 39 ] in 2021 published a prospective case series of 110 patients who underwent mini PCNL using Moses p120 W; they found that the use of Moses technology in conjunction with a proper suction system may potentially achieve maximum dusting, improving SFR. In a similar way, Leotsakos et al [ 40 ] published their series of 12 patients who underwent ultra-mini PCNL using the same technology.…”

Section: Resultsmentioning

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

View full text Add to dashboard Cite

(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.

show abstract

Section: Resultsmentioning

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

View full text Add to dashboard Cite

show abstract

“…Clinical trials have been performed using this technology for ELL, including percutaneous nephrolithotomy (PCNL) and ureteroscopy (URS). A study by Leotsakos et al [ 12 ] showed promising results when using MT in ultra-mini PCNL (UMPCNL). For stones of 7810.6 mm 3 , the laser was configured in Moses contact (MC) mode with the following settings: 0.6–0.8 J/80 Hz.…”

Section: Resultsmentioning

confidence: 99%

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

Corrales

Sierra

Traxer

2022

JCM

View full text Add to dashboard Cite

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.

show abstract

“…Beside these devices, holmium laser machines became an indispensable tool that was used mainly for ureteroscopic and mini-PCNL procedures, as well as for treating symptomatic prostatic enlargement, strictures, and upper tract urothelial cancer. 4,[11][12][13][14] Standard PCNL for the treatment of large and infected stones is still being carried out through 18-26 FR nephroscopes with 4-4.5 mm working channels, with the intention not only to dust or fragment the stones but also to actively remove the residual material. These needs cannot be accomplished with a laser fiber, even if it is wide (500-1000 nm) and used in combination with a stabilizing catheter to reduce fiber trepidations related to the pulsed photo-acoustic mechanism of the holmium laser.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…18–26 FR) is not well-defined. 4 , 5 As such, endourology units must be equipped with both ultrasonic and ballistic devices for PCNL in addition to the holmium laser for carrying out other endoscopic approaches. A novel laser suction handpiece (LSH) (Lumenis Ltd., Yokneam, Israel) was designed under the rationale that the endourological needs might be reduced to a single multipurpose source of energy.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Introducing in clinical practice a new laser suction handpiece for percutaneous nephrolithotomy

et al. 2021

View full text Add to dashboard Cite

Objective: To assess a novel combined laser suction handpiece (LSH) for performing PCNL in a clinical setting. Methods: The study comprised 40 consecutive PCNLs performed between May 2019 and February 2020. The first 20 procedures (Group A) were performed with conventional ultrasonic or pneumatic devices and the other 20 (Group B) were performed with the use of the new LSH. All patients were treated by tubeless supine PCNL. The groups were compared for demographics, clinical data, operative time, lithotrite effectiveness, stone clearance rate (SCR), and outcome. Results: Groups A and B were similar in age, and in stone size, complexity, and density (Hounsfield units) ( p < 0.05). The average operative time was 99 and 78 min, SCR 143 and 200 mm3/min, hospital stay 1.6 and 1.1 days, and stone-free rate 90% and 95%, respectively. Despite a trend toward better results with the new LSH, none of these comparisons reached statistical significance. Ineffective lithotripsy with the initial device (ultrasonic) requiring conversion to another modality (ballistic) occurred in six (30%) procedures in Group A, while all procedures were effectively accomplished with the LSH in Group B ( p = 0.02). There were two complications in Group A and none in Group B ( p > 0.05). Conclusions: The LSH is as effective and safe as the traditional lithotrites for performing PCNLs. This new tool completes the capabilities of the holmium laser high-power machines, enabling them to serve as the sole platform for all endourological treatments.

show abstract

Initial experience in combined ultra-mini percutaneous nephrolithotomy with the use of 120-W laser and the anti-retropulsion “Moses effect”: the future of percutaneous nephrolithotomy?

Cited by 12 publications

References 16 publications

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

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

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

Introducing in clinical practice a new laser suction handpiece for percutaneous nephrolithotomy

Contact Info

Product

Resources

About