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

Abstract

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.

Thulium fiber laser in endourology: current clinical evidence

“…Ulvic et al [36] conducted one the first prospective randomized clinical trials on Ho:YAG and TFL during URS. The median laser on time was comparable in these groups – 8 [4–14,15 ▪▪ ,16,17 ▪▪ ,18,19] min in the Ho:YAG group and 10 [6,17 ▪▪ ] min in the TFL group, P = 0.9. TFL allowed for quicker surgery than Ho:YAG (median operation time 49 (32–63) min and 60 (45–70) min, respectively, P = 0.008).…”

“…During invitro trials, addition of pulse modulation resulted in an improvement in stone ablation rate [5,6]. However, according to the recently published systematic review by Corrales et al [7] clinical efficiency of systems with pulse modulation is seemingly similar to those without. Pulse modulation turned out to be a mere technical adjustment as opposed to a new step in lithotripsy.…”

Thulium oder Holmium-Laser oder beides: wo geht die Reise hin?

“…Die erste Serie, die über die Ergebnisse des TFL während der PCNL berichtete, wurde 2020 veröffentlicht und zeigte eine Gesamt-Steinfreiheitsrate von 85% bei einer 17%-igen Komplikationsrate, die allerdings nicht primär mit dem Laser zusammenhing [39]. Taratkin et al verglichen 56 Patienten, die sich einer Mini-PCNL (16,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)5 Fr) unterzogen mit 14 Patienten, die per URS behandelt wurden. In beiden Gruppen wurden Dusting-Einstellungen verwendet und es gab keine Unterschiede in den Ablationsraten.…”

“…In in-vitro-Versuchen führte die Pulsmodulation zu einer Verbesserung der Steinablationsrate [5,6]. In einer Übersichtsarbeit von Corrales et al zeigte sich allerdings kein Unterschied in der klinischen Effizienz von Systemen mit Pulsmodulation zu den Lasern ohne Pulsmodulation [7]. Im Gegensatz zu der lediglich technischen Anpassung der Pulseinstellungen bei Ho: YAG-Lasern, kam es auf Seiten der Thuliumlaser zu einem bedeutenden Fortschritt in der Lithotripsiezur Entwicklung des gepulsten Thuliumlasers [8].…”

“…However, as TFL is still a new technology, only limited studies are available to date, and optimal settings for lithotripsy have not been established. For enucleation, the differences of TFL compared [7]. Im Gegensatz zu der lediglich technischen Anpassung der Pulseinstellungen bei Ho: YAG-Lasern, kam es auf Seiten der Thuliumlaser zu einem bedeutenden Fortschritt in der Lithotripsiezur Entwicklung des gepulsten Thuliumlasers [8].…”