Stone ablation rates using innovative pulse modulation technology: Vapor tunnel, virtual basket, and bubble blast. An in vitro experimental study

Martínez, Begoña Ballesta; Peteinaris, Angelis; Tsaturyan, Arman; Natsos, Anastasios; Κούκιου, Γεωργία; Vagionis, Athanasios; Pagonis, Konstantinos; Adaibat, Mohamed; Liourdi, Despoina; Vrettos, Theofanis; Liatsikos, Evangelos; Kallidonis, Panagiotis

doi:10.1002/lsm.23503

Cited by 24 publications

(13 citation statements)

References 19 publications

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“…In addition, the influence of pulse modulation modes, such as MM and VBM, on irrigation temperatures has also been investigated. Both the MM and VBM are two-staged laser shot modes based on Moses technology and available by using Pulse 120H and Cyber Ho 100W, respectively [ 11 , 12 ]. In these modes, the second laser pulse penetrates the bubble of the first laser pulse.…”

Section: Discussionmentioning

confidence: 99%

Dynamic Changes in Fluid Temperatures during Laser Irradiation Using Various Laser Modes: A Thermography-Based In Vitro Phantom Study

Yamashita

Inoue

Imai³

et al. 2023

JCM

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The differences in dynamic thermal changes during laser lithotripsy between various laser pulse modes are unclear. We used thermography to evaluate the temporal changes in high-temperature areas during laser activation in order to compare different laser pulse modes. An unroofed artificial kidney model was used for the experiments. The laser fired for 60 s with a laser setting of 0.4 J/60 Hz in the following four different laser pulse modes without saline irrigation: short pulse mode (SPM), long pulse mode (LPM), virtual basket mode (VBM) and Moses mode (MM). Using the first 30 s of moving images, we compared the ratio of a high-temperature area of >43 °C to the total area every 5 seconds. The dynamic changes in fluid temperatures were shown to be different between the laser pulse modes. The extent of the high-temperature areas during the laser activation was large in the LPM and MM compared with the SPM and VBM. While the high-temperature areas expanded in an anterior direction in the early laser irradiation period using the LPM, they spread in a posterior direction in the early laser activation period using the MM. Although only the temperature profile in one specific plane was investigated, these results are considered useful for preventing thermal injuries during retrograde intrarenal surgeries.

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Section: Discussionmentioning

confidence: 99%

Dynamic Changes in Fluid Temperatures during Laser Irradiation Using Various Laser Modes: A Thermography-Based In Vitro Phantom Study

Yamashita

Inoue

Imai³

et al. 2023

JCM

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“…The future of lithotripsy research is focused on either optimizing current laser settings or developing new laser technology altogether. In a study comparing several laser pulse modulation technologies from Quanta Systems, the Virtual Basket demonstrated improved ablation rates by creating bubbles from the fiber tip compared to either Bubble Blast or Vapor Tunnel [ 26 ]. A comparison of holmium software systems from either Lumenis with Moses or Quanta Systems with Virtual Basket has not been explored but would be valuable to explore in the future.…”

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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“…MT has shown in multiples in-vitro studies superiority to short pulse and regular pulse [21,22]. Virtual Basket have shown to be better than Vapor tunnel and bubble blast at HP [19]. For now, only one in vitro study has shown better ablation with MT at distance mode vs. long pulse [23] and one in-vitro study has reported that Virtual Basket is better than long pulse achieving less operative time, better stone free rate and lower retropulsion [24 ▪ ] although more clinical evaluations are missing as some studies have also reported similar efficiency compared to long pulse [16 ▪ ].…”

Section: Holmium:yagmentioning

confidence: 99%

Lasers for stone lithotripsy: advantages/disadvantages of each laser source

Emiliani

Kanashiro

Angerri

2023

Current Opinion in Urology

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The purpose of this article was to make a narrative review of the literature in search of all articles regarding thulium:yttrium-aluminium-garnet (YAG), thulium laser fiber (TFL) and holmium:YAG (Ho:YAG) for lithotripsy from 2020 to 2023. A selection of articles of special interest and best evidence was made in order to give a better perspective on their advantages and disadvantages. Recent findingsNew Ho:YAG technologies of as high power, high frequency and pulsed modulations have shown promising results for lithotripsy by reducing retropulsion with good ablation efficiency. High peak power makes it particularly good for percutaneous nephrolithotomy. High intrarenal temperatures and correct setting are still concerning points. TFL has arrived to be one of the main players in flexible ureteroscopy. Being highly efficient and quick, and by producing micro-dusting the laser is quickly heading to become a gold standard. The new pulsed Thulium YAG is the newest laser. For now, only in-vitro studies show promising results with efficient lithotripsy. As the peak power lies between Ho:YAG and TFL it may be able to adequately perform when needing and low power lithotripsy. SummarySeveral new technologies have been developed in the last years for stone lithotripsy. All being efficient and safe if well used. Different advantages and disadvantages of each laser must be taken into consideration to give each laser the proper indication.

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Stone ablation rates using innovative pulse modulation technology: Vapor tunnel, virtual basket, and bubble blast. An in vitro experimental study

Cited by 24 publications

References 19 publications

Dynamic Changes in Fluid Temperatures during Laser Irradiation Using Various Laser Modes: A Thermography-Based In Vitro Phantom Study

Dynamic Changes in Fluid Temperatures during Laser Irradiation Using Various Laser Modes: A Thermography-Based In Vitro Phantom Study

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

Lasers for stone lithotripsy: advantages/disadvantages of each laser source

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