As more powerful lasers for lithotripsy have entered the market, they have boosted our ability to treat large stones more efficiently and avoid percutaneous removal. But we’ve learned that to get the most from high-powered lasers, power isn’t enough: we need control.

I treat an average of 40 kidney stone cases per month at two different hospitals—one equipped with a high-powered lumenis holmium laser with MOSES technology and another that offers a thulium fiber laser and a traditional 30-watt holmium laser.

With the MOSES laser, which optimizes pulse modulation and tissue targeting through Moses Technology I have a great deal of control over the power at both the high and low ends and I can work much more efficiently. I can scale up the power or dial it down based on the situation. In addition to high-frequency, fast-firing dusting of large stones in the kidney1,4, the MOSES laser can be dialed down to safely fragment smaller distal stones. I can control the power to safely and effectively treat stones in the delicate ureter without concern about charring2,3,4. As a result, when I have access to the MOSES laser, I can use it to treat stones of all sizes and locations, including large kidney stones up to 2cm in the calyces in select patients.3,4 I recently tried the laser with MOSES 2.0 technology, and I found it to be even more efficient.

“I treat an average of 40 kidney stone cases per month at two different hospitals—one equipped with a high-powered lumenis holmium laser with MOSES technology and another that offers a thulium fiber laser and a traditional 30-watt holmium laser”.

When I work in the second OR with the thulium fiber laser and a traditional 30-watt holmium laser, neither laser is an all-around solution. The thulium laser has the same high frequency as the MOSES laser, which is effective for dusting large stones in the kidney. However, because I have noticed more charring effect on mucosa with the thulium laser, I use the safe traditional holmium laser for stones in the ureter, so I don’t have to worry about scar tissue formation, stricture, obstruction of the kidney, increased stone formation, and additional surgery.

A secondary consideration with using a high-powered laser in the ureter is stone retropulsion. The MOSES laser generally produces less retropulsion than the thulium laser. If the high-frequency thulium laser is used in the ureter, it can kick a stone fragment into the kidney. If the surgeon is aware of the problem, extra time is needed to chase down the fragment. More commonly, the surgeon doesn’t know the fragment is in the kidney, and the patient could experience renal colic a few days later. I certainly do not want to tell a patient he’s stone-free, only to have him come back and tell me he passed a stone—or even worse, have to tell him he requires a second surgery.

Although thulium fiber laser is effective with large kidney stones and standard holmium is safe in the ureter, the MOSES laser stands out as a single laser solution for lithotripsy that fits all scenarios.* Regardless of the stone size or location, I know that the MOSES laser will be both effective and safe for my patients while giving me added reassurance and control during surgery.

  1. Tracey et al. Ureteroscopic High-Frequency Dusting Utilizing a 120-W Holmium Laser. J Endourol. 2018;32(4):290-295.
  2. Jiang H et al. Ureteroscopic treatment of ureteral calculi with holmium: YAG laser lithotripsy. J Endourol. 2007;21(2):151-4
  3. Ibrahim J et al. Double‐Blind Prospective Randomized Clinical Trial Comparing Regular and Moses Modes of Holmium Laser Lithotripsy. J Endourol. 2020 May;34(5):624-628.
  4. Wang M. Efficiency and Clinical Outcomes of Moses Technology with Flexible Ureteroscopic Laser Lithotripsy for Treatment of Renal Calculus. Urol Int. 2021;105(7-8):587-593

 

*As per the intended use and indications of use of Lumenis Pulse 120H as detailed in “Detailed Indications of Use” section in the User Manual (UM-10012510)

The above urology blog article is based on Dr. Ross Simon publication as per his own experience.

Risk information and laser safety label are available at Lumenis website, operator’s manual and brochure.

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This post was first published on Dr. Ross Simon’s Linkedin profile