EAU 2018: Ureteroscopic Holmium Laser Lithotripsy Using the Moses Technology

Copenhagen, Denmark (UroToday.com) Dr. Khurshid Ghani presented his video on the use of “Moses” laser technology and outlined the use of these 120 watt lasers for holmium laser lithotripsy. Moses technology allows energy emission from the laser fiber to lead to the formation of a vapor channel or bubble through which the laser radiation is transmitted through. This phenomenon of separating fluid and creating a tunnel has been described as the “Moses Effect” in past studies which have demonstrated its high rates of ablation efficiency. 

During his presentation, Dr. Ghani presented several renal stone cases demonstrating the use of two Moses technology modes, “Contact” and “Distance” for stone dusting and fragmentation. Contact mode is optimized for use at a distance or around 1mm from the stone while Distance mode is optimized 2 to 3 mm from the stone. For all the cases presented laser setting of 0.4-0.5 J and 70-80 Hz were used for Contact and Distance modes with a 200 um laser fiber. 

The first patient had 13 and 11 mm renal stones with a density of 1200 HU. They started the case by nudging the pelvic stone into the upper pole using the ureteroscope and placing the patient in trendelenburg position. Then they began dusting using contact laser lithotripsy using the Moses technology Contact mode to break up the stone into dust and other smaller fragments. This was followed by non-contact laser lithotripsy using the popcorn technique to pulverize fragments in a calyx to produce fine stone residue for spontaneous passage.  The remaining renal cases used a combination of Contact and Distance modes followed by basketing. 

The results of the cases presented showed that the Moses technology Contact Mode helped to facilitate increased energy ablation, which was helpful for dusting large renal stones and was also helpful in reducing retropulsion. Distance mode was shown to be useful in breaking down stones in hard to reach calyces. Dr. Aldoukhi concluded by stating that further studies are needed to better understand the safety aspects of this technology. 

Presented by: Khurshid Ghani, MD 
Author Information: University of Michigan, Dept. of Urology, Ann Arbor, United States of America

Written by: Renai Yoon Department of Urology, University of California-Irvine at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark

Read More: 
Holmium Laser Lithotripsy Enhanced by Moses Technology - Beyond the Abstract
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