Holmium Pulse Shapes and the Effect on Ablation Efficiency

Holmium lasers have become the standard of care in urology, especially for laser lithotripsy treatments. However, up until now, the industry has continued to fall upon challenges, as technologies aimed at reducing retropulsion and stone migration hindered optimal energy transmission. Now, Lumenis’ MOSES™ Technology offers a breakthrough in this standard, providing the future of urology care and efficiency.

By leveraging versatility, speed and power, the MOSES Technology advanced the next generation of Lithotripsy and BPH treatments that are fit for all patients. 1-3 Offering a full spectrum of stone management techniques, including stone dusting and fragmentation fit for all stone sizes, compositions and locations, MOSES may reduce the need for retrieval devices and follow up procedures.

Holmium laser lithotripsy ablation is significantly affected by distance, the closer the fibre is to the stone, the more energy is delivered to the stone resulting in greater ablation. Therefore, if ablation is performed at a 1-2 mm distance from the stone, the results produce a larger ablation crater than at 3 mm distance. 4

The MOSES Technology harnesses a modulated pulse that achieves up to 2.6x greater ablation volume reducing the dependency of energy transmission on distance, thus enabling surgeons to treat patients from a distance without compromising on results. Furthermore, in higher frequencies up to 120Hz, MOSES has demonstrated up to 85% superior stone ablation. 4-7

This unique pulse modulation is optimised for two modes, ‘contact’ and ‘distance’ mode. The pulse shape is divided into two adjacent pulse peaks. The first pulse separates the water surrounding the stone and the second pulse travels through the vapour bubble created by the first pulse delivering the remaining energy towards the stone, therefore less energy is lost and the laser transmission is less dependent on fibre-stone distance. This innovative design minimises urinary stone retropulsion and improves stone fragmentation. 8

Dr. Khurshid Ghani conducted extensive research in the field, demonstrating “holmium laser lithotripsy ablation is significantly affected by fibre distance with the greatest ablation volume obtained with the fibre in contact with the stone.” Dr. Ghani concluded that the ablation crater produced by the MOSES technology was significantly larger than those produced by short and long pulse durations at the same energy level. 4

Dr. Michael Lipkin also demonstrated that the MOSES technology reduced stone mass more than both short and long pulse modes. 9

To see this revolutionary Holmium Laser technology in practice watch ‘The MOSES Technology by Lumenis’ video here. Showcasing how the MOSES pulse delivers results with an increased  stone ablation, a reduced retropulsion and a reduced stone migration. 8

https://www.youtube.com/watch?time_continue=1&v=XMoQ3F6a7Fo&feature=emb_title

For more information on how Lumenis’ MOSES technology provides efficient Lithotripsy results, with 20% faster procedures and 33% shorter fragmentation time  and how this can aid your clinic, contact us today [Link: https://lumenis.com.au/contact/].

References:

  1. Large T, Nottingham C, Stoughton C, Williams J Jr, Krambeck A. Comparative Study of Holmium Laser Enucleation of the Prostate With MOSES Enabled Pulsed Laser Modulation. 2020;136:196-201.
  2. Hussein Y, Petrelli F, Ceresoli F, Milesi R, Bellangino M, Vavassori I. HoLEP vs MoLEP,First Prospective Randomized Trial on 140 Patients. J Urol. 2020:203(4S).e1190.
  3. Deuker M, Rührup J, Karakiewicz PI, Welte M, Kluth LA, Banek S, Roos FC, Mandel P, Chun FKH, Becker A. Holmium Laser Enucleation of the Prostate: Efficacy, Safety and Preoperative Management in Patients Presenting with Anticoagulation Therapy. World J Urol. 2020 Jun 2. doi: 10.1007/s00345-020-03272-2.
  4. Aldoukhi AH, Roberts WW, Hall TL, Ghani KR. Watch Your Distance: The Role of Laser Fiber Working Distance on Fragmentation When Altering Pulse Width or Modulation. J Endourol. 2019;33(2):120-6.
  5. Elhilali MM, Badaan S, Ibrahim A, Andonian S. Use of the Moses Technology to Improve Holmium Laser Lithotripsy Outcomes: A Preclinical Study. J Endourol. 2017;31(6):598-604.
  6. Ibrahim A, Badaan S, Elhilali MM, Andonian S. Moses Technology in a Stone Simulator. Can Urol Assoc J. 2018;12(4):127-30.
  7. Data on file
  8. Ibrahim A, Elhilali MM, Fahmy N, Carrier S, Andonian S. Double-Blinded Prospective Randomized Clinical Trial Comparing Regular and Moses Modes of Holmium Laser Lithotripsy. J Endourology. 2020;34(5):624-8.
  9. Winship B, Wollin D, Carlos E, Li J, Peters C, Simmons WN, Preminger GM, Lipkin M. Dusting Efficiency of the Moses Holmium Laser: an Automated in vitro Assessment. J Endourol. 2018;32(12):1131-5.

Risk Information

The use of the MOSES Pulse 120H laser system and fibres and in urology is contraindicated for patients who are unable to receive endoscopic treatments or are intolerant to prolonged anaesthesia, as well as for resection or excision of large vascularised organs. Holmium lasers are intended solely for use by physicians trained in the use of the Ho:YAG (2.1 μm) wavelength.Incorrect treatment settings can cause serious tissue damage. The laser should be used only on tissues that are fully observable. See the system user manual for a complete list of contraindications and risks.

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