Category: Stones: PCNL

VS2-6 - Ambulatory Tubeless Mini-PCNL using Moses technology and Dusting Technique

Fri, Sep 21
10:00 AM - 12:00 PM

Introduction & Objective :

Mini-PCNL offers smaller tract dilatation which can be attractive when considering ambulatory stone surgery in select patients. Due to the miniaturization of equipment, the holmium laser serves as an ideal energy source for fragmentation. The Moses technology is a new pulse modulation method that can reduce stone retropulsion, which may have advantages when used during mini-PCNL. We present a case that evaluates the role of this new technology for mini-PCNL.

Methods :

A 63 year old patient with a 1.5 cm right lower pole stone (1300 Hounsfield Unit) underwent mini-PCNL using a 120W holmium laser (MosesP120, Lumenis). Moses has two modes - “Contact” and “Distance” - optimized for operation at 0-1 mm, and 2-3 mm from the stone surface, respectively. Percutaneous access was obtained into the lower pole. Using the medium size (17.5F) mini-PCNL set (Karl Storz), the stone was fragmented using dusting settings with a 230 um Moses ball-tip fiber (0.3J x 20-30Hz; Moses Contact and Distance modes).

Results :

The video demonstrates the capabilities of treating a lower pole stone with a dusting technique using the Moses mode. Dusting, to decrease the stone size so that it can fit within the sheath, in combination with fragment expulsion with the Venturi effect, as well as extraction with graspers/baskets resulted in complete stone removal. Following placement of an antegrade stent (tubeless technique) and sealing of the tract with FloSeal, the patient was discharged from the recovery unit. Ambulatory mini-PCNL was feasible with no adverse events. The ureteral stent was removed after 7 days, and follow-up KUB at 2 weeks showed zero fragments.

Conclusions :

In our early experience, the Moses technology with mini-PCNL allows a combination of dusting and stone extraction. For lower pole stones it can be performed in an ambulatory setting, and is an attractive alternative to ureteroscopy or shockwave lithotripsy with the potential for complete stone clearance.

Khurshid R. Ghani

Associate Professor of Urology
University of Michigan
Ann Arbor, Michigan

Khurshid Ghani is an Associate Professor of Urology at the University of Michigan. His research interests include novel techniques of endoscopic and robotic surgery for renal stone disease, health services research and surgical quality improvement. In particular Dr Ghani has been focused on advancing a Dusting technique for endoscopic stone surgery and has extramural funding to study optimal laser settings for holmium laser lithotripsy. He is the Course Director of the Developments in Ureteroscopic Stone Treatment (D.U.S.T.) symposium. In addition, Dr Ghani serves as Co-Director of the Michigan Urological Surgery Improvement Collaborative, which is a consortium of 44 urology practices aiming to improve the quality of urological care in the state of Michigan.

Ali H. Aldoukhi

Research fellow
University of Michigan
Ann Arbor, Michigan

I'm a research fellow in the Urology department at the University of Michigan. In our lab we study factors affecting stone fragmentation during holmium laser lithtotripsy.

James Shields

Assistant Professor
University of Michigan
Ann Arbor, Michigan