Category: Stones: Ureteroscopy
Introduction & Objective :
The holmium-YAG laser is a commonly used laser for endourological procedures, particularly for intracorporeal lithotripsy. Recently, the Moses technology has been developed in the issue of holmium laser: with this technology, laser pulse first separates the water and then it delivers the remaining energy toward the target stone. It has been demonstrated in the first and unique in vitro study that Moses technology resulted in more efficient lithotripsy and less stone retropulsion. The aim of this video is to describe this technology and to show its potentialities in intracorporeal lithotripsy.
This video gives an overview of how the Moses technology works, by using examples in vitro and in vivo of stone lithotripsy, comparing regular mode with Moses mode.
Moses technology introduces a pulse-shape modulation that optimizes energy delivery through water to the target tissue. On this way, less energy is lost and the energy transmission is optimized to the working distance. It also results in minimized stone movement due its vapor bubbles characteristics: the Moses technology delivers an initial vapor bubble and then the remaining energy can hit directly the stone. While the rest of the energy impacts the stone, the initial vapor bubble collapses away from the stone, pulling it back to its place. The collapse of the vapor bubble stabilizes the stone and minimizes its movement; this balance coupled with the smaller vapor bubbles characteristics and more targeted energy delivery results in significantly less stone retropulsion.
The Moses characteristics are also optimized for maximum energy delivery at two different fiber-target distances. The first setting, Moses contact mode, is optimized for operation at a close distance (around 1 mm). The second setting, Moses distance mode, is optimized for lithotripsy at a distance around 2 mm. The two different settings could be chosen according to the clinical scenarios: the distance mode could be useful during a lithotripsy with a stone from a distance due to anatomical restrictions or during the pop-corning technique. Moreover, the Moses mode induces a different ablation pattern when compared to the regular mode, leading to a more concise and narrow incision. The Moses technology results in more efficient laser lithotripsy, in addition to significantly reduced stone retropulsion that could lead to a shorter procedural time and safer lithotripsy.
Conclusions : The Moses technology has the potentiality to be a step ahead in laser lithotripsy. The true usefulness and safety of this new technology need to be assessed and validated by in vitro and in vivo studies.
Moises Rodriguez-Socarras– Urologist-Fellow, Ospedale San Raffaele-Turro, Milan, Italy., Milan, Lombardia, Italy
Silvia Proietti– Urologist, Ospedale San Raffaele Turro, Milan, Italy, Milan, Lombardia, Italy
Giuseppe Saitta– Ospedale San Raffaele-Turro, Milan, Italy., Milan, Lombardia, Italy
Guglielmo Mantica– Ospedale San Raffaele-Turro, Milan, Italy., Milan, Lombardia, Italy
Davide De Marchi– Ospedale San Raffaele-Turro, Milan, Italy., Milan, Lombardia, Italy
Piera Bellinzoni– Ospedale San Raffaele-Turro, Milan, Italy., Milan, Lombardia, Italy
Franco Gaboardi– Ospedale San Raffaele-Turro, Milan, Italy., Milan, Lombardia, Italy
Guido Giusti– Head of European Training Center in Endourology, Ospedale San Raffaele-Turro IRCCS , Milan, Italy, Milan, Lombardia, Italy
Ospedale San Raffaele-Turro, Milan, Italy.
Milan, Lombardia, Italy
Ospedale San Raffaele Turro, Milan, Italy
Milan, Lombardia, Italy
Dr Silvia Proietti graduated at University of Perugia (Italy) in 2006 with full marks cum laude.
During her residency, she won LLP-Erasmus Student Placement and she spent 4 months at Guy’s and St Thomas’ NHS Foundation Trust of London, under the direction of Professor Prokar Dasgupta; she also developed particular interest in functional urology, under the supervision of Professor Antonella Giannantoni.
She then graduated at School of Urology of University of Perugia on October 2006 with full marks cum laude.
From 2012 to April 2015 she was member of staff of Urology Department at Humanitas Clinical and Research Center in Milan and in particular at the “Stone Center” directed by Dr Guido Giusti.
In 2015, she did a 6-month fellowship in endourology at Tenon University Hospital under the direction of Professor Olivier Traxer.
She is currently working at Urology Department of San Raffaele Hospital, Ville Turro Division, in Milan, principally performing endourological treatment of stones and upper urinary tract tumors, which represent her main field of interest.
She is ViceDirector of the European Training Center of Endourology (ETCE) under the direction of Dr Giusti.
She is author of several papers published in peer-reviewed Journals and she won several awards at National and International meetings.