Initial experience in combined ultra-mini percutaneous nephrolithotomy with the use of 120-W laser and the anti-retropulsion “Moses effect”: the future of percutaneous nephrolithotomy?

• Published in: Lasers in medical science 2020-12, Vol.35 (9), p.1961-1966
• Main Authors: Leotsakos, Ioannis, Katafigiotis, Ioannis, Lorber, Amitay, Sfoungaristos, Stavros, Sabler, Itay M., Yutkin, Vladimir, Gofrit, Ofer N., Duvdevani, Mordechai
• Format: Article
• Language: English
• Subjects: Anesthesia; Complications; Dentistry; Fiber lasers; Fluoroscopy; Fragmentation; Hemoglobin; Holmium; Lasers; Medicine; Medicine & Public Health; Optical Devices; Optics; Original Article; Photonics; Prone position; Quantum Optics; Radiation; Radiation dosage; Semiconductor lasers; Sheaths; Stone; YAG lasers
• ISSN: 0268-8921; 1435-604X
• DOI: 10.1007/s10103-020-02986-4

The purpose is to present our preliminary results where ultra-mini PCNL (UMPCNL) with the new 120-watt laser with the anti-retropulsion (Lumenis® MOSES Pulse™120H Holmium: YAG laser) was used for the first time to our knowledge. Twelve patients underwent ultra-mini PCNL in prone position under general anesthesia using a 12-F nephroscope with a 14-F Access sheath in our tertiary center. The fragmentation was performed with a 500 μm laser fiber using the 120-watt Lumenis® MOSES Pulse™120H Holmium: YAG laser). Efficacy was considered in terms of stone-free rates (SFR), complication rate, duration of the operation, and hospital stay. Our SFR was 91.6% with 11 patients out of 12 being completely free of any residual stone. The duration of the operation was 86.4 ± 36.8 (40–165) min, whereas the mean laser time (real stone fragmentation laser time) was 755.7 ± 954.7(241–3425) sec. The total laser energy used was 39.7 ± 52 KJoules (11.3–182). The fluoroscopy time and radiation doses were 358.5 ± 180.4 (154–750) sec and 64.7 ± 41.2 (14.7–159.0) mGy, respectively. The mean reduction in levels of hemoglobin postoperatively was 0.6 ± 0.3 (0.1–0.9) g/dL, and no complications were observed. The combination of UMPCNL with the new 120-watt laser and the unique anti-retropulsion technology (Lumenis® MOSES Pulse™120H Holmium: YAG laser) delivered very promising results and it could be the future of PCNL.