Introduction: Holmium laser is the current standard for ureteroscopic treatment of nephrolithiasis. We sought to compare stone disintegration using two state-of-the-art holmium laser systems and their unique settings: Lumenis Pulse 120H “MOSES 2.0” versus the Quanta MasterPULSE 100H (MP) “Virtual Basket” and “Vapor Tunnel”.
Methods: Two in-vitro experimental models were designed to investigate dusting and fragmentation of BegoTM stones (0.2g phantoms). Ureteral and calyceal models were constructed using a clear 30F vinyl tube and a metal screen with 1 mm aperture at one end. A ureteral access sheath was introduced at the opposite end, through which a flexible digital ureteroscope connected to saline irrigation was placed. Under direct vision, stone dusting was tested in the calyceal model in 4 scenarios: MOSES 2.0 distance and contact modes at 0.3J/70 Hz and 0.3J/120 Hz, and MP Virtual Basket and standard modes, both at 0.3 J/70 Hz. The ureteral model was then used to assess fragmentation and retropulsion using MOSES 2.0 distance and contact modes, and MP Virtual Basket and Vapor Tunnel modes, all at 0.8 J/8 Hz. Each scenario was repeated 3 times. Primary outcomes were time to complete dusting (calyceal model) and time for retropulsion of stones to 60cm (ureteral model); secondary outcomes were total energy used, and residual fragment weight after 4 minutes of fragmentation.
Results: All results are shown in figure 1. No significant difference was noted in dusting time across all groups (p = 0.21). More pronounced retropulsion was noted in the MOSES distance mode, when compared with Vapor Tunnel (113.3 sec vs. 126.7 sec respectively, p <0.05). However, retropulsion became similar with the MOSES contact mode, against both MS Vapor Tunnel and Virtual Basket modes. There was no significant difference in residual fragment weight after fragmentation (p = 0.055), and total energy expended was not significantly different.
Conclusions: In this benchtop model, we compared and demonstrate similar performance of two novel variants of holmium laser technology, the Lumenis MOSES 2.0 and Quanta MP Vapor Tunnel and Virtual Basket. Both systems were comparable in dusting time, stone retropulsion, and fragmentation at 4 minutes. Further clinical studies will help validate these findings.