Use of the Moses Technology to Improve Holmium Laser Lithotripsy Outcomes: A Preclinical Study
Use of the Moses Technology to Improve Holmium Laser Lithotripsy Outcomes: A Preclinical Study
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DOI：
10.1089/end.2017.0050
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发表时间：
2017-06-01
影响因子：
2.7
通讯作者：
Andonian, Sero
中科院分区：
文献类型：
--
作者：
Elhilali, Mostafa M.;Badaan, Shadie;Andonian, Sero
目的：评价摩西激光技术在体外和体内的治疗效果，并与常规模式进行比较。方法：采用Lumenis(R)Pulse(TM)P120HHo激光系统，配合摩西D/F/L光纤，利用高速摄像机，比较常规模式和摩西模式对结石的消融效果。此外，使用猪输尿管镜模型来评估结石的碎裂和除尘以及激光-组织与输尿管壁的相互作用。结果：在体外实验中，激光脉冲后，使用摩西模式的结石移位实验显示，结石的回缩显著减少。在0.8J和10赫兹的频率下，结石的移动减少了50倍(p<；0.01)。在碎裂设置(高能)和除尘(低能量，高赫兹)过程中，明显地观察到摩西模式下的回退明显减少。此外，碎石试验表明，与常规模式相比，摩西模式的消融体积显著增加(高160%；p<；0.001)。活体评估也支持在治疗猪肾结石时减少退缩。对直接激光碎石后猪输尿管的组织学分析表明，与常规模式相比，直接激光碎石术对输尿管的损伤更小。结论：在显著减少结石回退的同时，MISH技术可获得更高的激光碎石效率，且具有一定的安全范围，可缩短碎石时间，提高碎石安全性。
Objective: To evaluate in vitro and in vivo effects of Moses technology in Holmium laser and to compare it with the Regular mode in terms of lithotripsy efficiency and laser-tissue interactions.Methods: The Lumenis (R) Pulse (TM) P120H holmium laser system together with Moses D/F/L fibers were used to compare the Regular mode with the Moses modes in stone retropulsion by using a high-speed camera, and stone ablation efficiency. In addition, a porcine ureteroscopy model was used to assess stone fragmentation and dusting as well as laser-tissue interaction with the ureteral wall.Results: After a laser pulse, in vitro stone displacement experiments showed a significant reduction in retropulsion when using the Moses mode. The stone movement was reduced by 50 times at 0.8 J and 10 Hz (p < 0.01). The pronounced reduction of retropulsion in the Moses mode was clearly observed during fragmentation setting (high energy) and dusting (low energy, high Hz). In addition, stone fragmentation tests showed that the Moses modes resulted in a significantly higher ablation volume when compared with the Regular mode (160% higher; p < 0.001). In vivo assessment also supported the reduction in retropulsion when treating stones in the porcine kidney. Histological analysis of the porcine ureter after direct lasing in the Moses mode suggested less damage than in the Regular mode.Conclusions: The Moses technology resulted in more efficient laser lithotripsy, in addition to significantly reduced stone retropulsion, and displayed a margin of safety that may result in a shorter procedural time and safer lithotripsy.