Dusting Efficiency of the Moses Holmium Laser: An Automated In Vitro Assessment

Introduction: Moses technology is a novel Holmium:YAG laser system designed to minimize stone retropulsion and improve stone ablation when the laser is not in direct contact with the stone. Our aim was to assess the efficiency of Moses technology relative to short- and long-pulse lithotripsy using an automated in vitro dusting model of stone comminution. Methods: All tests were conducted using a Lumenis Pulse 120H Holmium:YAG laser with a 365 mu m Moses D/F/L fiber. Hard (15:3) and soft (15:6) Begostones mimicking calcium oxalate monohydrate and uric acid stones, respectively, were used. To assess ablation efficiency and fiber tip degradation, a dusting model was employed: the laser was moved by a three-dimensional positioning system in a spiral motion across a flat Begostone surface submerged in water. Ablation efficiency was measured as stone mass loss after 4 kJ of energy delivery. Fiber tip degradation was measured at 1 kJ intervals. Comparative trials with short pulse, long pulse, Moses contact, and Moses distance settings were completed with the laser tip positioned at 0, 1, and 2 mm distances from the stone at energy settings of 0.4 J delivered at 70 Hz. Results: In our dusting model, stone ablation was significantly greater the closer the laser was to the stone. On hard stones, pulse type did not have a significant impact on ablation at any distance. On soft stones at 0 mm, Moses contact produced the greatest ablation, significantly greater than long pulse (p < 0.05). At 1 mm, Moses distance produced significantly greater ablation than all other settings (p = 0.025) and was as effective as long or short pulse at 0 mm. At 2 mm distance, no pulse type demonstrated significantly different ablation. Fiber tip degradation was minimal and not significant between settings. Conclusions: Moses technology delivers greater ablation of soft stones when in contact and 1mm from the stone surface.