Duke urologists implemented the latest technology for minimally invasive ureteroscopy with laser lithotripsy more than two years ago, resulting in shorter and more efficient surgeries and improved patient outcomes. As more urologists are pivoting from shockwave to laser lithotripsy for the treatment of urinary tract stones, Duke is participating in new clinical trials and building research programs to help advance the science and application of lithotripsy.
In this Q&A, Duke urologist Michael E. Lipkin, MD, discusses the benefits of newer technologies and how Duke is remaining at the forefront of surgical and medical management of urinary tract stones.
Q: How does the latest laser technology for lithotripsy compare to traditional holmium lasers?
Lipkin: The high-speed MOSES pulse laser system (Lumenis Ltd., Yokneam, Israel) is the latest technology. It’s basically a modification of the traditional holmium lasers, which emit energy with a single pulse to break a stone up for removal. With holmium lasers, there are three ways we can vary energy delivery: the amount of energy per pulse, the rate of pulses or frequency, and the pulse width. All of these methods provide some advantages depending on the size and location of the stone.
But MOSES technology is the first unique way of manipulating how energy is delivered to the stone. It uses two pulses sequenced close together; the first pulse creates a vapor channel between the laser tip and the stone surface, and the second delivers energy to the stone unimpeded by intervening fluid. This results in more efficient energy transmission to the stone. The secondary effect is that the stone moves around less, so it’s less challenging for the surgeon to target it.
Q: How does laser lithotripsy benefit patients and surgeons?
Lipkin: Since it’s a minimally invasive endoscopic procedure, patients recover in about a week, and it improves our safety margins because we don’t have to touch the stone with the laser to break it up. It also makes the surgery easier for the surgeon because it increases efficiency, and I believe anything that makes surgery easier for surgeons—even if it saves only five or six minutes per procedure—indirectly benefits patients in terms of faster access to specialists and procedures.
Q: What are the next steps for Duke’s research on laser lithotripsy?
Lipkin: We’re currently participating in a multicenter trial through a consortium of kidney stone centers and academic medical centers to compare MOSES technology with standard holmium laser lithotripsy. In addition, along with our colleagues in Duke’s engineering department, we’ve developed a program of laser research and received an NIH grant that’s a combination of research and education, with the goal of building experience with laser lithotripsy technology.
There hasn’t been a lot of strong basic science research in this space to date, so this is a great opportunity for Duke to continue its leadership in stone research, encourage bright young scientists to learn more about the field, and help push the latest technologies further forward to ultimately improve patient outcomes for this common condition.
For more information on laser lithotripsy technology, read a 2018 study co-authored by Michael E. Lipkin, MD, and Glenn M. Preminger, MD, chief of the Duke Urology Division, published in the Journal of Endourology.