Initial experience in combined ultra-mini percutaneous nephrolithotomy with the use of 120-W laser and the anti-retropul
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ORIGINAL ARTICLE
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? Ioannis Leotsakos 1 & Ioannis Katafigiotis 1 & Amitay Lorber 1 & Stavros Sfoungaristos 1 & Itay M. Sabler 1 & Vladimir Yutkin 1 & Ofer N. Gofrit 1 & Mordechai Duvdevani 1 Received: 12 March 2019 / Accepted: 21 February 2020 # Springer-Verlag London Ltd., part of Springer Nature 2020
Abstract The purpose is to present our preliminary results where ultra-mini PCNL (UMPCNL) with the new 120-watt laser with the antiretropulsion (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. Keywords Anti-retropulsion technology . Laser fragmentation . Ultra-mini PCNL . Urinary lithiasis
Introduction Since 1976, when Fernstrom and Johansson first described the innovative technique of percutaneous nephrolithotomy (PNL) for the removal of large volume stone from the kidney, the evolution of technology used in the Endourology improved
both the safety and the efficacy [1, 2]. According to the European Urology Association (EAU) guidelines, the PNL is the gold standard of the treatment for large renal calculi (> 20 mm) and also for smaller lower pole stones (10– 20 mm) when unfavorable factors for shock wave lithotripsy (SWL) exist [3]. Despite the evolution of the procedure, the
* Ioannis Leotsakos [email protected]
Vladimir Yutkin [email protected]
Ioannis Katafigiotis [email protected]
Ofer N. Gofrit [email protected]
Amitay Lorber [email protected]
Mordechai Duvdevani [email protected]
Stavros Sfoungaristos [email protected] Itay M. Sabler [email protected]
1
Department of Urology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
Lasers Med Sci
improvement of the instrumentar
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