Corrales Mariela, Sierra Alba, Traxer Olivier
GRC Urolithiasis No. 20 Tenon Hospital, Sorbonne University, F-75020 Paris, France.
Department of Urology AP-HP, Tenon Hospital, Sorbonne University, F-75020 Paris, France.
J Clin Med. 2022 Aug 18;11(16):4828. doi: 10.3390/jcm11164828.
Moses technology was born with the aim of controlling the Moses effect present in every single Ho:YAG laser lithotripsy. The capacity to divide the energy pulse into two sub-pulses gained popularity due to the fact that most of the energy would be delivered in the second pulse. However, is this pulse modulation technique really better for endocorporeal laser lithoripsy? A review of the literature was performed and all relevant clinical trials of Moses 1.0 and 2.0, as well as the lab studies of Moses 2.0 carried out up to June 2022 were selected. The search came back with 11 clinical experiences (10 full-text clinical trials and one peer-reviewed abstract) with Moses 1.0 and Moses 2.0, and three laboratory studies (peer-reviewed abstracts) with Moses 2.0 only. The clinical experiences confirmed that the MT (1.0) has a shorter lasing time but lower laser efficacy, because it consumes more J/mm when compared with the LP Ho:YAG laser (35 W). This gain in lasing time did not provide enough savings for the medical center. Additionally, in most comparative studies of MT (1.0) vs. the regular mode of the HP Ho:YAG laser, the MT did not have a significant different lasing time, operative time or stone-free rate. Clinical trials with Moses 2.0 are lacking. From what has been published until now, the use of higher frequencies (up to 120 Hz) consumes more total energy and J/mm than Moses 1.0 for similar stone-free rates. Given the current evidence that we have, there are no high-quality studies that support the use of HP Ho:YAG lasers with MT over other lasers, such as LP Ho:YAG lasers or TFL lasers.
摩西技术诞生的目的是控制每一次钬激光碎石术中出现的摩西效应。将能量脉冲分成两个子脉冲的能力之所以受到欢迎，是因为大部分能量会在第二个脉冲中释放。然而，这种脉冲调制技术真的更适合体内激光碎石术吗？我们进行了文献综述，并选取了截至2022年6月所有关于摩西1.0和2.0的相关临床试验，以及摩西2.0的实验室研究。检索结果显示有11项关于摩西1.0和摩西2.0的临床经验（10项全文临床试验和1篇同行评审摘要），以及仅3项关于摩西2.0的实验室研究（同行评审摘要）。临床经验证实，MT（1.0）的激光发射时间较短，但激光疗效较低，因为与低功率钬激光（35瓦）相比，它每毫米消耗的焦耳更多。激光发射时间的这种增加并没有为医疗中心节省足够的成本。此外，在大多数MT（1.0）与高功率钬激光常规模式的对比研究中，MT在激光发射时间、手术时间或结石清除率方面没有显著差异。目前缺乏关于摩西2.0的临床试验。从目前已发表的内容来看，在结石清除率相似的情况下，使用更高频率（高达120赫兹）的摩西2.0比摩西1.0消耗的总能量和每毫米焦耳更多。鉴于我们目前所掌握的证据，没有高质量的研究支持使用配备MT的高功率钬激光优于其他激光，如低功率钬激光或钬光纤激光。
