with Dr. Khurshid Ghani
Dr. Khurshid Ghani Surgical and his Team at the Michigan Medicine, Brighton Center for Speciality Care perform a Kidney Stone Dusting with the Moses Technology surgery.
Dr. Ghani demonstrates the high frequency dusting technique using the holmium laser system (P120) and Pulse modulation with Moses Technology. The Moses technology provides a multi-pulse, where the laser pulse is modulated to two sequences: the first one separates the fluid to create a vapor bubble; a second vapor bubble is then created through which the remaining part of the energy travels to result in improved energy transmission. It leads to increased fragmentation and less retropulsion. With a combination of contact (painting, dancing chipping) and non-contact (pop-dusting) laser lithotripsy, the goal is to get fragments < 1 mm in size, so that the patient can spontaneously pass these fragments to obtain optimal stone clearance.
Clinical Background
1. Cystoscopy with insertion of working and safety guidewires into the renal pelvis
2. Insertion of ureteral access sheath
3. Examination of collecting system with single use flexible ureteroscope
4. Placement of patient in Trendelenburg position
5. Insertion of 230 core ball-tip Moses laser fiber
6. Contact laser lithotripsy using settings ranging from 0.2-0.3J (pulse energy) and 50-80Hz (frequency)
7. Use of Moses Distance mode to facilitate dusting technique
8. Use of dancing, chipping and painting of stone to debulk the stone
9. Nudging of large stones from renal pelvis to calyces
10. Combination of contact and non-contact laser lithotripsy using Moses Distance mode
11. Use of pop-dusting (0.5J x 80 Hz) and pop-corning (1J x 20 Hz) techniques to pulverize stones into sub-millimeter fragments
12. Flushing of calyces at end with saline
13. Inspection of ureter on withdrawal of scope and sheath to assess for ureteral trauma
14. Placement of ureteral stent with extraction string for drainage, and removal at home by patient on post-op day 7
Technique Description
Use of multi-pulse modulation with Moses Technology using the Moses Distance mode to improve fragmentation and reduce retropulsion for dusting technique
Settings and technique for contact phase laser lithotripsy
Settings and technique for non-contact phase laser lithotripsy
Parameter selection and safety aspects for high power holmium laser lithotripsy
71-year-old female
Seen by general urology for asymptomatic microscopic hematuria
CTU demonstrated left sided 15 mm UPJ kidney stone, and 7 mm upper pole stone
Urine culture negative
Referred to Endourologist for treatment
Decision made to perform retrograde intrarenal surgery – flexible ureteroscopy with laser lithotripsy
No family history of kidney stones
Factor V Leiden trait
Hyperlipidemia
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