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The Moses holmium system - time is money
Cleveland Clinic Foundation, Cleveland, Ohio, USA
Jun  2018 (Vol.  25, Issue  3, Pages( 9313 - 9316)
PMID: 29900818


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    The Moses technology of the holmium laser has been shown to decrease retropulsion in the ureter and procedural time in kidney stones during laser lithotripsy. Theoretically, these improvements could lead to cost savings for the patient.


    All patients with total laser energy data recorded who underwent ureteroscopy with laser lithotripsy by a single surgeon at a tertiary care center were included. Total lasing time was calculated from the total laser energy. Sub-analyses were done on stone size and stone composition. The procedure time using Moses technology was projected to be approximately 35% less than procedure time without the Moses technology based on prior in vitro studies. The projected cost savings was then utilized to predict cost-effectiveness of the Moses technology.


    Forty patients underwent ureteroscopy with laser lithotripsy. Mean stones size was 10.2 mm and mean lasing time was 3.02 minutes. Linear regression showed a positive association between stone size and laser time, p = 0.01. There was no significant correlation between stone composition or stone Hounsfield units and lasing time. On cost analyses, for stones of all sizes the Moses system has a price differential of an increase in $292.36 when compared to the standard Holmium TracTip system. Specifically for stones larger than 10 mm, the price differential is an increase in $253.16 for the Moses technology.


    The decrease in lasing time achieved by the Moses system does not translate into sufficient cost savings to off-set the higher cost of the laser fiber and software.