Mini PCNL with MOSES Laser Lithotripsy
We report on a 47-year-old female patient with a history of macrohematuria and mild right flank pain. Urological evaluation by ultrasound and NCCT revealed a 17 mm stone in the right renal pelvis. The patient was referred to us for further treatment and the decision was made to perform a Mini PCNL. We demonstrate our technique of percutaneous access by combined ultrasound and fluoroscopy. After retrograde placement of a ureteral occlusion catheter the patient is turned onto a flat prone position. Dilation after puncture of the lower pole is done by means of a 16.5F single-step dilator and a 17.5F modified Amplatz Sheath is introduced. The stone can be visualized and is the disintegrated by the Lumenis Pulse 120H Holmium Laser with MOSES technology. The Moses technology is a unique technique patented by Lumenis. where the laser pulse is modulated to two sequences - the first one separates the water to create a small bubble, through which the remaining part of the energy travels to result in better energy transmission. It leads to higher dusting and fragmenting efficacy, significantly less retropulsion and eventually to faster procedures. Stone fragments are flushed out passively through the sheath. Flexible nephroscopy at the end of the procedure and contrast imaging confirm a complete stone-free status. A 14F nephrostomy is placed and the ureteral catheter is removed. The patient will be sent home on day 2.