New Generation Pulse Modulation in Holmium:YAG Lasers: A Systematic Review of the Literature and Meta-Analysis

• Published in: Journal of clinical medicine Vol. 11; no. 11; p. 3208
• Main Authors: Sánchez-Puy, Antoni, Bravo-Balado, Alejandra, Diana, Pietro, Baboudjian, Michael, Piana, Alberto, Girón, Irene, Kanashiro, Andrés K, Angerri, Oriol, Contreras, Pablo, Eisner, Brian H, Balañà, Josep, Sánchez-Martín, Francisco M, Millán, Félix, Palou, Joan, Emiliani, Esteban
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 04.06.2022; MDPI
• Subjects: Ablation; Clinical medicine; Collaboration; Energy; holmium; laser; Lasers; Lithotripsy; Meta-analysis; pulse modulation; Software; Systematic Review; urinary stones; Italy; Japan; Germany; pulse modulation; laser; urinary stones; holmium
• ISSN: 2077-0383; 2077-0383
• DOI: 10.3390/jcm11113208

(1) Background: New pulse modulation (PM) technologies in Holmium:YAG lasers are available for urinary stone treatment, but little is known about them. We aim to systematically evaluate the published evidence in terms of their lithotripsy performance. (2) Methods: A systematic electronic search was performed (MEDLINE, Scopus, and Cochrane databases). We included all relevant publications, including randomized controlled trials, non-randomized comparative and non-comparative studies, and in-vitro studies investigating Holmium:YAG lithotripsy performance employing any new PM. (3) Results: Initial search yielded 203 studies; 24 studies were included after selection: 15 in-vitro, 9 in-vivo. 10 In-vitro compared Moses with regular PM, 1 compared Quanta's, 1 Dornier MedTech's, 2 Moses with super Thulium Fiber Laser, and 1 compared Moses with Quanta PMs. Six out of seven comparative studies found a statistically significant difference in favor of new-generation PM technologies in terms of operative time and five out of six in fragmentation time; two studies evaluated retropulsion, both in favor of new-generation PM. There were no statistically significant differences regarding stone-free rate, lasing and operative time, and complications between Moses and regular PM when data were meta-analyzed. (4) Conclusions: Moses PM seems to have better lithotripsy performance than regular modes in in-vitro studies, but there are still some doubts about its in-vivo results. Little is known about the other PMs. Although some results favor Quanta PMs, further studies are needed.