Laser shattering kidney stone

Moses Technology Revolutionizes Kidney Stone Treatment: Is Mini-PCNL the Future?

Mira Elwood monogram
Mira Elwood in Health & Wellness October 2026 • 4 min read.

"Discover how the innovative Moses laser technology is making minimally invasive kidney stone removal safer, more efficient, and potentially an alternative to traditional methods."


Kidney stones affect millions worldwide, causing significant pain and discomfort. Traditional treatments often involve invasive procedures with lengthy recovery times. However, recent advancements in medical technology are paving the way for less invasive and more effective solutions. One such breakthrough is the integration of Moses technology with mini-percutaneous nephrolithotomy (mini-PCNL), offering a promising alternative for patients seeking relief from kidney stones.

Mini-PCNL is a minimally invasive procedure used to remove kidney stones through a small incision in the back. Unlike traditional PCNL, which requires a larger incision, mini-PCNL utilizes smaller instruments, resulting in less pain, reduced bleeding, and faster recovery times. Combining this technique with the Moses laser system further enhances its precision and efficacy.

This article will delve into the innovative use of Moses technology in mini-PCNL, exploring its benefits, how it works, and why it's becoming an increasingly popular choice for treating kidney stones. We'll examine the experiences of medical professionals and patients, providing a comprehensive overview of this groundbreaking approach to kidney stone management.

AI Search Multiple angles on this topic

MOSES and Stone-Treatment Efficiency

MOSES technology was developed by Lumenis Ltd to maximize the lithotripsy potential of high-powered lasers. Holmium lasers are typically used to treat kidney or ureteral stones that are too large to remove en bloc. One study report says higher-power use of MOSES was significantly faster for lithotripsy and reduced operative time and the number of patients needing a second procedure to become stone-free.

What is Moses Technology and How Does it Enhance Mini-PCNL?

Laser shattering kidney stone

Moses technology is a cutting-edge laser system designed to optimize holmium laser lithotripsy, a technique used to break up kidney stones. The system modulates the laser pulse, creating a 'Moses effect' that reduces stone retropulsion—the backward movement of stone fragments during the procedure. This is particularly advantageous in mini-PCNL, where maintaining clear visibility and control is crucial due to the smaller working space.

The Moses system operates in two modes: 'Contact' and 'Distance.' The Contact mode is optimized for use at a very short distance from the stone surface (0-1 mm), while the Distance mode is designed for slightly further away (2-3 mm). This flexibility allows surgeons to tailor the laser settings to the specific characteristics of the stone and the surgical environment, ensuring optimal fragmentation and minimal tissue damage.

  • Reduced Stone Retropulsion: The Moses effect minimizes the backward movement of stone fragments, improving visibility and control.
  • Optimized Fragmentation: The Contact and Distance modes allow for precise laser settings, enhancing fragmentation efficiency.
  • Minimal Tissue Damage: The controlled laser pulses reduce the risk of injury to surrounding tissues.
  • Versatility: Suitable for various stone sizes and locations, making it a versatile tool for kidney stone management.
AI Search Multiple angles on this topic

Recent Studies of MOSES in Stone Treatment

A study described in a 2024 paper set out to compare conventional basketing plus dusting with MOSES pop-dusting during flexible ureteroscopy (FURS) for 2–3 cm renal calculi. It included 230 patients randomly divided between the methods, with efficiency and safety as comparison goals. A 2025 study investigated X-ray-free retrograde intrarenal surgery (RIRS) using MOSES for nephrolithiasis associated with intrarenal infundibular conditions. Separately, a clinical comparison of MOSES and non-MOSES ureteroscopy was motivated by earlier in-vitro findings, while noting that clinical evidence remained scarce.

Clinical Benefits Remain Uncertain

Although MOSES has improved fragmentation efficiency in vitro, its clinical performance compared with conventional technology remains unclear. A single-center randomized trial reported no significant differences between the two lasers in ureteroscope time, stone-free rates, or complication rates. A 2023 meta-review addressed ongoing controversy over whether MOSES should replace regular mode in clinical practice, despite reported benefits in reducing stone drifting and powdering stones in laboratory and animal work.

MOSES in Supine Mini-PCNL

A 2022 report on supine tubeless ambulatory mini-percutaneous nephrolithotomy (mini-PCNL) states that improved fragmentation with MOSES technology facilitates the supine mini-PCNL technique. The source presents this as a procedural advantage; it does not provide comparative outcome figures in the supplied material.

In a recent study, researchers at the University of Michigan demonstrated the successful application of Moses technology in mini-PCNL for treating a lower pole kidney stone. The procedure involved a 63-year-old patient with a 1.5 cm stone. Using a 120W holmium laser with the Moses system, the surgeons fragmented the stone using dusting settings and a 230 µm Moses fiber. The combination of dusting, fragment expulsion with the Venturi effect, and extraction with graspers/baskets resulted in complete stone removal.

The Future of Kidney Stone Treatment

The integration of Moses technology with mini-PCNL represents a significant advancement in kidney stone treatment. Its ability to reduce stone retropulsion, optimize fragmentation, and minimize tissue damage makes it a valuable tool for urologists. As technology continues to evolve, we can expect even more innovative solutions that improve patient outcomes and quality of life. For individuals seeking relief from kidney stones, consulting with a urologist to explore the potential benefits of Moses technology and mini-PCNL may be a step towards a stone-free future.

AI Search Multiple angles on this topic

Mini-PCNL and Minimally Invasive Care

The supplied article describes MOSES use in mini-percutaneous nephrolithotomy (PCNL) as a way to enhance precision, reduce complications, and offer new possibilities for patients seeking effective, less invasive treatment. These are the article’s stated potential benefits. Separately, a nephrostomy devices market outlook identifies kidney stones, tumors, and congenital urological disorders among the devices’ top applications, and notes a trend toward minimally invasive techniques and smart-sensor integration.

Infundibular Stenosis and Treatment Complexity

Surgical management of calculi associated with infundibular stenosis is challenging. The supplied study describes MOSES as splitting holmium-laser energy into two pulses, which it says increases fragmentation efficiency and reduces stone displacement. Another study notes that data remain limited on how stone volume and density relate to flexible ureteroscopy lithotripsy efficiency and outcomes with the MOSES Ho:YAG system; it examined these factors alongside lasing time, energy use, and short-term clinical outcomes.

How Moses compares with other mini-PCNL approaches

In a randomized MiniPCNL comparison, the Moses-based high-power holmium approach was reported as effective and safe, and comparable to standard high-power laser use; the authors emphasized a broader range of settings rather than a demonstrated outcome advantage.[1]

A separate MiniPerc comparison found no statistically significant differences between the Moses holmium and thulium fiber laser arms in fragmentation rate or total laser energy, alongside the comparable lasing times reported above. Its matched groups came from a prospective institutional registry, with matching based on stone size and density.[2]

The early ultra-mini PCNL experience used prone positioning, general anesthesia, and a 12-F nephroscope with a 14-F access sheath; it reported an operation duration of 86.4 ± 36.8 minutes and mean laser time of 755.7 ± 954.7 seconds. These observations describe a specific initial setup, not a controlled comparison.[3]

A broader comparison of MiniPCNL with Standard-PCNL found shorter stays, less hemoglobin drop and fewer transfusions in the MiniPCNL group, but longer operative time. These findings concern the access approach, not a Moses-versus-other-laser effect.[4]

What remains unresolved for Moses in mini-PCNL

  • Do the broader setting options reported for Moses translate into a measurable patient or procedural advantage over standard high-power laser use? The reported comparison describes the approaches as comparable but does not establish such an advantage.[1]
  • Would the findings from the matched registry comparison hold in other patient groups or settings? Its matching accounted for stone size and density, but the supplied evidence describes a single institutional registry.[2]

Terms used in mini-PCNL comparisons

Ultra-mini PCNL
Ultra-mini percutaneous nephrolithotomy[3]

Sources

  1. Use of Moses 2.0 with extended frequency and optimized Moses vs. high-power laser in MiniPCNL: a randomized controlled trial. (pubmed.ncbi.nlm.nih.gov)
  2. High-Power Holmium with MOSES Technology or Thulium Fiber Laser in MiniPerc with Suction: A New Curiosity. (pubmed.ncbi.nlm.nih.gov)
  3. Initial experience in combined ultra-mini percutaneous nephrolithotomy with the use of 120-W laser and the anti-retropulsion "Moses effect": the future of percutaneous nephrolithotomy? (pubmed.ncbi.nlm.nih.gov)
  4. Comparison of postoperative outcomes of mini percutaneous nephrolithotomy and standard percutaneous nephrolithotomy: a meta-analysis (pmc.ncbi.nlm.nih.gov)

About this Article -

Written with AI assistance from published research, and reviewed by the Mystum team. See our About page for more information.

Everything You Need To Know

1

What exactly is Moses technology?

Moses technology is a state-of-the-art laser system specifically engineered to enhance holmium laser lithotripsy. It achieves this through a unique modulation of the laser pulse, known as the 'Moses effect'. This modulation is key in minimizing stone retropulsion, which is the backward movement of stone fragments during the procedure, thereby improving visibility and control for the surgeon. The system offers two operational modes: 'Contact' and 'Distance,' providing flexibility in tailoring the laser settings to the stone's characteristics and the surgical environment, which is especially beneficial during mini-PCNL.

2

What is mini-PCNL and how does it work?

Mini-percutaneous nephrolithotomy (mini-PCNL) is a minimally invasive procedure designed to remove kidney stones through a small incision in the back. Compared to traditional PCNL, mini-PCNL utilizes smaller instruments, resulting in less pain, reduced bleeding, and faster recovery times. When combined with Moses technology, mini-PCNL gains enhanced precision and effectiveness, offering a superior option for patients. The integration of Moses technology further reduces complications and optimizes stone fragmentation, highlighting its significance in modern kidney stone management.

3

How does the 'Moses effect' improve kidney stone removal?

The 'Moses effect' is a critical feature of Moses technology. It refers to the specific modulation of the laser pulse, engineered to reduce stone retropulsion. This is significant in mini-PCNL because a smaller working space demands clear visibility. By minimizing the backward movement of stone fragments, the surgeon can maintain better control and precision during the procedure. This effect is pivotal for the efficiency and safety of stone removal, allowing for more effective fragmentation and reducing the risk of complications.

4

What are the 'Contact' and 'Distance' modes in Moses technology, and why are they important?

The 'Contact' and 'Distance' modes in Moses technology offer versatility in treating kidney stones. The 'Contact' mode is optimized for use very close to the stone surface (0-1 mm), while the 'Distance' mode is designed for slightly further away (2-3 mm). This flexibility enables surgeons to select the most effective laser settings based on the stone's size, location, and composition, leading to optimal fragmentation. This tailored approach helps minimize tissue damage and ensures efficient stone removal. These modes contribute to making Moses technology suitable for various stone sizes and locations, enhancing its utility in kidney stone management.

5

Why is the combination of Moses technology and mini-PCNL important for patients?

The use of Moses technology and mini-PCNL is significant because it represents a major advancement in kidney stone treatment. This combination offers a less invasive approach compared to traditional methods, resulting in reduced pain, faster recovery times, and fewer complications. The precision and effectiveness of Moses technology enhance mini-PCNL, leading to improved patient outcomes and quality of life. This method is a promising step toward a future where kidney stone removal is safer, more efficient, and less burdensome for patients seeking relief.

Newsletter Subscribe

Subscribe to get the latest articles and insights directly in your inbox.