Exodus 17: Smite the rock, and water shall come out of it

‘Moses,’ a new stone-striking method, seen as ‘game changer’ for urologists

Israeli firm Lumenis’ technology helps bust urinary stones faster and more efficiently

Shoshanna Solomon was The Times of Israel's Startups and Business reporter

Israeli firm Lumenis' Moses technology is considered a 'gamechanger' in the treatment of urinary stones (YouTube Screenshot)
Israeli firm Lumenis' Moses technology is considered a 'gamechanger' in the treatment of urinary stones (YouTube Screenshot)

Anyone who has had urinary stones can know the acute pain — sometimes compared to that of women in labor — that can accompany the condition, caused when minerals crystallize in concentrated urine restricting the flow.

Sometimes bladder stones — like their counterparts that form in the upper urinary tract, called kidney stones — simply come out with the urine. At other times, a non-surgical technique using high-intensity shock waves is used to break up the stones into fragments that are then small enough to pass in the urine. This treatment, however, is not effective for all stones; they may be too big or in a challenging location, so sometimes surgery is needed.

One of the most-used surgical methods today is a minimally invasive laser treatment called  holmium laser lithotripsy, whereby doctors use a laser beam and a ureteroscope to break the stone into small pieces and flush them from their location.

Israel-based Lumenis, the nation’s largest medical devices firm, is the company that developed, some 30 years ago, the world’s first holmium surgical laser to blast the urinary stones, whether they are located in the kidneys, bladder or in between. Now, it has come up with a new technology, called Moses, that the Yokne’am-Israel based company says is even more effective than its original urology lasers.

“The treatment of urinary stones is one of the areas in which some of the greatest technological changes have taken place in the past 30 years,” said Prof. Mordechai Duvdevani, the vice chairman of urology and the head of endourology at the Hadassah Hebrew University Medical Center, who has started using the new technology. “With stone treatment and endourology, we thought we had reached the peak of innovation, but now Lumenis has developed its Moses technology. After using it for two days at Hadassah, I told the hospital that we had to get the system. It is a game changer.”

Duvdevani is not connected to the company in any way, he said, but is collaborating with the firm to see how the technology can be even further improved.

The new method is cleverly named. In the Bible, Moses was ordered by the Lord to take his staff and hit a rock, which proceeded to produce water for the thirsty Israelites he was leading through the desert.

Launched a year ago, the technology aims to help urologists perform endourology procedures — in which small internal endoscopes are used to remove stones — faster and in more efficiently. A study published by McGill University in Canada has shown that the technology saves 20 percent of procedure time — meaning less anesthesia time for the patient and less surgery time for the physician, saving money.

“Doctors who are using our technology are saying that it helps to reduce procedure time and for certain patients it even saves the need for a second surgery, because complex cases can be done in one shorter procedure,” said Ayelet Barneah, the head of the surgical business unit at Lumenis, in which urology is a major component. “Doctors are saying this is the biggest innovation in the field since we invented the holmium laser treatment for urology 30 years ago.”

Ayelet Barneah, Head of Surgical Business Unit at Lumenis Ltd. (Courtesy)

The new technology better controls the delivery of the laser pulse, whichis emitted in two parts. The first part of the pulse creates a small vapor bubble around the stone, while the second part of the pulse is transmitted via the vapor bubble, thus reaching a farther distance and delivering the energy more efficiently, Barneah explained.

“The greater the energy of the laser pulse, the more effective is the breaking of the stone,” she said.

However, this large amount of energy sometimes causes the stone to bounce off the pulse and move away, an effect that is called retropulsion. This results in the surgeon needing to locate the stone again during the procedure, and sometimes results in the stone migrating to hard-to-reach locations; in some cases a second surgery is needed.

The Moses system’s two-part pulse delivery “resolves the trade-off between efficient stone fragmentation and retropulsion,” said Barneah. “With Moses, it is as if the stone is actually drawn like a magnet to the laser. This saves procedure time because it significantly reduces retropulsion and minimizes stone migration.”

Moses striking the rock, Pieter de Grebber, 1630 (Public domain)

The technology, which has been patented in the US and will soon be patented in Europe, is currently being sold globally, with “some of the biggest and most influential institutions around the world using and researching it,” said Barneah. “For example, in the latest World Congress of Endourology, held in Paris on 20-24 September, abstracts were presented by University of Michigan, Duke University Medical Center and Indiana University School of Medicine showing the advantages of the technology in terms of fragmentation and procedure efficiency.”

In Israel, Hadassah Medical Center in Jerusalem, and Rambam Hospital in Haifa and Asaf Harofe, near Tel Aviv, have adopted the technology, while three or four others are evaluating it, she said.

Looking at other uses as well

“We are just getting started,” she said.  “We already have significant clinical evidence on advantages of Moses in stone treatment, and we are now focusing on generating the same level of evidence for treatment of enlarged prostate.”

To that end, clinical trials are underway at a hospital in the US. In addition, the company is seeking to determine the advantages of using the new system to treat transitional cell carcinoma and other tumors in the urinary system.

Founded in 1973, Lumenis is a maker of minimally invasive clinical devices ranging from the aesthetics market — for hair removal and skin treatments, for example — to the treatment of eye diseases and surgical uses, like its urology products.

In 2015 the company was acquired for some $510 million by XIO Group, which delisted the firm’s shares from the Nasdaq exchange. In May, Calcalist financial website said that US private equity firm CVC Capital Partners is in advanced talks to buy Lumenis from XIO for some $800 to $900 million, citing people familiar with the matter.

Barneah declined to comment on the reports about a possible sale of the company.

Lumenis employs 400 workers in Israel and some 1,400 employees globally.

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