Skip to main content
SpringerLink
Log in

EMS Lithoclast Trilogy™: an effective single-probe dual-energy lithotripter for mini and standard PCNL

  • Original Article
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Purpose

Several energy sources are available to clear stones during PCNL. Required improvements are faster stone clearance, optimized suction and ease of use while maintaining high patient safety standard. EMS LithoClast® Trilogy, is the first device combining electromagnetic impactor with ultrasonic energy and suction, all-in-one probe. Animal studies and in vitro phantom stone studies have proven safety and efficacy of this device. We aim to study safety and clinical efficacy of Trilogy in our patients.

Methods

31 patients with renal stones were included. Amplatz sheath sizes/Trilogy probe size was 22–28 Fr/10.2 Fr for standard PNL (n = 20) and 15 Fr./5.7 Fr for mini PNL access (n = 11). Analysis was done with respect to demography, stone characteristics, operation duration (total time and lithotripter activation time), post op Hb drop, clearance rate and adverse events. Stone area/volume was calculated based on CT using 3D doctor. Efficacy was determined by stone volume clearance rate (mm3/min).

Results

Male:female ratio was 6:5 and 16:4 for mini (MPNL)/standard PNL (SPNL). Stone densities were 1229 ± 206 vs. 1168 ± 344 HU (MPNL vs. SPNL). Mean stone volumes were 3776.1 ± 2132 mm3 for MPNL and 7096 ± 6441 for SPNL. Mean stone volume clearance ratios were 370.5 ± 171 mm3/min and 590.7 ± 250mm3/min for MPNL and SPNL, respectively. Hb drop was 1.24 ± 0.64 g/dL (MPNL) and 1.23 ± 0.89gm/dL (SPNL). Total procedure time/lithotripter activation time was 53.4 ± 23.8/14.7 ± 12.4 min for MPNL and 65.2 ± 23.5/12.0 ± 8.9 for SPNL. Immediate post-operative/1 month stone clearance rates were 93%/96% with one clinically insignificant residual fragment (< 3 mm) and no necessity for auxiliary procedures. No device failure occured and three Clavien grade I and one grade II complications were observed.

Conclusion

Swiss LithoClast® Trilogy provides fast stone clearance in standard/mini-PCNL procedures. Ease of use, high tissue safety and optimized suction that avoids fragment blockings are other key features.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Ganpule AP, Desai MR (2012) What’s new in percutaneous nephrolithotomy. Arab J Urol 10(3):317–323

    Article  Google Scholar 

  2. Türk C, Petřík A, Sarica K, Seitz C, Skolarikos A, Straub M, Knoll T (2016) EAU guidelines on interventional treatment for urolithiasis. Eur Urol 69(3):475–482

    Article  Google Scholar 

  3. Michel MS, Honeck P, Alken P (2008) New endourologic technology for simultaneous holmium: YAG laser lithotripsy and fragment evacuation for PCNL: ex-vivo comparison to standard ultrasonic lithotripsy. J Endourol 22(7):1537–1540

    Article  CAS  Google Scholar 

  4. Piergiovanni M, Desgrandchamps F, Cochand-priollet BÉ, Janssen T, Colomer S, Teillac P, Led uc AL (1994) Ureteral and bladder lesions after ballistic, ultrasonic, electrohydraulic, or laser lithotripsy. J Endourol 8(4):293–299

    Article  CAS  Google Scholar 

  5. Hofmann R, Pickl U, Hartung R (1996) The Lithoclast and Lithoclast Master—an experimental and clinical comparison. J Endourol 10:S119

    Google Scholar 

  6. Hofmann R, Pickl U, Schwarzer JU, Hartung R (1994) Mechanical vs. laser lithotripsy for ureteral calculi. J Urol 151(151):203A

    Google Scholar 

  7. Cho C, Yu JH, Sung LH, Chung JY, Noh CH (2010) Comparison of percutaneous nephrolithotomy using pneumatic lithotripsy (lithoclast®) alone or in combination with ultrasonic lithotripsy. Korean J Urol 51(11):783–787

    Article  Google Scholar 

  8. York NE, Borofsky MS, Chew BH, Dauw CA, Paterson RF, Denstedt JD, Razvi H, Nadler RB, Humphreys MR, Preminger GM, Nakada SY (2017) Randomized controlled trial comparing three different modalities of lithotrites for intracorporeal lithotripsy in percutaneous nephrolithotomy. J Endourol 31(11):1145–1151

    Article  Google Scholar 

  9. Hofmann R, Olbert P, Weber J, Wille S, Varga Z (2002) Clinical experience with a new ultrasonic and LithoClast combination for percutaneous litholapaxy. BJU Int 90(1):16–19

    Article  CAS  Google Scholar 

  10. Jou YC, Shen CH, Cheng MC, Chen PC (2007) High-power holmium: yttrium–aluminum–garnet laser for percutaneous treatment of large renal stones. Urology 69(1):22–25

    Article  Google Scholar 

  11. Kronenberg P, Traxer O (2015) Update on lasers in urology 2014: current assessment on holmium: yttrium–aluminum–garnet (Ho:YAG) laser lithotripter settings and laser fibers. World J Urol 33(4):463–469

    Article  Google Scholar 

  12. Kronenberg P, Somani B (2018) Advances in lasers for the treatment of stones—a systematic review. Curr Urol Rep 19(6):45

    Article  Google Scholar 

  13. Althunayan AM, Elkoushy MA, Elhilali MM, Andonian S (2014) Adverse events resulting from lasers used in urology. J Endourol 28(2):256–260

    Article  Google Scholar 

  14. Pugh JW, Canales BK (2010) New instrumentation in percutaneous nephrolithotomy. Indian J Urol J Urol Soc India 26(3):389

    Article  Google Scholar 

  15. Chew BH, Matteliano AA, de los Reyes T, Lipkin ME, Paterson RF, Lange D (2017) Benchtop and initial clinical evaluation of the ShockPulse stone eliminator in percutaneous nephrolithotomy. J Endourol 31(2):191–197

    Article  Google Scholar 

  16. Carlos EC, Wollin DA, Winship BB, Jiang R, Radvak D, Chew BH, Gustafson MR, Simmons WN, Zhong P, Preminger GM, Lipkin ME (2018) In vitro comparison of a novel single probe dual-energy lithotripter to current devices. J Endourol 32(6):534–540

    Article  Google Scholar 

  17. Khoder WY, Bader MJ, Haseke N, Stief CG, Baumgartl M, Pongratz T, Sroka R (2014) In vitro comparisons of retropulsion and fragmentation efficacy of 2 cordless, handheld pneumatic and electromechanical lithotripsy devices. Urology 83(4):726–731

    Article  Google Scholar 

  18. Denstedt JD, Razvi HA, Rowe E, Grignon DJ, Eberwein PM (1995) Investigation of the tissue effects of a new device for intracorporeal lithotripsy—the Swiss Lithoclast. J Urol 153(2):535–537

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The authors thank EMS Company for their support and Mr. Wolfgang Merkle for his technical support.

Funding

No competing financial interest exists. All the authors have nothing to disclose.

Author information

Authors and Affiliations

  1. Department of Urology, Muljhibhai Patel Urological Hospital, 1, Dr Virendra Desai Road, Nadiad, Gujarat, 387991, India

    Ravindra B. Sabnis, Parag L. Sonawane, Rohan Sharma, Mohankumar Vijayakumar, Abhishek G. Singh, Arvind P. Ganpule & Mahesh R. Desai

  2. Endourology, Muljhibhai Patel Urological Hospital, Nadiad, India

    Sudharsan S. Balaji

Authors
  1. Ravindra B. Sabnis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sudharsan S. Balaji
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Parag L. Sonawane
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rohan Sharma
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mohankumar Vijayakumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Abhishek G. Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Arvind P. Ganpule
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Mahesh R. Desai
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

RBS—protocol/project development, data collection or management, data analysis, manuscript writing/editing. SSB—protocol/project development, data collection or management, data analysis, manuscript writing/editing. PLS—data collection or management, data analysis. RS—data collection or management, data analysis. MV—data collection or management, data analysis, manuscript writing/editing. AGS—data collection or management, data analysis, manuscript writing/editing. APG—data analysis, manuscript writing/editing. MRD—data analysis, manuscript writing/editing.

Corresponding author

Correspondence to Ravindra B. Sabnis.

Ethics declarations

Conflict of interest

No potential conflict of interest exists with any of the authors.

Human/animal rights statement

This study involves human subjects, after proper Institutional ethical committee presentation and clearance. The study has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Written informed consent was obtained from all the participants.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (XLSX 26 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sabnis, R.B., Balaji, S.S., Sonawane, P.L. et al. EMS Lithoclast Trilogy™: an effective single-probe dual-energy lithotripter for mini and standard PCNL. World J Urol 38, 1043–1050 (2020). https://doi.org/10.1007/s00345-019-02843-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-019-02843-2

Keywords

Search

Navigation