Interview with ESWL expert Professor Axel Häcker, M.D.
Professor Häcker, your clinic has been using extracorporeal lithotripsy since 1989, starting with the first MODULITH® SL10/20. You personally used a lithotripter from STORZ MEDICAL, the MODULITH® SLK »classic«, until February this year. You and your department have now decided to purchase the new MODULITH® SLK »inline«. What were the reasons for your decision, and what do you expect from the new MODULITH® SLK »inline« for your clinic, your patients and yourself? We would like to ask you a few questions about this.
Why did you choose the new MODULITH® SLK »inline« and, in your opinion, what is so advantageous about this particular lithotripter?
Professor Häcker: We have always made very good experiences with STORZ MEDICAL lithotripters over the last 20 years, and indeed, initially we saw no need at all for us to consider a new lithotripter. However, the opportunity arose for us to collaborate as consultants in the development of this new generation of lithotripters, and at the end of the development phase I was astonished at how innovative a lithotripter can be, 31 years after stones were first treated with shock waves. The overall concept, the established material quality, the reliability, the new mobility, the incredible user-friendliness and, of course, the proven electromagnetic cylinder source, with its inline arrangement of the X-rays, convinced not only me but also our entire medical staff.
You are also familiar with other lithotripters, which you could use. What differentiates the MODULITH® SLK »inline« from other manufacturers' models?
Professor Häcker: Innovations in this highly sensitive area of medical technology must make sense. The new ease-ofuse, the comfortable positioning of the patient, the versatile use of the device for endourological interventions as well - all of this simply makes a lot of sense. The unconditional performance principle is also important for our clinic. In other words, we must be able to depend on the device at all times and for any treatment. We have a considerable patient flow, and – as with the cost-effectiveness of the device – there cannot be any limitations here either.
The perceived value principle is important for us: STORZ MEDICAL lithotripters are made to last practically an eternity. The technologies with which we all surround ourselves on a daily basis must necessarily fulfil special requirements. We are talking about decades here. Naturally the relatively low running costs and the service life of the electromagnetic cylinder source are also decisive factors. In our opinion the MODULITH® SLK »inline« has also been given huge individuality. I was able to participate in many of the decisions made regarding the configuration of the lithotripter, so that the device now completely fulfils our clinical needs and requirements. In addition to this, the system is also continuing to develop, so that we have, at the same time, secured the technological progress that will naturally continue in the future, without having to buy another new device immediately.
What do you think of the learning curve on the MODULITH® SLK »inline«? (Also in relation to other ESWL devices with which you are familiar)
Professor Häcker: The learning curve is very steep. Anyone who knows how an ESWL works, including localisation, will be able to handle this device straight away. Another important thing for us is something I call the »simple and intuitive principle«: Device functions, patient positioning, the operation of the complete system – everything works simply and intuitively. You don't actually need to read the manual because a lot is selfexplanatory.
How have your initial clinical experiences been with the new STORZ MEDICAL lithotripter?
Professor Häcker: We have now been using the device since February and have already treated several patients success-fully. The results conform to the usual high standards that we are accustomed to with STORZ MEDICAL lithotripters. We will only be able to make statistical statements on the efficiency after some time, when an adequately large quantity of data is available.
How do you rate the in-line localisation concept?
Professor Häcker: The coaxial design of the X-ray and shock wave system makes adjustment of the stone into focus easy. The height positioning is less critical than in systems with 45° coupling angles, as the length of the focus acts as a safety buffer and the stone is located securely in the focus volume. You can easily monitor the progress of the stone fragmentation through the opening on the therapy head and correct the position if necessary.
What are the advantages of the flexible therapy head in combination with the STORZ MEDICAL patient table?
Professor Häcker: The table supports patients from children through to adipose adults easily and safely. Irrespective of the position of the stone in the urinary tract, the patient always remains in the supine position and the head is always at the same end of the table. The therapy head enables coupling and treatment with shock waves ventrally or dorsally. This eliminates the need for laborious rearrangement of the patient, and the anaesthetic can remain fixed in one location in the room.
What are your experiences with endourological use?
Professor Häcker: The device table is well suited for endourological interventions. On the MODULITH® SLK »inline« we perform regularly all transurethral interventions of the lower (TUR-bladder, TUR-prostate, laser enucleation of the prostate) and upper urinary tract (URS). Thanks to accessories such as the insert plate, leg holder and drain bag the device can be quickly prepared for treatments other than ESWL. This means that we can achieve good capacity utilisation of the device and treatment room.
Is there a statement that spontaneously occurs to you about the device?
Professor Häcker: »Complexity« of handling this new lithotripter would just be a silly excuse.
Professor Häcker, thank you for this interview.