We express our gratitude to the patients, surgeons, anesthesiologists, scrub nurses, and technicians who actively participated in this study. Without their cooperation, this research would not have been possible.

This prospective observational study, involving outpatient hysteroscopy surgery patients, was conducted from March to December 2023. It was approved by the hospital&#39;s ethics committee of Shanghai JiAi Genetics &#38; IVF Institute (ethics file number: JIAI E2020-09). All participants provided informed consent prior to inclusion in the study.
1. Patient selection and preparation
<ol>
	<li>Patient eligibility
	<ol>
		<li>Inclusion criteria: include patients with primary or secondary infertility, aged 18-45, with at least one transvaginal ultrasound suggesting uneven endometrial thickening or suspicion of endometrial polyps.</li>
		<li>Exclusion criteria: exclude individuals aged below 18 or above 45 years, those with severe internal medical comorbidities, unstable hemodynamics, acute pelvic inflammatory diseases, untreated infections, body temperature exceeding 37.5 &#176;C on the day of surgery, pregnant women, individuals with suspected endometrial or cervical cancer, uncontrolled hyperthyroidism, uterine enlargement with uterine cavity exceeding 12 cm, and those unwilling to provide informed consent.</li>
	</ol>
	</li>
	<li>Preoperative patient preparation
	<ol>
		<li>Perform a thorough assessment covering tests for hepatitis B, hepatitis C, human immunodeficiency virus (HIV), and syphilis, alongside evaluations such as an electrocardiogram, liver and kidney function tests, blood coagulation function analysis, complete blood count, vaginal discharge examination, and preoperative transvaginal ultrasound.</li>
		<li>Schedule surgery within 10 days following the cessation of menstrual bleeding. Prepare the following surgical instruments: a speculum, Hegar dilators, sponge holder, cervical forceps, sterilized gauze, probes, and curettes, as illustrated in Figure 1A.</li>
	</ol>
	</li>
</ol>
2. Surgical preparation
<ol>
	<li>Pre-operative preparation
	<ol>
		<li>Gather comprehensive medical history records encompassing the patient&#39;s age, obstetric and menstrual history, underlying medical conditions, history of uterine and abdominal procedures, and pertinent clinical symptoms such as irregular vaginal bleeding. Additionally, document uterine size, position (anteverted or retroverted), endometrial thickness, endometrial echo, and the presence of other uterine diseases such as uterine fibroids or adenomyosis through transvaginal ultrasound examinations during the follicular phase preceding the surgery.</li>
		<li>Determine the surgical risks to the patient and obtain their signed informed consent. Furthermore, prior to the surgical procedure, evaluate the patient&#39;s anesthesia risks, obtain their signed informed consent, and allow the patient to choose between local anesthesia and no anesthesia based on their individual condition.</li>
	</ol>
	</li>
	<li>Operation field
	<ol>
		<li>Ask the surgical team to be positioned as follows: the surgeon is situated at the foot of the patient, the first assistant stands to the right of the surgeon, the anesthesiologist is located on the left side at the head end of the patient, and the scrub nurse is positioned on the left side of the patient (refer to Figure 1B).</li>
		<li>Position the endoscopic equipment on the right side at the foot of the patient, place the anesthesia equipment on the right side at the head end of the patient, and situate the monitoring equipment at the head end of the patient. Place the patient in the lithotomy position, with the lower legs secured by bandages on both sides to ensure immobilization during the procedure.</li>
	</ol>
	</li>
	<li>Disinfection
	<ol>
		<li>Perform disinfection according to the principle of disinfecting from top to bottom and inside to outside. Use iodine gauze to disinfect the external genitalia, labia, perineum, inner thighs, and perianal skin three times. Perform iodine gauze disinfection of the vagina 3 times. Complete the surgical draping with sterile surgical drapes.</li>
	</ol>
	</li>
</ol>
3. Surgical procedure
<ol>
	<li>Perform the following tasks as per the personnel&#39;s specialization: the anesthesiologist establishes peripheral venous access; the primary surgical assistant is responsible for assembling the hysteroscope lens, cleaning the lens, adjusting focus, and setting the white balance. 
	NOTE: All surgeries are performed using a 5.2-mm-diameter hysteroscope by the same experienced hysteroscopic surgeon.</li>
	<li>Set the hysteroscope pressure at 100 mmHg, with a flow rate of 300 mL/min. Use 0.9% saline solution as the distension media. Evacuate gas from the uterine cavity using the hysteroscope. Use cervical forceps to grasp the lower right lip of the cervix and carry out iodine disinfection again for the vagina, fornix, and cervix.</li>
	<li>Introduce the hysteroscope into the uterine cavity through the cervical canal. In case of encountering difficulties, retract the hysteroscope and use a measuring probe with a scale to evaluate the uterine cavity&#39;s positioning and depth. Then, pull the cervical clamp to flatten the overly curved uterus to facilitate the hysteroscope to enter the uterine cavity.</li>
	<li>Perform cervical dilation using Hegar dilators ranging from No. 3.5 to No. 5.5. Administer Phloroglucinol (80 mg intravenous injection) to relax the cervical smooth muscle if required.</li>
	<li>Keep detailed records during hysteroscopy surgeries upon introducing the hysteroscope into the uterine cavity, documenting the presence or absence of endometrial polyps, along with their location, size, morphology (pedunculated or broad-based), and any other notable endometrial conditions.</li>
	<li>Polyp removal
	<ol>
		<li>For patients with a single uterine polyp, perform the following steps.
		<ol>
			<li>Carry out individual removal using micro-forceps. Use the blunt end of the micro-forceps to pinpoint the basal layer of the endometrium (refer to Figure 2A). An anatomical gap exists between the endometrial polyp and the basal layer (as illustrated in Figure 2B); place the forceps here to grasp the basal portion of the endometrial polyp.</li>
			<li>Swiftly withdraw the micro-forceps to ensure complete separation of the polyp base from the endometrial base (as depicted in Figure 2C). Carry out the procedure incrementally until the polyp is entirely excised. Collect the excised polyp tissue for pathological examination. The typical pre- and post-operative images are shown in Figure 3A, B.</li>
		</ol>
		</li>
		<li>For patients with multiple endometrial polyps, perform the following steps.
		<ol>
			<li>In patients presenting with multiple endometrial polyps causing obstructive effects during surgery, employ micro-scissors initially to excise most of the polyps (refer to Figure 2D). This strategy is intended to increase the surgical space and enhance visibility within the operative field. Following this, remove any remaining polyp bases utilizing step 3.6.1. 
			NOTE: Special caution should be exercised when using micro-scissors to avoid cutting too deeply during the procedure to prevent injury to the basal layer of the endometrium.</li>
			<li>Start the sequence for polyp excision with the posterior uterine wall, followed by the uterine lateral wall and corners, and then the anterior uterine wall. This surgical order is designed to optimize the clarity of the surgical field.</li>
			<li>Once the complete excision of all polyp bases is confirmed, withdraw the hysteroscope and use a small curette or sponge forceps to ensure complete removal of the polyp tissue. The typical pre- and post-operative images are shown in Figure 3C-E. 
			NOTE: To minimize the heightened risk of infection associated with repeated hysteroscope insertions, it is generally advisable not to conduct further hysteroscopic exploration after the tissue removal.</li>
		</ol>
		</li>
	</ol>
	</li>
	<li>Following the retrieval of all surgical instruments, clean the cervix and vagina by iodine disinfection.</li>
</ol>
4. Postoperative procedures
<ol>
	<li>Following the surgical procedure, thoroughly document all observations and surgical interventions performed. After this, submit the specimens for pathological evaluation.</li>
	<li>Carry out postoperative monitoring for 1 h to assess the patient&#39;s condition. In the absence of any complications, discharge patients without the need for additional medication. 
	NOTE: The surgery process does not require any electronic devices and only requires the use of micro-scissors and micro-forceps. If electronic devices are used during surgery, it will be documented as a failure of the surgical procedure. All surgical complications should be documented, and postoperative pathological reports should also be recorded.</li>
</ol>
5. Statistical analysis
<ol>
	<li>For quantitative data, use descriptive statistics such as mean, standard deviation, median, and confidence interval; for qualitative data, use frequency and percentage for description.</li>
</ol>

Hysteroscopic Technique with Micro-Scissors and Forceps for Polyp Removal

<ol>
	<li>Kim, K. R., Peng, R., Ro, J. Y., Robboy, S. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+diagnostically+useful+histopathologic+feature+of+endometrial+polyp:+the+long+axis+of+endometrial+glands+arranged+parallel+to+surface+epithelium.">A diagnostically useful histopathologic feature of endometrial polyp: the long axis of endometrial glands arranged parallel to surface epithelium.</a> Am J Surg Pathol. 28 (8), 1057-1062 (2004).</li><li>Check, J. H., Bostick-Smith, C. A., Choe, J. K., Amui, J., Brasile, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Matched+controlled+study+to+evaluate+the+effect+of+endometrial+polyps+on+pregnancy+and+implantation+rates+following+in+vitro+fertilization-embryo+transfer+(IVF-ET).">Matched controlled study to evaluate the effect of endometrial polyps on pregnancy and implantation rates following in vitro fertilization-embryo transfer (IVF-ET).</a> Clin Exp Obstet Gynecol. 38 (3), 206-208 (2011).</li><li>Afifi, K., Anand, S., Nallapeta, S., Gelbaya, T. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Management+of+endometrial+polyps+in+subfertile+women:+a+systematic+review.">Management of endometrial polyps in subfertile women: a systematic review.</a> Eur J Obstet Gynecol Reprod Biol. 151 (2), 117-121 (2010).</li><li>Taylor, E., Gomel, V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+uterus+and+fertility.">The uterus and fertility.</a> Fertil Steril. 89 (1), 1-16 (2008).</li><li>Spiewankiewicz, B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+effectiveness+of+hysteroscopic+polypectomy+in+cases+of+female+infertility.">The effectiveness of hysteroscopic polypectomy in cases of female infertility.</a> Clin Exp Obstet Gynecol. 30 (1), 23-25 (2003).</li><li>Yan, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Impact+of+estrogen+and+progesterone+receptor+expression+on+the+incidence+of+endometrial+polyps.">Impact of estrogen and progesterone receptor expression on the incidence of endometrial polyps.</a> Biomark Med. 17 (21), 881-887 (2023).</li><li>Shveiky, D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Complications+of+hysteroscopic+surgery:+&amp;#34;Beyond+the+learning+curve&amp;#34.">Complications of hysteroscopic surgery: &amp;#34;Beyond the learning curve&amp;#34.</a> J Minim Invasive Gynecol. 14 (2), 218-222 (2007).</li><li>Raz, N., Feinmesser, L., Moore, O., Haimovich, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endometrial+polyps:+Diagnosis+and+treatment+options-A+review+of+literature.">Endometrial polyps: Diagnosis and treatment options-A review of literature.</a> Minim. 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J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pain+and+operative+technologies+used+in+office+hysteroscopy:+A+systematic+review+of+randomized+controlled+trials.">Pain and operative technologies used in office hysteroscopy: A systematic review of randomized controlled trials.</a> J Minim Invasive Gynecol. 28 (10), 1699-1711 (2021).</li><li>Sharon, A., Zidane, M., Aiob, A., Apel-Sarid, L., Bornstein, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Nonelectric+shaving+of+endometrial+polyp+by+hysteroscopy+-+A+new+technique+to+eliminate+thermal+damage.">Nonelectric shaving of endometrial polyp by hysteroscopy - A new technique to eliminate thermal damage.</a> Eur J Obstet Gynecol Reprod Biol. 285, 170-174 (2023).</li><li>Mencaglia, L., Lugo, E., Consigli, S., Barbosa, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bipolar+resectoscope:+the+future+perspective+of+hysteroscopic+surgery.">Bipolar resectoscope: the future perspective of hysteroscopic surgery.</a> Gyneco Surg. 6 (1), 15-20 (2009).</li><li>Qu, D., Liu, Y., Zhou, H., Wang, Z. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Chronic+endometritis+increases+the+recurrence+of+endometrial+polyps+in+premenopausal+women+after+hysteroscopic+polypectomy.">Chronic endometritis increases the recurrence of endometrial polyps in premenopausal women after hysteroscopic polypectomy.</a> BMC Womens Health. 23 (1), 88 (2023).</li><li>Clark, T. 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The authors declare no competing interests.

Our research presents a novel surgical technique for removing endometrial polyps without cutting or causing electrical damage to the uterine endometrium, which is especially beneficial for women with fertility concerns. Sharon et al. introduced a similar technique using a non-electric loop for polyp excision11, demonstrating its efficacy and safety. However, the traditional resectoscope has a larger diameter12, necessitating cervical dilation and potentially increasing the ...

Endometrial polyps are abnormal tissue growths in the uterine lining with significant implications for fertility and reproductive health1. The estimated incidence rate of endometrial polyps is approximately 35% among patients with infertility2, though this figure may vary. These polyps can disrupt embryo implantation by inducing structural deformities in the uterine cavity and impacting the endometrium&#39;s ability to support implantation3,4,5,6. While hysteroscopic surgery is a common procedure for removing endometrial polyps, it is not without risks, with uterine perforation being the primary complication, particularly during the removal of multiple polyps7. Hysteroscopy with resectoscopes and classic mechanical resection with scissors and/or graspers remain standard for evaluating and treating the pathology of the cervical canal and endometrial cavity8. The application of electric energy during the procedure can result in endometrial damage, especially in cases involving anatomical variations such as a unicornuate uterus9. Mechanical technology such as morcellators and scissors are less painful than electrical devices when eliminating structural lesions in the office10.
In response to these challenges, a novel approach is proposed involving the combined use of micro-scissors and forceps during hysteroscopy. This technique aims to minimize the risk of injury to the endometrium, particularly the basal layer while ensuring the complete excision of polyps to enhance fertility outcomes for women. The technique is easy to learn and requires two doctors to perform the operation. Doctors with experience in hysteroscopy are capable of executing this procedure. It is a new and unique technique that eliminates thermal damage in a very common gynecologic indication.
Overall, this innovative approach presents a safer and more precise method for eliminating endometrial polyps, particularly in women with fertility concerns, offering a valuable alternative to traditional hysteroscopic procedures and potentially enhancing outcomes for patients requiring treatment for endometrial polyps.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Grasping Forceps</td>
			<td>ShenDa</td>
			<td>X5164B</td>
			<td></td>
		</tr>
		<tr>
			<td>Hysteroscope Lens</td>
			<td>ShenDa</td>
			<td>J0122A</td>
			<td></td>
		</tr>
		<tr>
			<td>Hysteroscopic Infusion Set</td>
			<td>ShenDa</td>
			<td>T7511&#160;</td>
			<td></td>
		</tr>
		<tr>
			<td>IMAGE 1 S CONNECT</td>
			<td>KARL STORZ</td>
			<td>TC200</td>
			<td></td>
		</tr>
		<tr>
			<td>IMAGE1 HD</td>
			<td>KARL STORZ</td>
			<td>H3-Z</td>
			<td></td>
		</tr>
		<tr>
			<td>IMAGE1 S H3-LINK</td>
			<td>KARL STORZ</td>
			<td>TC300</td>
			<td></td>
		</tr>
		<tr>
			<td>Monitor</td>
			<td>NDS surgical imaging, LLC</td>
			<td>N-90X0568-G</td>
			<td></td>
		</tr>
		<tr>
			<td>Optical Cable</td>
			<td>ShenDa</td>
			<td>U8724</td>
			<td></td>
		</tr>
		<tr>
			<td>Scissors</td>
			<td>ShenDa</td>
			<td>X5261A&#160;</td>
			<td></td>
		</tr>
		<tr>
			<td>Sealing Cap</td>
			<td>ShenDa</td>
			<td>T7303</td>
			<td></td>
		</tr>
		<tr>
			<td>Uterine Balloon Dilator</td>
			<td>ShenDa</td>
			<td>U9522 DG-1</td>
			<td></td>
		</tr>
		<tr>
			<td>XENON NOVA 300</td>
			<td>KARL STORZ</td>
			<td>201340 20</td>
			<td></td>
		</tr>
	</tbody>
</table>

improved hysteroscopic resection of endometrial polyps using 6-fr micro-scissors and forceps

Endometrial polyps commonly contribute to female infertility, and hysteroscopic resection is the established surgical approach for their treatment. Numerous resection methods are available, with the most used and cost-effective options being cold resection employing micro-scissors or hot resection using an electric loop. However, both methods involve sharp resection, posing a challenge in achieving complete polyp removal while avoiding damage to the uterine endometrium. To address this issue, this study proposes an innovative approach: the combined use of the 6 Fr micro-scissors and forceps under hysteroscopy. The method entails utilizing 6 Fr micro-scissors to initially remove large polyps, followed by using 6 Fr micro-forceps to extract the remaining polyp tissue expeditiously and bluntly near the basal layer of the endometrium. This approach not only prevents surgical damage to the basal layer of the endometrium but also mitigates the risk of residual polyps resulting from incomplete resection. This method is particularly suitable for women with fertility requirements, offering additional considerations for the selection of treatment options for endometrial polyp resection.

A total of 114 patients suspected of having endometrial polyps based on transvaginal ultrasound findings participated in this study (Figure 4). All patients underwent hysteroscopy, with 15 patients diagnosed without endometrial polyps. The remaining 99 patients underwent endometrial polyp resection using the hysteroscopy technique. Among these 99 patients, aged between 26 and 44 years (Table 1), the average parity was 0.54 &#177; 0.78, and the median diameter of endometrial ...

Author Spotlight: A Reproductive Hysteroscopy Approach for Complete Endometrial Polyp Removal and Enhanced Endometrial Receptivity

The novel technique presented here employs a combination of 6-Fr micro-scissors and forceps for hysteroscopic treatment of endometrial polyps, demonstrating encouraging outcomes for infertile patients afflicted with this condition.

Improved Hysteroscopic Resection of Endometrial Polyps Using 6-Fr Micro-Scissors and Forceps

Endometrial polyps commonly contribute to female infertility, and hysteroscopic resection is the established surgical approach for their treatment. ...

improved-hysteroscopic-resection-endometrial-polyps-using-6-fr-micro

Research

JoVE Journal

Medicine

465 Views.  Shanghai Geriatrics Medical Center. The novel technique presented here employs a combination of 6-Fr micro-scissors and forceps for hysteroscopic treatment of endometrial polyps, demonstrating encouraging outcomes for infertile patients afflicted with this condition.

Video: Author Spotlight: A Reproductive Hysteroscopy Approach for Complete Endometrial Polyp Removal and Enhanced Endometrial Receptivity

Two Methods for Establishing Primary Human Endometrial Stromal Cells from Hysterectomy Specimens

Many efforts have been devoted to establish in vitro cell culture systems. These systems are designed to model a vast number of in vivo processes. Cell culture systems arising from human endometrial samples are no exception. Applications range from normal cyclic physiological processes to endometrial pathologies such as gynecological cancers, infectious diseases, and reproductive deficiencies. Here, we provide two methods for establishing primary endometrial stromal cells from surgically resected endometrial hysterectomy specimens. The first method is referred to as &#8220;the scraping method&#8221; and incorporates mechanical scraping using surgical or razor blades whereas the second method is termed &#8220;the trypsin method.&#8221; This latter method uses the enzymatic activity of trypsin to promote the separation of cells and primary cell outgrowth. We illustrate step-by-step methodology through digital images and microscopy. We also provide examples for validating endometrial stromal cell lines via quantitative real time polymerase chain reactions (qPCR) and immunofluorescence (IF).

Establishing primary endometrial stromal cell culture systems from hysterectomy specimens is a valuable biological technique and a crucial step prior to pursuing a vast array of research aims. Here, we describe two methods used to establish stromal cultures from surgically resected endometrial tissues of human patients.&#160;

Many efforts have been devoted to establish in vitro cell culture systems. These systems are designed to model a vast number of in vivo processes. Cell ...

Murine Ileocolic Bowel Resection with Primary Anastomosis

Intestinal resections are frequently required for treatment of diseases involving the gastrointestinal tract, with Crohn&#8217;s disease and colon cancer being two common examples. Despite the frequency of these procedures, a significant knowledge gap remains in describing the inherent effects of intestinal resection on host physiology and disease pathophysiology. This article provides detailed instructions for an ileocolic resection with primary end-to-end anastomosis in mice, as well as essential aspects of peri-operative care to maximize post-operative success. When followed closely, this procedure yields a 95% long-term survival rate, no failure to thrive, and minimizes post-operative complications of bowel obstruction and anastomotic leak. The technical challenges of performing the procedure in mice are a barrier to its wide spread use in research. The skills described in this article can be acquired without previous surgical experience. Once mastered, the murine ileocolic resection procedure will provide a reproducible tool for studying the effects of intestinal resection in models of human disease.

Ileocolic resection is commonly performed in several human diseases; however, little is known regarding the impact of intestinal resection on surgical illnesses. This article provides instruction on executing the procedure in mice with high success, providing a means to study the effects of ileocolic resection in models of disease.

Intestinal resections are frequently required for treatment of diseases involving the gastrointestinal tract, with Crohn&#8217;s disease and colon cancer ...

Calibrated Forceps Model of Spinal Cord Compression Injury

Compression injuries of the murine spinal cord are valuable animal models for the study of spinal cord injury (SCI) and spinal regenerative therapy. The calibrated forceps model of compression injury is a convenient, low cost, and very reproducible animal model for SCI. We used a pair of modified forceps in accordance with the method published by Plemel et al. (2008) to laterally compress the spinal cord to a distance of 0.35 mm. In this video, we will demonstrate a dorsal laminectomy to expose the spinal cord, followed by compression of the spinal cord with the modified forceps. In the video, we will also address issues related to the care of paraplegic laboratory animals. This injury model produces mice that exhibit impairment in sensation, as well as impaired hindlimb locomotor function. Furthermore, this method of injury produces consistent aberrations in the pathology of the SCI, as determined by immunohistochemical methods. After watching this video, viewers should be able to determine the necessary supplies and methods for producing SCI of various severities in the mouse for studies on SCI and/or treatments designed to mitigate impairment after injury.

Spinal cord injury models should be highly reproducible. We demonstrate that the calibrated forceps compression model of spinal cord injury is an easy to use surgical method for generating reproducible injuries to the murine spinal cord.

Compression injuries of the murine spinal cord are valuable animal models for the study of spinal cord injury (SCI) and spinal regenerative therapy. The ...

An Improved Method for Rapid Intubation of the Trachea in Mice

Despite some anatomical and physiological differences, mouse models continue to be an essential tool for studying human lung disease. Bleomycin toxicity is a commonly used model to study both acute lung injury and fibrosis, and multiple methods have been developed for administering bleomycin (and other toxic agents) into the lungs. However, many of these approaches, such as transtracheal instillation, have inherent drawbacks, including the need for strong anesthetics and survival surgery. This paper reports a quick, reproducible method of intratracheal intubation that involves mild inhaled anesthesia, visualization of the trachea, and the use of a surrogate spirometer to confirm exposure. As a proof of concept, 8-12 week old C57BL/6 mice were administered either 2.0 U/kg of bleomycin or an equivalent volume of PBS, and both damage and fibrotic endpoints were measured post-exposure. This procedure allows researchers to treat a large cohort of mice in a relatively short period with little expense and minimal post-procedure care.

This article presents a rapid and simple method for administering bleomycin directly into the mouse trachea via intubation. Key advantages of this method are that it is highly reproducible, easy to master, and does not require specialized equipment or lengthy recovery times.

Despite some anatomical and physiological differences, mouse models continue to be an essential tool for studying human lung disease. Bleomycin toxicity ...

Image-Guided Resection of Glioblastoma and Intracranial Implantation of Therapeutic Stem Cell-seeded Scaffolds

Glioblastoma (GBM), the most common and aggressive primary brain cancer, carries a life expectancy of 12-15 months. The short life expectancy is due in part to the inability of the current treatment, consisting of surgical resection followed by radiation and chemotherapy, to eliminate invasive tumor foci. Treatment of these foci may be improved with tumoricidal human mesenchymal stem cells (MSCs). MSCs exhibit potent tumor tropism and can be engineered to express therapeutic proteins that kill tumor cells. Advancements in preclinical models indicate that surgical resection induces premature MSC loss and reduces therapeutic efficacy. Efficacy of MSC treatment can be improved by seeding MSCs on a biodegradable poly(lactic acid) (PLA) scaffold. MSC delivery into the surgical resection cavity on a PLA scaffold restores cell retention, persistence, and tumor killing. To study the effects of MSC-seeded PLA implantation on GBM, an accurate preclinical model is needed. Here we provide a preclinical surgical protocol for image-guided tumor resection of GBM in immune-deficient mice followed by MSC-seeded scaffold implantation. MSCs are engineered with lentiviral constructs to constitutively express and secrete therapeutic TNF&#945;-related apoptosis-inducing ligand (TRAIL) as well as green fluorescent protein (GFP) to allow fluorescent tracking. Similarly, the U87 tumor cells are engineered to express mCherry and firefly luciferase, providing dual fluorescent/luminescent tracking. While currently used for investigating stem cell mediated delivery of therapeutics, this protocol could be modified to investigate the impact of surgical resection on other GBM interventions.

Tumor-seeking therapeutic mesenchymal stem cells (MSCs) show promise as a treatment for invasive glioblastoma. Optimal transplantation involves delivery of MSCs into the tumor resection cavity on scaffolds. Here, preclinical techniques to study MSC treatment of glioblastoma are provided including: image-guided tumor resection; implantation of MSC-seeded scaffolds; and postoperative therapy tracking.

Glioblastoma (GBM), the most common and aggressive primary brain cancer, carries a life expectancy of 12-15 months. The short life expectancy is due in ...

Endoscopic Septoplasty with Limited Two-line Resection: Minimally Invasive Surgery for Septal Deviation

Endoscopic septoplasty is a surgical procedure in otolaryngology that is commonly performed to treat nasal airway obstruction caused by nasal septal deviation. It has a long history with multiple variations. In this article, a modified endoscopic septoplasty procedure using the limited two-line resection (2LoRs) technique at the posterior and inferior junction of the cartilaginous and bony septum is presented based on embryologic and anatomic knowledge of the nasal septum and the biomechanics of cartilaginous behavior. With this procedure, the quadrangular cartilage can be preserved as much as possible, which is helpful in retaining the supporting framework and rigidness of the septum. 2LoRs has been proven effective and sound for the correction of nasal septal deviation with rare complications. This modified procedure can be applied to correct the deviated nasal septum in the absence of any external nasal deformity to improve nasal patency or to improve access to the middle meatus or to the axillary region of the middle turbinate. It may also be used to expand the indications of septoplasty to children and adolescents because of its minimally invasive approach.

Endoscopic septoplasty is a time-honored surgical procedure with multiple variations. This paper focuses on a step-by-step surgical approach to perform a modified septoplasty procedure known as limited two-line resection. This surgical technique can be applied to correct a deviated nasal septum in the absence of an external nasal deformity.

Endoscopic septoplasty is a surgical procedure in otolaryngology that is commonly performed to treat nasal airway obstruction caused by nasal septal ...

Transaxillary First Rib Resection for Treatment of the Thoracic Outlet Syndrome

Thoracic outlet syndrome (TOS) is a common disorder that causes a significant loss of productivity. The transaxillary first rib resection (TFRR) protocol has been used for the decompression of trapped neurovascular structures in the TOS. Among the other surgical procedures, the advantage of the TFRR is that it has the smallest rate of recurrence and better cosmetic outcomes. The disadvantage of TFRR is that it provides a narrow, and deep working corridor that makes obtaining vascular control challenging.

Here, we present a protocol of the transaxillary resection of the first rib for treatment of thoracic outlet syndrome caused by compression of the brachial plexus, subclavian vein and artery.

Thoracic outlet syndrome (TOS) is a common disorder that causes a significant loss of productivity. The transaxillary first rib resection (TFRR) protocol ...

Robot-Assisted Radical Antegrade Modular Pancreatosplenectomy Including Resection and Reconstruction of the Spleno-Mesenteric Junction

This article shows the technique of robot-assisted radical antegrade modular pancreatosplenectomy, including resection and reconstruction of the spleno-mesenteric junction, for cancer of the body-tail of the pancreas. The patient is placed supine with the legs parted and a pneumoperitoneum is established and maintained at 10 mmHg. To use the surgical system, four 8 mm ports and one 12 mm port are required. The optic port is placed at the umbilicus. The other ports are placed, on either side, along the pararectal line and the anterior axillary line at the level of the umbilical line. The assistant port (12 mm) is placed along the right pararectal line. Dissection begins by detaching the gastrocolic ligament, thus opening the lesser sac, and by a wide mobilization of the splenic flexure of the colon. The superior mesenteric vein is identified along the inferior border of the pancreas. Lymph node number 8a is removed to permit clear visualization of the common hepatic artery. A tunnel is then created behind the neck of the pancreas. To permit safe resection and reconstruction of the spleno-mesenteric junction, further preemptive dissection is required before dividing the pancreatic neck to bring in clear view all relevant vascular pedicles. Next, the splenic artery is ligated and divided, and the pancreatic neck is divided, with selective ligature of the pancreatic duct. After vein resection and reconstruction, dissection proceeds to complete the clearance of peripancreatic arteries that are peeled off from all lympho-neural tissues. Both celiac ganglia are removed en-bloc with the specimen. The Gerota fascia covering the upper pole of the left kidney is also removed en-bloc with the specimen. Division of short gastric vessels and splenectomy complete the procedure. A drain is left near the pancreatic stump. The round ligament of the liver is mobilized to protect the vessels.

The robotic technique shown herein aims at faithfully reproducing the open procedure for radical treatment of cancer of the body-tail of the pancreas. The protocol also demonstrates the ability to master involvement of major peripancreatic vessels without conversion to open surgery.

This article shows the technique of robot-assisted radical antegrade modular pancreatosplenectomy, including resection and reconstruction of the ...

Endoscopy Guided Photoablation of Endometrial Cysts using a 980 nm Laser with a Contact Fiber in Mares

In mares, endometrial cysts are associated with endometriosis and can cause maternal recognition failure or compromise and delay pregnancy diagnoses. Historical treatments were invasive and had adverse effects on the endometrium. Hysteroscopically guided laser therapy is easy and effective for endometrial cysts resection, with no deleterious effects for the endometrium.
A 110 cm long and 1.0 cm wide endoscope is sterilely introduced in the uterus through the open cervix of an estrous mare after vulvar cleaning. The uterus is slowly infused with less than 1 L of physiologic solution and the laser fiber is inserted in the biopsy canal of the endoscope. Cysts are then cauterized with the 980 nm diode laser with a contact fiber set at 20&#8210;2 5W in continuous mode. Each cyst is punctured&#160;until complete voiding of the cyst and shrinking of the cyst wall around the fiber. Uterine lavages with sterile saline solution are performed directly after the surgery and for one or two days as non-inflammatory fluid can be observed.
This procedure is easy and quickly performed, with no obvious deleterious effects. Cysts resection makes ultrasound pregnancy diagnosis easier and, in some cases, could restore proper embryo migration in the uterine horns between day 6.5 and 17. However, this treatment does not improve the underlying histological lesions related to endometriosis. These considerations should be clearly expressed to the breeder before this procedure.

The aim of this report is to describe the photoablation of endometrial cysts in the mare using an endoscopic laser device, and to discuss the interest and limitations of this new approach to deal with low fertility issues.

In mares, endometrial cysts are associated with endometriosis and can cause maternal recognition failure or compromise and delay pregnancy diagnoses. ...

An In Vivo Mouse Model of Total Intravenous Anesthesia During Cancer Resection Surgery

Anesthesia is a routine component of cancer care that is used for diagnostic and therapeutic procedures. The anesthetic technique has recently been implicated in impacting long-term cancer outcomes, possibly through modulation of adrenergic-inflammatory responses that impact cancer cell behavior and immune cell function. Emerging evidence suggests that propofol-based total intravenous anesthesia (TIVA) may be beneficial for long-term cancer outcomes when compared to inhaled volatile anesthesia. However, the available clinical findings are inconsistent. Preclinical studies that identify the underlying mechanisms involved are critically needed to guide the design of clinical studies that will expedite insight. Most preclinical models of anesthesia have been extrapolated from the use of anesthesia in in vivo research and are not optimally designed to study the impact of anesthesia itself as the primary endpoint. This paper describes a method for delivering propofol-TIVA anesthesia in a mouse model of breast cancer resection that replicates key aspects of clinical delivery in cancer patients. The model can be used to study mechanisms of action of anesthesia on cancer outcomes in diverse cancer types and can be extrapolated to other non-cancer areas of preclinical anesthesia research.

An In Vivo Mouse Model of Total Intravenous Anesthesia During Cancer Resection Surgery

This paper describes a method for modeling total intravenous anesthesia (TIVA) during cancer resection surgery in mice. The goal is to replicate key features of anesthesia delivery to patients with cancer. The method allows investigation of how anesthetic technique affects cancer recurrence after resection surgery.

Anesthesia is a routine component of cancer care that is used for diagnostic and therapeutic procedures. The anesthetic technique has recently been ...