我们感谢积极参与这项研究的患者、外科医生、麻醉师、擦洗护士和技术人员。没有他们的合作，这项研究是不可能的。

这项前瞻性观察研究于 2023 年 3 月至 2023 年 12 月进行，涉及门诊宫腔镜手术患者。它得到了上海吉爱遗传与体外孕育研究所医院伦理委员会的批准（伦理文件编号:JIAI E2020-09）。所有参与者在纳入研究前都提供了知情同意书。
1. 患者选择和准备
<ol><li>患者资格<ol><li>纳入标准:包括年龄在 18-45 岁之间的原发性或继发性不孕症患者，至少一次经阴道超声提示子宫内膜增厚不均匀或怀疑子宫内膜息肉。</li>
		<li>排除标准:排除 18 岁以下或 45 岁以上的个体、有严重内部内科合并症、血流动力学不稳定、急性盆腔炎、感染未经治疗、手术当天体温超过 37.5 °C 的个体、孕妇、疑似子宫内膜癌或宫颈癌、甲状腺功能亢进症、子宫增大伴子宫腔超过 12 cm的个体，以及不愿提供知情同意者。</li>
	</ol></li>
	<li>术前患者准备<ol><li>进行全面评估，包括乙型肝炎、丙型肝炎、人类免疫缺陷病毒 （HIV） 和梅毒检测，以及心电图、肝肾功能检查、凝血功能分析、全血细胞计数、阴道分泌物检查和术前经阴道超声等评估。</li>
		<li>在月经停止后 10 天内安排手术。准备以下手术器械:窥器、Hegar 扩张器、海绵架、宫颈钳、消毒纱布、探针和刮风，如图 1A 所示。</li>
	</ol></li>
</ol>2. 手术准备
<ol><li>术前准备<ol><li>收集全面的病史记录，包括患者的年龄、产科和月经史、潜在的医疗状况、子宫和腹部手术史以及相关的临床症状，如不规则阴道出血。此外，在手术前卵泡期通过经阴道超声检查记录子宫大小、位置（前倾或后倾）、子宫内膜厚度、子宫内膜回声以及其他子宫疾病（如子宫肌瘤或子宫腺肌病）的存在。</li>
		<li>确定患者的手术风险并获得他们签署的知情同意书。此外，在手术前，评估患者的麻醉风险，获得他们签署的知情同意书，并允许患者根据个人情况在局部麻醉和无麻醉之间进行选择。</li>
	</ol></li>
	<li>操作字段<ol><li>要求手术团队的位置如下:外科医生位于患者脚下，第一助理站在外科医生的右侧，麻醉师位于患者头部的左侧，擦洗护士位于患者的左侧（参见 图1B）。</li>
		<li>将内窥镜设备放置在患者脚部右侧，将麻醉设备放置在患者头部右侧，将监测设备放置在患者头部。将患者置于截石姿势，两侧用绷带固定小腿，以确保手术过程中固定。</li>
	</ol></li>
	<li>消毒<ol><li>按照从上到下、从里到外消毒的原则进行消毒。用碘纱布对外生殖器、阴唇、会阴、大腿内侧和肛周皮肤消毒 3 次。对阴道进行碘纱布消毒 3 次。使用无菌手术单完成手术悬垂。</li>
	</ol></li>
</ol>3. 外科手术
<ol><li>根据人员的专业情况执行以下任务: 麻醉师建立外周静脉通路;主要手术助理负责组装宫腔镜镜头、清洁镜头、调整焦距和设置白平衡。 注意: 所有手术均由同一位经验丰富的宫腔镜外科医生使用 5.2 毫米直径的宫腔镜进行。</li>
	<li>将宫腔镜压力设置为 100 mmHg，流速为 300 mL/min。使用 0.9% 盐水溶液作为膨胀介质。使用宫腔镜从子宫腔中排出气体。用宫颈钳抓住宫颈右下唇，再次对阴道、穹窿和宫颈进行碘消毒。</li>
	<li>将宫腔镜通过宫颈管引入子宫腔。如果遇到困难，请缩回宫腔镜并使用带有刻度的测量探头评估子宫腔的位置和深度。然后，拉动宫颈夹，将过度弯曲的子宫变平，以利于宫腔镜进入子宫腔。</li>
	<li>使用从 3.5 号到 5.5 号的 Hegar 扩张器进行宫颈扩张。如果需要，给予 Phloroglucinol（80 mg 静脉注射）以放松颈椎平滑肌。</li>
	<li>在宫腔镜手术期间将宫腔镜引入子宫腔时，保留详细记录，记录子宫内膜息肉的存在与否，以及它们的位置、大小、形态（带蒂或宽基）和任何其他值得注意的子宫内膜状况。</li>
	<li>息肉切除<ol><li>对于单个子宫息肉的患者，请执行以下步骤。<ol><li>使用微镊子进行单独移除。使用微镊子的钝端精确定位子宫内膜的基底层（参见 图2A）。子宫内膜息肉和基底层之间存在解剖间隙（如图 2B 所示）;将镊子放在这里以抓住子宫内膜息肉的基底部分。</li>
			<li>迅速拔出微镊子，以确保息肉基底与子宫内膜基底完全分离（如图 2C 所示）。逐步执行该程序，直到息肉完全切除。收集切除的息肉组织进行病理检查。典型的术前和术后图像如图 3A、B 所示。</li>
		</ol></li>
		<li>对于多发性子宫内膜息肉患者，请执行以下步骤。<ol><li>对于在手术过程中出现多发性子宫内膜息肉引起阻塞作用的患者，最初使用微剪刀切除大部分息肉（参见 图2D）。该策略旨在增加手术空间并提高手术区域内的可见性。在此之后，使用步骤 3.6.1 去除任何剩余的息肉基底。 注意:使用微型剪刀时应特别小心，避免在手术过程中剪得太深，以免损伤子宫内膜的基底层。</li>
			<li>从子宫后壁开始进行息肉切除，然后是子宫外壁和角落，然后是子宫前壁。该手术顺序旨在优化手术区域的清晰度。</li>
			<li>一旦确认完全切除所有息肉基底，拔出宫腔镜并使用小刮刀或海绵钳确保完全切除息肉组织。典型的术前和术后图像如图 3C-E 所示。 注意:为了最大限度地降低与反复宫腔镜插入相关的感染风险增加，通常建议在组织切除后不要进行进一步的宫腔镜探查。</li>
		</ol></li>
	</ol></li>
	<li>取出所有手术器械后，通过碘消毒清洁宫颈和阴道。</li>
</ol>4. 术后操作
<ol><li>手术后，彻底记录所有观察和进行的手术干预。在此之后，提交标本进行病理评估。</li>
	<li>进行术后监测 1 小时以评估患者的状况。在没有任何并发症的情况下，患者无需额外药物即可出院。 注意:手术过程不需要任何电子设备，只需要使用微剪刀和微镊子。如果在手术过程中使用电子设备，则将被记录为外科手术失败。应记录所有手术并发症，并记录术后病理报告。</li>
</ol>5. 统计分析
<ol><li>对于定量数据，请使用描述性统计量，例如平均值、标准差、中位数和置信区间;对于定性数据，请使用 frequency 和 percentage 进行描述。</li>
</ol>

使用微剪刀和镊子去除息肉的宫腔镜技术

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作者声明没有利益冲突。

我们的研究提出了一种新颖的手术技术，可以在不切割子宫内膜或对子宫内膜造成电损伤的情况下切除子宫内膜息肉，这对有生育问题的女性特别有益。Sharon 等人介绍了一种使用非电环进行息肉切除的类似技术11，证明了其有效性和安全性。然而，传统的电切镜直径更大12，需要宫颈扩张并可能增加宫颈功能障碍的风险。相比之下，我们使用的宫腔镜直径更小?...

子宫内膜息肉是子宫内膜的异常组织生长，对生育能力和生殖健康有重大影响1。在不孕症患者中，子宫内膜息肉的估计发病率约为 35%2，尽管这个数字可能会有所不同。这些息肉可以通过在子宫腔中诱导结构畸形并影响子宫内膜支持植入的能力来破坏胚胎植入 3,4,5,6。虽然宫腔镜手术是切除子宫内膜息肉的常见手术，但它并非没有风险，子宫穿孔是主要并发症，尤其是在切除多发性息肉期间7。使用电切镜进行宫腔镜检查和使用剪刀和/或抓手进行经典的机械切除术仍然是评估和治疗宫颈管和子宫内膜腔病变的标准8。在手术过程中施加电能会导致子宫内膜损伤，尤其是在涉及解剖变化的情况下，例如单角子宫9。在消除办公室的结构病变时，粉碎器和剪刀等机械技术比电气设备痛苦小10.
为了应对这些挑战，提出了一种新方法，涉及在宫腔镜检查期间联合使用微剪刀和镊子。该技术旨在最大限度地降低子宫内膜，尤其是基底层受伤的风险，同时确保完全切除息肉以提高女性的生育结果。该技术易于学习，需要两名医生进行手术。具有宫腔镜检查经验的医生能够执行此程序。这是一种新颖而独特的技术，可消除非常常见的妇科适应症中的热损伤。
总体而言，这种创新方法为消除子宫内膜息肉提供了一种更安全、更精确的方法，尤其是在有生育问题的女性中，为传统宫腔镜手术提供了有价值的替代方案，并可能改善需要治疗子宫内膜息肉的患者的预后。

<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

子宫内膜息肉通常会导致女性不孕症，宫腔镜切除术是治疗子宫内膜息肉的既定手术方法。有许多切除方法可供选择，其中最常用和最具成本效益的选择是使用显微剪刀的冷切除或使用电环的热切除。然而，这两种方法都涉及锐利切除，在避免损伤子宫内膜的同时实现完全切除息肉构成了挑战。为了解决这个问题，本研究提出了一种创新方法:在宫腔镜下联合使用 6 Fr 微剪刀和镊子。该方法需要使用 6 Fr 微型剪刀初步切除大息肉，然后使用 6 Fr 微型镊子在子宫内膜基底层附近迅速而钝地提取剩余的息肉组织。这种方法不仅可以防止手术损伤子宫内膜的基底层，还可以降低因切除不完全导致残留息肉的风险。这种方法特别适合有生育要求的女性，为子宫内膜息肉切除术治疗方案的选择提供了额外的考虑。

共有 114 名基于经阴道超声检查结果疑似子宫内膜息肉的患者参与了这项研究（图4）。所有患者均接受宫腔镜检查，其中 15 例患者诊断无子宫内膜息肉。其余 99 例患者使用宫腔镜技术接受了子宫内膜息肉切除术。在这 99 名年龄在 26 至 44 岁之间的患者中 （表1），平均产次为 0.54 ± 0.78，子宫内膜息肉的中位直径为 12 毫米 （范围 4-22 毫米）。在本研究中，最常?...

作者聚焦:一种用于完全切除子宫内膜息肉和增强子宫内膜容受性的生殖宫腔镜方法

这里介绍的新技术采用 6-Fr 微型剪刀和镊子的组合进行子宫内膜息肉的宫腔镜治疗，为患有这种疾病的不孕症患者展示了令人鼓舞的结果。

使用 6-Fr 微型剪刀和镊子改进子宫内膜息肉的宫腔镜切除术

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

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

464 次观看.  Shanghai Geriatrics Medical Center. 我们的研究主要是关于生殖宫腔镜检查，我们要解决的主要问题是如何确保子宫内膜患者的子宫环境达到最佳的妊娠条件。现在的主要挑战是如何在保护患者生育能力的同时完全切除子宫内膜息肉，而不损伤子宫内膜的基底层。我们的手术方案可以确保完全切除息肉，同时最大限度地提高患者的子宫内膜容受性，以提高患者的生育能力。

视频: 作者聚焦:一种用于完全切除子宫内膜息肉和增强子宫内膜容受性的生殖宫腔镜方法

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;

两种方法从子宫切除标本小学建立人子宫内膜基质细胞

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 ...

科研

医学

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.

鼠回结肠肠管切除原发性吻合

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.

脊髓压迫损伤的校准钳型

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.

在小鼠气管插管快速的改进方法

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.

影像引导切除治疗干细胞种子支架的胶质母细胞瘤和颅内植入术

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.

内镜下鼻中隔成形术有限双线切除: 间隔偏差微创手术

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.

经腋窝第一肋骨切除术治疗胸廓出口综合征

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.

机器人辅助基质前体模块化胰腺切除术，包括切除和重建的斯普尔诺-梅森特克结

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.

内窥镜引导光活内膜囊肿使用 980 nm 激光与接触纤维在马雷斯

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.

癌症切除手术中全静脉麻醉的 体内 小鼠模型

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