作者要感谢帕斯卡尔·勒琼先生在所有程序中给予的技术支持。

所提交的协议用于在马医院展示的母马，并遵循机构动物护理指南。
注:在麻醉前进行子宫内膜囊肿光解:因此在7月底或8月观察到的热量似乎最可靠。不要在繁殖季节太晚执行此程序，因为它可以限制可用于治疗潜在子宫内膜炎的雌膜数量。
1. 在前一次埃斯特鲁斯期间
<ol><li>对母马进行完整的繁殖健全性检查，包括子宫内膜活检1（ 此处未描述），以确保母马在手术后可能怀孕。</li>
	<li>如果子宫内膜活检不良，根据肯尼的分类1，给予胚胎转移或细胞内精子注射（ICSI）计划优先于子宫内膜囊肿光化。</li>
</ol>2. 在前述死亡事件中
<ol><li>一旦直肠是空的，计数，测量和地图子宫内膜囊肿的母马使用跨直肠超声学引导直肠心绞痛与7.5或5MHz线性直肠探头和卡钳在屏幕上（图3）在竞争股票。</li>
	<li>在排卵后2天或3天内，在肌肉内施用250微克氯普罗司他诺，以诱导雌性。</li>
	<li>每天进行常见的常规超声波和子宫颈触觉观察埃斯特鲁斯体征，包括显著的子宫内膜水肿、35毫米的蚂蚁卵泡以及软化和打开的子宫颈。</li>
</ol>3. 母马在高温下准备
<ol><li>限制戴眼保护眼镜的人进入手术室。</li>
	<li>排空直肠后，用碘-波维酮包裹尾巴并清洁外阴。</li>
	<li>为了确保母马的易操作和舒适性，用21G针头静脉静脉注射去托米丁（10微克/千克）和丁醇（0.1毫克/千克）。</li>
	<li>每个阴道，安装胚胎收集导管通过子宫颈和气泡气球与40mlL的空气。</li>
	<li>向子宫注入1.5升无菌盐水溶液（0.9%NaCl），使子宫充气。</li>
	<li>放气气球，取出导管。</li>
	<li>通过内窥镜无菌套内的子宫颈。</li>
</ol>4. 技术
<ol><li>将 600 μm 石英纤维连接到 980 nm 的二极管激光器。将电源设置为 20+20125 W 的连续模式。</li>
	<li>通过直径为 10 毫米的视频内窥镜活检通道传递柔性石英纤维，直到屏幕上可识别 3+20124 厘米的免费光纤。纤维末端至少应可见 10 mm。</li>
	<li>激活激光，以最好地刺穿囊肿的顶点:设备上有专用踏板，以保持手自由。在某些情况下，为了完全使囊肿失效，需要在不同位置进行多次穿刺。囊性液体被动地排出到子宫中。</li>
	<li>囊肿衬里在纤维周围坍塌后，部署激光直到膜收缩。</li>
	<li>在手术过程中尽可能多地对子宫进行转录超声波检查，以确认子宫内膜囊肿已经消失。</li>
</ol>5. 术后治疗
<ol><li>实施一般抗生素治疗:22，000 UI/kg青霉素-前列素悬浮，肌肉内，每天两次，为期3天。</li>
	<li>干预后，执行上述子宫厕所（见步骤 3.4-3.6）。<ol>
<li>通过无菌袖口导管收集子宫内窥镜手术前注入的液体。</li>
		<li>用连续灌输 1 L 无菌异位溶液 （0.9% NaCl） 冲洗子宫，直到收集到透明液体。</li>
		<li>在手术结束时，静脉注射20IU催产素。</li>
		<li>后天对母马子宫进行转录超声检查:经常观察到无发光液体（见第2.1步）。</li>
	</ol>
</li>
	<li>只要通过转录超声波观察到自由发光体，直到热结束，每天执行子宫熔岩与上述程序（步骤3.4-3.6）。有时，血清状、淡淡和黄色染色液体会收集数天。 注:母马在雌激素中每4小时或更短的时间内反复注射催产素（20 IU），可避免液体积聚，降低子宫细菌污染的风险。</li>
	<li>在以下死亡过程中进行跨直肠子宫超声检查，以确认子宫内囊肿的消失和缺乏发光内自由液。 注:如果观察到免费的发光液，建议注射前列腺素以诱导新的雌激素，诊断最终的子宫内膜炎并治疗它。</li>
</ol>

<ol><li>Kenney, R. M., Ganjam, V. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Selected+pathological+changes+of+the+mare+uterus+and+ovary%5BTitle%5D)+AND+%22Journal+of+Reproduction+and+Fertility%22%5BJournal%5D)">Selected pathological changes of the mare uterus and ovary.</a> Journal of Reproduction and Fertility. (23), 335-339 (1975).</li>
<li>Bracher, V., Mathias, S., Allen, W. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Videoendoscopic+evaluation+of+the+mare%27s+uterus%3A+II.+Findings+in+subfertile+mares%5BTitle%5D)+AND+%22Equine+Veterinary+Journal%22%5BJournal%5D)">Videoendoscopic evaluation of the mare's uterus: II. Findings in subfertile mares.</a> Equine Veterinary Journal. 24 (4), 279-284 (1992).</li>
<li>Kaspar, B., Kahn, W., Laging, C., Leidl, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Endometrial+cysts+in+the+mare.+1.+Post-mortem+studies%3A+occurrence+and+morphology%5BTitle%5D)+AND+%22Tier%C3%A4rztliche+Praxis%22%5BJournal%5D)">Endometrial cysts in the mare. 1. Post-mortem studies: occurrence and morphology.</a> Tierärztliche Praxis. 15 (2), 161-166 (1987).</li>
<li>Leidl, W., Kaspar, B., Kahn, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Endometrial+cysts+in+the+mare.+2.+Clinical+studies%3A+occurrence+and+significance%5BTitle%5D)+AND+%22Tier%C3%A4rztliche+Praxis%22%5BJournal%5D)">Endometrial cysts in the mare. 2. Clinical studies: occurrence and significance.</a> Tierärztliche Praxis. 15 (3), 281-289 (1987).</li>
<li>Mather, E. C., Refsal, K. R., Gustafsson, B. K., Seguin, B. E., Whitmore, H. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((The+use+of+fibre-optic+techniques+in+clinical+diagnosis+and+visual+assessment+of+experimental+intrauterine+therapy+in+mares%5BTitle%5D)+AND+%22Journal+of+Reproduction+and+Fertility%22%5BJournal%5D)">The use of fibre-optic techniques in clinical diagnosis and visual assessment of experimental intrauterine therapy in mares.</a> Journal of Reproduction and Fertility. (27), 293-297 (1979).</li>
<li>Stanton, M. E. <a target="_blank" href="http://scholar.google.com/scholar?hl=en&safe=off&q=author%3aStanton%2C+ME+%22Equine+Reproduction+Vol.+2%22">Equine Reproduction Vol. 2</a>. Mc Kinnon, A. O., Squires, E. L., Vaala, W. E., Varner, D. D. , Blackwell. Ch. 276 2665-2668 (2011).</li>
<li>Bracher, V., Mathias, S., Allen, W. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Influence+of+chronic+degenerative+endometritis+%28endometrosis%29+on+placental+development+in+the+mare%5BTitle%5D)+AND+%22Equine+Veterinary+Journal%22%5BJournal%5D)">Influence of chronic degenerative endometritis (endometrosis) on placental development in the mare.</a> Equine Veterinary Journal. 28 (3), 180-188 (1996).</li>
<li>Tannus, R. J., Thun, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Influence+of+endometrial+cysts+on+conception+rate+of+mares%5BTitle%5D)+AND+%22Zentralbl+Veterinarmed+A%22%5BJournal%5D)">Influence of endometrial cysts on conception rate of mares.</a> Zentralbl Veterinarmed A. 42 (4), 275-283 (1995).</li>
<li>Pipers, F. S., Zent, W., Holder, R., Asbury, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Ultrasonography+as+an+adjunct+to+pregnancy+assessments+in+the+mare%5BTitle%5D)+AND+%22Journal+of+the+American+Veterinary+Medical+Association%22%5BJournal%5D)">Ultrasonography as an adjunct to pregnancy assessments in the mare.</a> Journal of the American Veterinary Medical Association. 184 (3), 328-334 (1984).</li>
<li>LeBlanc, M., Mc Kinnon, A. O. <a target="_blank" href="http://scholar.google.com/scholar?hl=en&safe=off&q=author%3aLeBlanc%2C+M+%22Equine+Reproduction+Vol.+2%22">Equine Reproduction Vol. 2</a>. Mc Kinnon, A. O., Squires, E. L., Vaala, W. E., Varner, D. D. , Blackweel Publishing. Ch. 272 2620-2642 (2011).</li>
<li>van Ittersum, A. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((The+electrosurgical+treatment+of+endometrial+cysts+in+the+mare%5BTitle%5D)+AND+%22Tijdschr+Diergeneeskd%22%5BJournal%5D)">The electrosurgical treatment of endometrial cysts in the mare.</a> Tijdschr Diergeneeskd. 124 (21), 630-633 (1999).</li>
<li>Rambags, B. P., Stout, T. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Transcervical+endoscope-guided+emptying+of+a+transmural+uterine+cyst+in+a+mare%5BTitle%5D)+AND+%22Vet+Record%22%5BJournal%5D)">Transcervical endoscope-guided emptying of a transmural uterine cyst in a mare.</a> Vet Record. 156 (21), 679-682 (2005).</li>
<li>Blikslager, A. T., Tate, L. P., Weinstock, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Effects+of+neodymium%3Ayttrium+aluminum+garnet+laser+irradiation+on+endometrium+and+on+endometrial+cysts+in+six+mares%5BTitle%5D)+AND+%22Veterinary+Surgery%22%5BJournal%5D)">Effects of neodymium:yttrium aluminum garnet laser irradiation on endometrium and on endometrial cysts in six mares.</a> Veterinary Surgery. 22 (5), 351-356 (1993).</li>
<li>Bartmann, C. P., Stief, B., Schoon, H. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Thermal+injury+and+wound+healing+of+the+endometrium+subsequent+to+minimally+invasive+transendoscopic+use+of+Nd%3AYAG-laser-and+electrosurgery+in+horses%5BTitle%5D)+AND+%22Dtsch+Tierarztl+Wochenschr%22%5BJournal%5D)">Thermal injury and wound healing of the endometrium subsequent to minimally invasive transendoscopic use of Nd:YAG-laser-and electrosurgery in horses.</a> Dtsch Tierarztl Wochenschr. 110 (7), 271-280 (2003).</li>
<li>Conley, A. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Review+of+the+reproductive+endocrinology+of+the+pregnant+and+parturient+mare%5BTitle%5D)+AND+%22Theriogenology%22%5BJournal%5D)">Review of the reproductive endocrinology of the pregnant and parturient mare.</a> Theriogenology. 86 (1), 355-365 (2016).</li>
<li>Guzeloglu, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Expression+of+enzymes+and+receptors+of+leukotriene+pathway+genes+in+equine+endometrium+during+the+estrous+cycle+and+early+pregnancy%5BTitle%5D)+AND+%22Theriogenology%22%5BJournal%5D)">Expression of enzymes and receptors of leukotriene pathway genes in equine endometrium during the estrous cycle and early pregnancy.</a> Theriogenology. 80 (2), 145-152 (2013).</li>
<li>Senger, P. L. <a target="_blank" href="http://scholar.google.com/scholar?hl=en&safe=off&q=author%3aSenger%2C+PL+%22Pathways+to+pregnancy+and+parturition%2C+3rd+edn%22">Pathways to pregnancy and parturition, 3rd edn</a>. , (2015).</li>
</ol>

所有作者均受雇于列日大学的 Equine 诊所，与任何交易上述产品之一的公司没有利益冲突。

子宫内膜囊肿的子宫镜检查和激光光化是减少母马中大的发光囊肿的简单程序，如前所述14。从技术上讲，当在雌雄母马上执行时，此方法会得到改进。与空气填充和执行过程中的连续吸入相比，使用无菌盐水溶液充气子宫可提高能见度。 小腹囊肿（<10毫米）更难到达和治疗。此外，如果激光治疗时间延长，治疗这些小囊肿可能导致子宫内膜和骨髓穿孔。然而，他们很少干扰胚?...

母马的子宫内膜囊肿是肯尼1号在七十年代描述的组织病理学。在八十年代末期，使用子宫镜检查和超声波检查导致他们的临床描述，并有助于了解它们对生育力的影响2，3，4，5。
在早期阶段，子宫内膜囊肿与子宫内膜的退化有关，现在称为子宫内膜1，3，4，6，7，8，目前人们承认，小（<1厘米）囊肿与子宫内膜腺纤维化有关，而较大的囊肿与淋巴扩张6有关.这些大囊肿最有可能在第6.5天至第17天之间干扰马胚胎移植，从而通过损害母体识别1、3、4、6、8来降低生育能力。子宫内膜囊肿也可能干扰早孕诊断，特别是如果它们是圆形的，其大小与胚胎囊泡3、4、6、9相似（见图1）。因此，他们可以通过推迟第一次胚胎超声波检查和双胞胎妊娠评估（见图2）来增加两次授精之间的间隔。子宫内膜囊肿也可能机械地干扰子宫厕所期间的液体收集，以治疗子宫内膜炎或收集胚胎。因此，子宫内膜囊肿对观察到的母马的生育能力有影响，在育种场有潜在的经济后果。
除了尝试治疗基础子宫内膜10，内窥镜引导的囊肿焦点治疗已经提出。电外科烧灼被描述，但热暴露可能会伤害囊肿11周围的子宫内膜。只有当分泌结构在穿刺12时不再活跃时，囊肿的吸气才有效。激光照射与980纳米二极管激光与接触纤维似乎显示较小的后续子宫内膜疤痕6，13。激光设备和程序6的改进，现在使我们能够提出这种安全和有效的技术，在马匹临床实践。但是，必须告知母马所有者此选项的局限性。囊肿的光化将增加一些母马的胚胎识别，在某些情况下将推进妊娠诊断，并可能限制子宫内膜囊肿对子宫厕所的负面机械影响，以治疗子宫内膜炎或收集胚胎。然而，它永远不会治疗伴随的根本子宫内膜异位症或子宫内膜炎。
本报告旨在描述在母马中执行子宫镜导引二极管激光囊肿消融的有效程序。临床应用的准备和程序将实际描述。

<table><tbody><tr><td>Butorphanol</td><td>Animedica</td><td>Morphasol 10 mg/mL</td><td></td></tr><tr><td>Detomidine</td><td>Dechra</td><td>Domidine 10 mg/mL</td><td></td></tr><tr><td>Endoscope</td><td>Olympus</td><td>Vet 170-10 SN2012729</td><td></td></tr><tr><td>Endoscope Vid&amp;eacute;o Tower</td><td>Olympus</td><td>CLE-E &amp;amp; CV-E</td><td></td></tr><tr><td>Laser device</td><td>Wuhan Giga Optronics</td><td>Velas II-60B GA19-V3186</td><td></td></tr><tr><td>NaCl 0.9%</td><td>Baxter</td><td></td><td></td></tr><tr><td>P&amp;eacute;nicilline-proca&amp;iuml;ne</td><td>Kela</td><td>PENI-Kel 300.00 UI/ml</td><td></td></tr><tr><td>Ultrasonography</td><td>Aloka</td><td>Aloka 500 &amp;amp; 5mHz transrectal probe</td><td></td></tr></tbody></table>

endoscopy guided photoablation of endometrial cysts using a 980 nm laser with a contact fiber in mares

在母体中，子宫内膜囊肿与子宫内膜异位症有关，可导致产妇识别失败或妥协和延迟妊娠诊断。历史治疗具有侵入性，对子宫内膜有不良影响。歇斯底里引导激光治疗是简单和有效的子宫内膜囊肿切除，没有对子宫内膜的有害影响。
子宫内窥镜长110厘米，宽1.0厘米，在外阴清洗后，通过母马的开放子宫颈进行无菌引入。子宫缓慢地注入小于1升的生理溶液，激光纤维插入内窥镜的活检管中。然后用 980 nm 二极管激光烧灼，接触纤维设置为 20+20122 5W，以连续模式。每个囊肿被刺穿，直到囊肿完全失效和纤维周围的囊肿壁收缩。子宫熔岩与无菌盐水溶液在手术后直接进行，并作为非炎症液体可以观察到一两天。
此过程简单且快速执行，没有明显的有害效果。囊肿切除术使超声波妊娠诊断更容易，在某些情况下，可以在6.5至17日之间恢复子宫角的适当胚胎迁移。然而，这种治疗并不能改善与子宫内膜异位症相关的基本组织病变。在进行此程序之前，应向育种者明确表达这些考虑。

手术是在有直径超过15毫米的囊肿的母马身上进行的。然而，如果其他较小的囊肿也存在，尝试其他囊肿的光消融。一般来说，这些大囊肿是在分叉或角的基础。然而，其中一些在子宫内，并受到同等对待。
根据我们的经验，内膜囊肿很容易与内窥镜本地化。此外，在盐水溶液中执行此程序可提高子宫内的可见性:它避免蒸汽的排放、子宫内膜粘液和淋巴液混合导致的泡沫产?...

Watch this Scientific Journal Video about Endoscopy Guided Photoablation of Endometrial Cysts using a 980 nm Laser with a Contact Fiber in Mares at JoVE.com

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

本报告的目的是利用内窥镜激光装置描述母马子宫内膜囊肿的光消融，并讨论这种处理低生育率问题的新方法的兴趣和局限性。

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. ...

endoscopy-guided-photoablation-endometrial-cysts-using-980-nm-laser

Research

JoVE Journal

Medicine

4.3K 次观看.  Liège University. 本报告的目的是利用内窥镜激光装置描述母马子宫内膜囊肿的光消融，并讨论这种处理低生育率问题的新方法的兴趣和局限性。

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

Photoacoustic Cystography

Conventional pediatric cystography, which is based on diagnostic X-ray using a radio-opaque dye, suffers from the use of harmful ionizing radiation. The risk of bladder cancers in children due to radiation exposure is more significant than many other cancers. Here we demonstrate the feasibility of nonionizing and noninvasive photoacoustic (PA) imaging of urinary bladders, referred to as photoacoustic cystography (PAC), using near-infrared (NIR) optical absorbents (i.e. methylene blue, plasmonic gold nanostructures, or single walled carbon nanotubes) as an optical-turbid tracer. We have successfully imaged a rat bladder filled with the optical absorbing agents using a dark-field confocal PAC system. After transurethral injection of the contrast agents, the rat's bladders were photoacoustically visualized by achieving significant PA signal enhancement. The accumulation was validated by spectroscopic PA imaging. Further, by using only a laser pulse energy of less than 1 mJ/cm2 (1/20 of the safety limit), our current imaging system could map the methylene-blue-filled-rat-bladder at the depth of beyond 1 cm in biological tissues in vivo. Both in vivo and ex vivo PA imaging results validate that the contrast agents were naturally excreted via urination. Thus, there is no concern regarding long-term toxic agent accumulation, which will facilitate clinical translation.

Photoacoustic cystography (PAC) has a great potential to map urinary bladders, a radiation sensitive internal organ in pediatric patients, without using any ionizing radiation or toxic contrast agent. Here we demonstrate the use of PAC for mapping urinary bladders with an injection of optical-opaque tracers in rats in vivo.

光声膀胱造影

Conventional pediatric cystography, which is based on diagnostic X-ray using a radio-opaque dye, suffers from the use of harmful ionizing radiation. The ...

科研

生物工程

One Minute, Sub-One-Watt Photothermal Tumor Ablation Using Porphysomes, Intrinsic Multifunctional Nanovesicles

We recently developed porphysomes as intrinsically multifunctional nanovesicles. A photosensitizer, pyropheophorbide &alpha;, was conjugated to a phospholipid and then self-assembled to liposome-like spherical vesicles. Due to the extremely high density of porphyrin in the porphyrin-lipid bilayer, porphysomes generated large extinction coefficients, structure-dependent fluorescence self-quenching, and excellent photothermal efficacy. In our formulation, porphysomes were synthesized using high pressure extrusion, and displayed a mean particle size around 120 nm. Twenty-four hr post-intravenous injection of porphysomes, the local temperature of the tumor increased from 30 &deg;C to 62 &deg;C rapidly upon one minute exposure of 750 mW (1.18 W/cm2), 671 nm laser irradiation. Following the complete thermal ablation of the tumor, eschars formed and healed within 2 weeks, while in the control groups the tumors continued to grow and all reached the defined end point within 3 weeks. These data show how porphysomes can be used as potent photothermal therapy (PTT) agents.

We developed novel intrinsic multifunctional nanovesicles called porphysomes, which have structure-dependent fluorescence self-quenching and unique photothermal properties, thus functioning as potent photothermal therapy agents. We formulated porphysomes using high pressure extrusion and investigated their photothermal therapy efficacy in a xenograft tumor model.

一分钟，小一瓦光热消融肿瘤使用Porphysomes，内在多功能纳米囊泡

We recently developed porphysomes as intrinsically multifunctional nanovesicles. A photosensitizer, pyropheophorbide &alpha;, was conjugated to a ...

Multi-Photon Laser Ablation of Cytoplasmic Microtubule Organizing Centers in Mouse Oocytes

The fidelity of oocyte meiosis is critical for generating developmentally competent euploid eggs. In mammals, the oocyte undergoes a lengthy arrest at prophase I of the first meiotic division. After puberty and upon meiotic resumption, the nuclear membrane disassembles (nuclear envelope breakdown), and the spindle is assembled mainly at the oocyte center. Initial central spindle positioning is essential to protect against abnormal kinetochore-microtubule (MT) attachments and aneuploidy. The centrally positioned spindle migrates in a time-sensitive manner toward the cortex, and this is a necessary process to extrude a tiny polar body. In mitotic cells, spindle positioning relies on the interaction between centrosome-mediated astral MTs and the cell cortex. On the contrary, mouse oocytes lack classic centrosomes and, instead, contain numerous acentriolar MT organizing centers (MTOCs). At the metaphase I stage, mouse oocytes have two different sets of MTOCs: (1) MTOCs that are clustered and sorted to assemble spindle poles (polar MTOCs), and (2) metaphase cytoplasmic MTOCs (mcMTOCs) that remain in the cytoplasm and do not contribute directly to spindle formation but play a crucial role in regulating spindle positioning and timely spindle migration. Here, a multi-photon laser ablation method is described to selectively deplete endogenously labeled mcMTOCs in oocytes collected from Cep192-eGfp reporter mice. This method contributes to the understanding of the molecular mechanisms underlying spindle positioning and migration in mammalian oocytes.

An optimized protocol is presented that enables the depletion of cytoplasmic microtubule organizing centers in mouse oocytes during metaphase I using a near-infrared femtosecond laser.

小鼠卵母细胞质微管组织中心的多光子激光消融

The fidelity of oocyte meiosis is critical for generating developmentally competent euploid eggs. In mammals, the oocyte undergoes a lengthy arrest at ...

发育生物学

Photoselective Vaporesection of the Prostate via an End-firing Lithium Triborate Crystal Laser

The occurrence of lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) is a common problem with a high incidence in the aging male population. Although it is not a life-threatening disease, BPH causes problems that seriously impact the quality of life. Here, we introduce a new technique called photoselective vaporesection of the prostate (PVRP) in treating BPH, which can be seen as a variation of photoselective vaporization of the prostate (PVP). This procedure presents several advantages compared to the PVP technique including less laser energy loss, less intraoperative complications as well as more tissue resection rate.

Here we present a protocol to perform Photoselective Vaporesection of the Prostate (PVRP) for benign prostatic hyperplasia (BPH) treatment.

选择性绿激光锂三硼酸晶体激光 Vaporesection 前列腺的研究

The occurrence of lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) is a common problem with a high incidence in the aging ...

医学

Enucleation of the Prostate for the Treatment of Benign Prostatic Hyperplasia Using a 980 nm Diode Laser

In the aging male population, the occurrence of lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) is a common problem. Here, we introduce a new technique called 980 nm diode laser enucleation (DiLEP) to treat BPH1. Diode lasers can absorb both water and hemoglobin at the same time, so they are good for cutting and hemostasis2. The diode laser was approved by the FDA in 2007, and has been used in the treatment of BPH because of its effective cutting and hemostasis effect3. DiLEP presents several advantages over other techniques, such as TURP, HoLEP, and PVP. During the procedure, we define the boundary of a high-volume prostate and separate it into three lobes with a diode laser by burning two rings and one groove (like a Cupid&#39;s arrow). Compared to other procedures, mDiLEP has fewer intraoperative complications, a shorter learning curve, and achieves more tissue resection.

Here, we present a protocol for modified 980 nm diode laser enucleation to treat large volume benign prostatic hyperplasia.

使用 980 nm 二极管激光进行前列腺摘除术治疗良性前列腺增生

In the aging male population, the occurrence of lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) is a common problem. ...

Development of a Noninvasive, Laser-Assisted Experimental Model of Corneal Endothelial Cell Loss

Nd:YAG lasers have been used to perform noninvasive intraocular surgery, such as capsulotomy for several decades now. The incisive effect relies on the optical breakdown at the laser focus. Acoustic shock waves and cavitation bubbles are generated, causing tissue rupture. Bubble sizes and pressure amplitudes vary with pulse energy and position of the focal point. In this study, enucleated porcine eyes were positioned in front of a commercially available Nd:YAG laser. Variable pulse energies as well as different positions of the focal spots posterior to the cornea were tested. Resulting lesions were evaluated by two-photon microscopy and histology to determine the best parameters for an exclusive detachment of corneal endothelial cells (CEC) with minimum collateral damage. The advantages of this method are the precise ablation of CEC, reduced collateral damage, and above all, the non-contact treatment.

Here, we present a protocol to detach corneal endothelial cells (CEC) from Descemet&#8217;s membrane (DM) using a neodymium:YAG (Nd:YAG) laser as an ex vivo disease model for bullous keratopathy (BK).

角膜内皮细胞损失非侵入性激光辅助实验模型的发展

Nd:YAG lasers have been used to perform noninvasive intraocular surgery, such as capsulotomy for several decades now. The incisive effect relies on the ...

Focal Laser Ablation of Prostate Cancer: An Office Procedure

In this article, we describe and illustrate an outpatient procedure for focal laser ablation (FLA) of prostate cancer (PCa). The procedure is conceptually similar to a fusion biopsy and is performed under local anesthesia in a clinic setting; treatment time is usually less than one hour. Laser insertion is guided by ultrasound; lesion targeting is via magnetic resonance imaging-ultrasound (MRI/US) fusion, as in targeted prostate biopsy. Real-time ablation monitoring is achieved utilizing a thermal probe adjacent to the laser fiber. The video demonstrates procedure planning, patient preparation, various steps during the procedure, and treatment monitoring. Safety, feasibility, and efficacy of this approach have been established during a previous trial. Outpatient FLA under local anesthesia is an option for management of intermediate risk prostate cancer.

This article presents and describes an outpatient treatment for prostate cancer using focal laser ablation. Laser catheter placement is guided by MRI-ultrasound fusion imaging in a fashion similar to prostate needle biopsy. Treatment is monitored in real-time with a thermal probe, placed adjacent to the laser fiber.

前列腺癌聚焦激光消融:办公室程序

In this article, we describe and illustrate an outpatient procedure for focal laser ablation (FLA) of prostate cancer (PCa). The procedure is conceptually ...

Surgical Techniques to Optimize Ovarian Reserve during Laparoscopic Cystectomy for Ovarian Endometrioma

Surgical management of ovarian endometrioma in patients desiring fertility is complicated by the need to balance maximal resection of disease with efforts to spare normal ovarian cortex. Optimization of tubal anatomy is another frequent consideration. Fertility-sparing laparoscopic techniques at the time of cystectomy for ovarian endometrioma seek to limit iatrogenic surgical damage to the ovarian cortex and strategically assess and respond to genital tract patency. Surgical candidates frequently desire relief from endometriosis-associated pain while also seeking to optimize spontaneous or assisted conception rates. Operative benefits include potential for surgical and histopathologic diagnosis of endometriosis, evaluation of genital tract patency, and treatment of visualized lesions. Resection of ovarian endometrioma nonetheless poses significant risks, including surgical injury, blood loss, post-surgical decline in ovarian reserve and post-operative inflammation with adhesion formation, both of which may impair folliculogenesis.
We present the case of a 32-year-old woman with known endometriosis and continued pain refractory to medical management who opted for surgical management of her disease tailored toward optimizing her chances at future conception. Using this case as an example, we describe techniques and considerations for diagnostic laparoscopy, adhesiolysis, ovarian cystectomy, chromopertubation, and salpingectomy with a focus on maintaining a fertility-preserving approach.

This protocol presents techniques to laparoscopically excise ovarian endometrioma, to perform adhesiolysis with sparing electrosurgical application, and to employ intraoperative chromopertubation to assess for genital tract patency. This systematic approach will facilitate optimal endometriosis management, guide concomitant adnexal surgeries, and enhance post-surgical fertility outcomes.

在卵巢子宫内膜异位症腹腔镜膀胱切除术期间优化卵巢储备的手术技术

Surgical management of ovarian endometrioma in patients desiring fertility is complicated by the need to balance maximal resection of disease with efforts ...

Fertility Sparing Procedure using Carbon Dioxide Fiber Laser Vaporization of Ovarian Endometrioma

The surgical management of endometrioma is still a matter of debate. Cystectomy, which is recognized as the standard technique, seems to be associated with a potential reduction in the ovarian reserve due to the inadvertent removal and thermal damage of healthy ovarian tissue. New ablative techniques with reduced tissue penetration depth and less thermal spread to the surrounding parenchyma may represent a viable alternative to cystectomy. For these reasons, the aim of this manuscript is to demonstrate the ablation of the endometrioma capsule using a CO2 fiber laser technique and discuss the clinical outcomes. Once the cyst has been drained and washed, a biopsy is taken. After cyst eversion, vaporization of the inner surface of the cyst is performed using a CO2 fiber laser. The technique is simple and reproducible as even young surgeons without any surgical experience were more confident in performing laser CO2 vaporization instead of cystectomy. The positive effects of CO2 technology are reported in a randomized controlled trial, where the postoperative changes in the antral follicular count (AFC) and antimullerian hormone (AMH) levels were compared between patients who had their endometrioma excised (cystectomy) and those who had undergone endometrioma vaporization with CO2 laser. The patients treated with CO2 laser showed significantly increased AFC without a reduction in serum AMH levels as compared to the cystectomy group, in which both parameters were significantly reduced. The postoperative pregnancy rate was also assessed, and comparable pregnancy rates were found after both treatments. On the contrary, patients treated with the CO2 fiber laser technique had more favorable in-vitro fertilization (IVF) outcomes compared to cystectomy.
In conclusion, the CO2 fiber laser technique may represent a viable alternative to cystectomy in the surgical treatment of endometrioma in terms of ovarian preservation, pregnancy rates, and IVF outcomes. Moreover, it has the advantage of being independent of the surgeon's skills and personal experience.

In this protocol, CO2 fiber laser technique is demonstrated for the surgical treatment of ovarian endometriosis, which represents a viable alternative in terms of fertility preservation with the major advantage of not being dependent on the surgeon's skills and personal experience.

使用二氧化碳光纤激光汽化卵巢子宫内膜异位瘤的生育保留程序

The surgical management of endometrioma is still a matter of debate. Cystectomy, which is recognized as the standard technique, seems to be associated ...

使用微剪刀和镊子去除息肉的宫腔镜技术

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.

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

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.

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. ...