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

<ol><li>Kim, K. R., Peng, R., Ro, J. Y., Robboy, S. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((A+diagnostically+useful+histopathologic+feature+of+endometrial+polyp%3A+the+long+axis+of+endometrial+glands+arranged+parallel+to+surface+epithelium%5BTitle%5D)+AND+%22Am+J+Surg+Pathol%22%5BJournal%5D)">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/pubmed?term=((Matched+controlled+study+to+evaluate+the+effect+of+endometrial+polyps+on+pregnancy+and+implantation+rates+following+in+vitro+fertilization-embryo+transfer+%28IVF-ET%29%5BTitle%5D)+AND+%22Clin+Exp+Obstet+Gynecol%22%5BJournal%5D)">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/pubmed?term=((Management+of+endometrial+polyps+in+subfertile+women%3A+a+systematic+review%5BTitle%5D)+AND+%22Eur+J+Obstet+Gynecol+Reprod+Biol%22%5BJournal%5D)">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/pubmed?term=((The+uterus+and+fertility%5BTitle%5D)+AND+%22Fertil+Steril%22%5BJournal%5D)">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/pubmed?term=((The+effectiveness+of+hysteroscopic+polypectomy+in+cases+of+female+infertility%5BTitle%5D)+AND+%22Clin+Exp+Obstet+Gynecol%22%5BJournal%5D)">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/pubmed?term=((Impact+of+estrogen+and+progesterone+receptor+expression+on+the+incidence+of+endometrial+polyps%5BTitle%5D)+AND+%22Biomark+Med%22%5BJournal%5D)">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/pubmed?term=((Complications+of+hysteroscopic+surgery%3A+%26%2334%3BBeyond+the+learning+curve%26%2334%5BTitle%5D)+AND+%22J+Minim+Invasive+Gynecol%22%5BJournal%5D)">Complications of hysteroscopic surgery: &#34;Beyond the learning curve&#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/pubmed?term=((Endometrial+polyps%3A+Diagnosis+and+treatment+options-A+review+of+literature%5BTitle%5D)+AND+%22Minim.+Invasive+Ther.+Allied+Technol%22%5BJournal%5D)">Endometrial polyps: Diagnosis and treatment options-A review of literature.</a> Minim. Invasive Ther. Allied Technol. 30, 278-287 (2021).</li>
<li>Munro, M. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Complications+of+hysteroscopic+and+uterine+resectoscopic+surgery%5BTitle%5D)+AND+%22Obstet+Gynecol+Clin+North+Am%22%5BJournal%5D)">Complications of hysteroscopic and uterine resectoscopic surgery.</a> Obstet Gynecol Clin North Am. 37 (3), 399-425 (2010).</li>
<li>De Silva, P. M., Stevenson, H., Smith, P. P., Clark, T. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Pain+and+operative+technologies+used+in+office+hysteroscopy%3A+A+systematic+review+of+randomized+controlled+trials%5BTitle%5D)+AND+%22J+Minim+Invasive+Gynecol%22%5BJournal%5D)">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/pubmed?term=((Nonelectric+shaving+of+endometrial+polyp+by+hysteroscopy+-+A+new+technique+to+eliminate+thermal+damage%5BTitle%5D)+AND+%22Eur+J+Obstet+Gynecol+Reprod+Biol%22%5BJournal%5D)">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/pubmed?term=((Bipolar+resectoscope%3A+the+future+perspective+of+hysteroscopic+surgery%5BTitle%5D)+AND+%22Gyneco+Surg%22%5BJournal%5D)">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/pubmed?term=((Chronic+endometritis+increases+the+recurrence+of+endometrial+polyps+in+premenopausal+women+after+hysteroscopic+polypectomy%5BTitle%5D)+AND+%22BMC+Womens+Health%22%5BJournal%5D)">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. J., Stevenson, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Endometrial+polyps+and+abnormal+uterine+bleeding+%28AUB-P%29%3A+what+is+the+relationship%2C+how+are+they+diagnosed+and+how+are+they+treated%5BTitle%5D)+AND+%22Best+Pract+Res+Clin+Obstet+Gynaecol%22%5BJournal%5D)">Endometrial polyps and abnormal uterine bleeding (AUB-P): what is the relationship, how are they diagnosed and how are they treated.</a> Best Pract Res Clin Obstet Gynaecol. 40, 89-104 (2017).</li>
<li>Yang, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Cold+scissors+versus+electrosurgery+for+hysteroscopic+adhesiolysis%3A+A+meta-analysis%5BTitle%5D)+AND+%22Medicine%22%5BJournal%5D)">Cold scissors versus electrosurgery for hysteroscopic adhesiolysis: A meta-analysis.</a> Medicine. 100 (17), e25676(2021).</li>
<li>van Gemert, J., Herman, M. C., Beelen, P., Geomini, P. M., Bongers, M. Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Endometrial+polypectomy+using+tissue+removal+device+or+electrosurgical+snare%3A+a+randomised+controlled+trial%5BTitle%5D)+AND+%22Facts+Views+Vis+Obgyn%22%5BJournal%5D)">Endometrial polypectomy using tissue removal device or electrosurgical snare: a randomised controlled trial.</a> Facts Views Vis Obgyn. 14 (3), 235-243 (2022).</li>
<li>Noventa, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Intrauterine+morcellator+devices%3A+The+icon+of+hysteroscopic+future+or+merely+a+marketing+image%3F+A+systematic+review+regarding+safety%2C+efficacy%2C+advantages%2C+and+contraindications%5BTitle%5D)+AND+%22Reprod+Sci%22%5BJournal%5D)">Intrauterine morcellator devices: The icon of hysteroscopic future or merely a marketing image? A systematic review regarding safety, efficacy, advantages, and contraindications.</a> Reprod Sci. 22 (10), 1289-1296 (2015).</li>
<li>Rothenberg, S., Nayak, S., Sanfilippo, J. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Clinical+use+of+the+intrauterine+morcellator%3A+A+single+academic+center%27s+experience%5BTitle%5D)+AND+%22Open+J+Obst+Gynecol%22%5BJournal%5D)">Clinical use of the intrauterine morcellator: A single academic center's experience.</a> Open J Obst Gynecol. 4 (6), 326-332 (2014).</li>
</ol>

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><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&amp;nbsp;</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&amp;nbsp;</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

625 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

Intraoperative Detection of Subtle Endometriosis: A Novel Paradigm for Detection and Treatment of Pelvic Pain Associated with the Loss of Peritoneal Integrity

Endometriosis is a common disease affecting 40 to 70% of reproductive-aged women with chronic pelvic pain (CPP) and/or infertility. The purpose of this study was to demonstrate the use of a blue dye (methylene blue) to stain peritoneal surfaces during laparoscopy (L/S) to detect the loss of peritoneal integrity in patients with pelvic pain and suspected endometriosis. Forty women with CPP and 5 women without pain were evaluated in this pilot study. During L/S, concentrated dye was sprayed onto peritoneal surfaces, then aspirated and rinsed with Lactated Ringers solution. Areas of localized dye uptake were evaluated for the presence of visible endometriotic lesions. Areas of intense peritoneal staining were resected and some fixed in 2.5% buffered gluteraldehyde and examined by scanning (SEM) electron microscopy. Blue dye uptake was more common in women with endometriosis and chronic pelvic pain than controls (85% vs. 40%). Resection of the blue stained areas revealed endometriosis by SEM and loss of peritoneal cell-cell contact compared to normal, non-staining peritoneum. Affected peritoneum was associated with visible endometriotic implants in most but not all patients. Subjective pain relief was reported in 80% of subjects. Based on scanning electron microscopy, we conclude that endometrial cells extend well beyond visible implants of endometriosis and appear to disrupt the underlying mesothelium. Subtle lesions of endometriosis could therefore cause pelvic pain by disruption of peritoneal integrity, allowing menstrual or ovulatory blood and associated pain factors access to underlying sensory nerves. Complete resection of affected peritoneum may provide a better long-term treatment for endometriosis and CPP. This simple technique appears to improve detection of subtle or near invisible endometriosis in women with CPP and minimal visual findings at L/S and may serve to elevate diagnostic accuracy for endometriosis at laparoscopy.

Loss of peritoneal integrity provides a new paradigm to understand and treat chronic pelvic pain in women with mild forms of endometriosis and can be easily detected using intraoperative instillation of dye at the time of laparoscopy.

术中的微妙的子宫内膜异位症的检测:A新型范式为相关联的与的的腹膜的完整性之亏损盆腔疼痛的的的的检测和治疗的

Endometriosis is a  common disease affecting 40 to 70% of reproductive-aged women with chronic  pelvic pain (CPP) and/or infertility. The purpose of this ...

科研

医学

Deep Neuromuscular Blockade Leads to a Larger Intraabdominal Volume During Laparoscopy

Shoulder pain is a commonly reported symptom following laparoscopic procedures such as myomectomy or hysterectomy, and recent studies have shown that lowering the insufflation pressure during surgery may reduce the risk of post-operative pain. In this pilot study, a method is presented for measuring the intra-abdominal space available to the surgeon during laproscopy, in order to examine whether the relaxation produced by deep neuromuscular blockade can increase the working surgical space sufficiently to permit a reduction in the CO2 insufflation pressure. Using the laproscopic grasper, the distance from the promontory to the skin is measured at two different insufflation pressures: 8 mm Hg and 12 mm Hg. After the initial measurements, a neuromuscular blocking agent (rocuronium) is administered to the patient and the intra-abdominal volume is measured again. Pilot data collected from 15 patients shows that the intra-abdominal space at 8 mm Hg with blockade is comparable to the intra-abdominal space measured at 12 mm Hg without blockade. The impact of neuromuscular blockade was not correlated with patient height, weight, BMI, and age. Thus, using neuromuscular blockade to maintain a steady volume while reducing insufflation pressure may produce improved patient outcomes.

This article presents a method for measuring the working abdominal volume during laproscopic myomectomy using the surgical grasper, and applies this technique to obtain pilot data on whether deep neuromuscular blockade (NMB) can enable the use of lower insufflation pressure. Reduced insufflation pressure during laproscopic surgery has been shown to reduce post-operative pain, and thus the use of NMB during surgery may enable improved patient outcomes.

深神经肌肉阻滞信息到更大的在腹腔镜腹腔容积

Shoulder pain is a commonly reported symptom following laparoscopic procedures such as myomectomy or hysterectomy, and recent studies have shown that ...

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 ...

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 ...

Apical Resection Mouse Model to Study Early Mammalian Heart Regeneration

Cardiovascular disease plagues the whole world due to intensive lifestyle changes. Heart regeneration holds great promise for repairing and restoring cardiomyocytes lost due to injury and disease. In contrast to the robust cardiac regeneration of certain lower vertebrates, adult mammalian hearts typically show minimal capacity for heart regeneration and repair. However, recent studies have sparked considerable scientific interest with the finding that, between postnatal day 1 to 7 (P1 to P7), the neonatal mouse heart retains significant regenerative potential after apical resection (i.e., surgical amputation and exposure of left ventricular apex). One major controversy over this finding might be due to the diverse surgery-related procedures used in efforts to replicate or expand upon this important finding. These instructions dynamically present the materials and methodology for apical resection in a mouse model. The salient steps of this rodent survival surgery involve hypothermia anesthesia, thoracotomy, surgical amputation of heart ventricular apex, and suture and recovery of mice. The approach described could expand the application of the apical resection mouse model for cardiovascular research.

A step-by-step video protocol of apical resection is demonstrated in this study. Apical resection is a recently highlighted surgical approach in mammalian heart regeneration research. This study may promote the application of apical resection as a standard methodology in research into the mechanism underlying heart regeneration.

根尖切除小鼠模型来研究早期哺乳动物心脏再生

Cardiovascular disease plagues the whole world due to intensive lifestyle changes. Heart regeneration holds great promise for repairing and restoring ...

Introduction of Intracapsular Rotary-cut Procedures (IRCP): A Modified Hysteromyomectomy Procedures Facilitating Fertility Preservation

Uterine fibroids are common benign tumors in the female reproductive system. A hysterectomy is the most effective treatment for symptomatic fibroids. For patients desiring pregnancy, laparoscopic intracapsular myomectomy (LM) is an alternative surgery option. Although LM is widely accepted to treat fibroids, it is technically demanding with risk of excessive bleeding and difficult suturing, especially in cases with large fibroids or tumors in unusual locations. Therefore, we developed an intracapsular rotary-cut procedure (IRCP) as a modification of laparoscopic intracapsular myomectomy, with the intention to minimize risks of LM and help uterine healing. A summary of the improvements to the IRCP is described: 1) making an incision at the site of the fibroid with a length of one-third to one-half of the fibroid&#39;s diameter at a depth reaching the fibroid&#39;s surface; 2) holding the fibroid stably and making rotary cuts on the fibroid at a depth of 0.5&#8211;1 cm within its pseudo-capsule while pulling it outward slightly, making sure not to cut off any pieces of the fibroid; and 3) repeating the cutting-and-pulling until the longest dimension of the fibroid is outside the incision. The multiple cuts are to minimize the diameter and extend the length of the fibroid. When the multiple cuts cause half of the fibroid body to &#34;shrink&#34;, the fibroid is squeezed out by contraction of the surrounding myometrium. Evaluation of the outcomes of IRCP showed that the time of enucleation and suturing, intraoperative bleeding, and decline of hemoglobin were significantly lower in the IRCP group than the LM group. As for reproductive outcomes, the full-term live birth rate of the IRCP group was significantly higher than that of LM group. However, there was no difference in delivery modes between the two groups. In conclusion, IRCP significantly benefits fertility preservation by minimizing damage to the uterus, protecting myofibers of the pseudo-capsule, and resulting in a shallower residual cavity, which eases stitching and causes less bleeding. It is worthwhile to adopt IRCP in younger patients who desire preservation of their fertility.

Introduction of Intracapsular Rotary-cut Procedures IRCP: A Modified Hysteromyomectomy Procedures Facilitating Fertility Preservation

Here, we present a protocol for performing an intracapsular rotary-cut procedure (IRCP), a modified laparoscopic intracapsular myomectomy that promotes fertility preservation.

囊内旋切手术 (ircp) 的介绍: 一种改良子宫肌瘤切除术促进生育保护

Uterine fibroids are common benign tumors in the female reproductive system. A hysterectomy is the most effective treatment for symptomatic fibroids. For ...

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. ...

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 ...