Name: photoselective vaporesection of the prostate via an end-firing lithium triborate crystal laser
Uploaded: 2018-05-09T14:00:00
Description: Watch this Scientific Journal Video about Photoselective Vaporesection of the Prostate via an End-firing Lithium Triborate Crystal Laser at JoVE.com

The authors have no acknowledgements.

All methods described here have been approved by ethics committee of Beijing Hospital. Indications for surgery are according to the European Association of Urology guidelines for nonneurogenic male LUTS. Contraindications include suspected prostate cancer or detrusor dysfunction.
1. Instruments for Operation
<ol>
	<li>Ensure the availability of a LBO crystal laser with a maximum power of 160 W.</li>
	<li>Employ an endfiring laser fiber and saline solution for intraoperative bladder irrigatin...

<ol>
	<li>Capit&#225;n, C., Bl&#225;zquez, C., Martin, M. D., Hern&#225;ndez, V., de la Pe&#241;a, E., Llorente, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=GreenLight+HPS+120W+laser+vaporization+versus+transurethral+resection+of+the+prostate+for+the+treatment+of+lower+urinary+tract+symptoms+due+to+benign+prostatic+hyperplasia:+A+randomized+clinical+trial+with+2-year+follow-up.">GreenLight HPS 120W laser vaporization versus transurethral resection of the prostate for the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia: A randomized clinical trial with 2-year follow-up.</a> Eur Urol. 60 (4), 734-739 (2011).</li><li>Cornu, J. N., Ahyai, S., Bachmann, A., de la Rosette, J., Gilling, P., Gratzke, 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=A+systematic+review+and+meta-analysis+of+functional+outcomes+and+complications+following+transurethral+procedures+for+lower+urinary+tract+symptoms+resulting+from+benign+prostatic+obstruction:+An+update.">A systematic review and meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic obstruction: An update.</a> Eur Urol. 67 (6), (2014).</li><li>Kang, H. W., Jebens, D., Malek, R. S., Mitchell, G., Koullick, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laser+vaporization+of+bovine+prostate:+A+quantitative+comparison+of+potassium-titanyl-phosphate+and+lithium+triborate+lasers.">Laser vaporization of bovine prostate: A quantitative comparison of potassium-titanyl-phosphate and lithium triborate lasers.</a> J Urol. 180 (6), 2675-2680 (2008).</li><li>Herrmann, T. R., Liatsikos, E. N., Nagele, U., Traxer, O., Merseburger, A. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=EAU+Guidelines+Panel+on+Lasers,+Technologies.+EAU+guidelines+on+laser+technologies.">EAU Guidelines Panel on Lasers, Technologies. EAU guidelines on laser technologies.</a> Eur Urol. 61 (4), 783-795 (2012).</li><li>Braeckman, J., Denis, L. <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+BPH+then+2000+and+now+2016+-+From+BPH+to+BPO.">Management of BPH then 2000 and now 2016 - From BPH to BPO.</a> Asian J Urol. 4 (3), 138-147 (2017).</li><li>Bachmann, A., Tubaro, A., Barber, N., d'Ancona, F., Muir, G., Witzsch, U., 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=A+European+multicenter+randomized+noninferiority+trial+comparing+180+W+GreenLight+XPS+laser+vaporization+and+transurethral+resection+of+the+prostate+for+the+treatment+of+benign+prostatic+obstruction:+12-month+results+of+the+GOLIATH+study.">A European multicenter randomized noninferiority trial comparing 180 W GreenLight XPS laser vaporization and transurethral resection of the prostate for the treatment of benign prostatic obstruction: 12-month results of the GOLIATH study.</a> J Urol. 193 (2), 570-578 (2015).</li><li>Peyronnet, B., Pradere, B., Brichart, N., Bodin, T., Bertrand, P., Members of French Group of GreenLight Users, ., Bruy&#232;re, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Complications+associated+with+photoselective+vaporization+of+the+prostate:+Categorization+by+a+panel+of+GreenLight+users+according+to+Clavien+score+and+report+of+a+single-center+experience.">Complications associated with photoselective vaporization of the prostate: Categorization by a panel of GreenLight users according to Clavien score and report of a single-center experience.</a> Urology. 84 (3), 657-664 (2014).</li><li>Cho, S. Y., Park, S., Jeong, M. Y., Ro, Y. K., Son, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=120W+GreenLight+high+performance+system+laser+for+benign+prostate+hyperplasia:+68+patients+with+3-year+follow-up+and+analysis+of+predictors+of+response.">120W GreenLight high performance system laser for benign prostate hyperplasia: 68 patients with 3-year follow-up and analysis of predictors of response.</a> Urology. 80 (2), 396-401 (2012).</li><li>Elmansy, H. M., Elzayat, E., Elhilali, M. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Holmium+laser+ablation+versus+photoselective+vaporization+of+prostate+less+than+60+cc:+Long-term+results+of+a+randomized+trial.">Holmium laser ablation versus photoselective vaporization of prostate less than 60 cc: Long-term results of a randomized trial.</a> J Urol. 184 (5), 2023-2028 (2010).</li><li>Hong, K., Liu, Y. Q., Lu, J., Xiao, C. L., Huang, Y., Ma, L. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Efficacy+and+safety+of+120W+thulium:+Yttrium-aluminum-garnet+vapoenucleation+of+prostates+compared+with+holmium+laser+enucleation+of+prostates+for+benign+prostatic+hyperplasia.">Efficacy and safety of 120W thulium: Yttrium-aluminum-garnet vapoenucleation of prostates compared with holmium laser enucleation of prostates for benign prostatic hyperplasia.</a> Chin Med J (Engl). 128 (7), 884-889 (2015).</li><li>Hermanns, T., Sulser, T., Fatzer, M., Baumgartner, M. K., Rey, J. M., Sigrist, M. W., 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=Laser+fiber+deterioration+and+loss+of+power+output+during+photo-selective+80-W+potassiumtitanyl-phosphate+laser+vaporization+of+the+prostate.">Laser fiber deterioration and loss of power output during photo-selective 80-W potassiumtitanyl-phosphate laser vaporization of the prostate.</a> Eur Urol. 55 (3), 679-686 (2009).</li><li>Hermanns, T., Strebel, D. D., Hefermehl, L. J., Gross, O., Mortezavi, A., M&#252;ller, A., 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=Lithium+triborate+laser+vaporization+of+the+prostate+using+the+120+W,+high+performance+system+laser:+High+performance+all+the+way?.">Lithium triborate laser vaporization of the prostate using the 120 W, high performance system laser: High performance all the way?.</a> J Urol. 185 (6), 2241-2247 (2011).</li><li>Schwartz, J., Renard, J., Wolf, J. P., Moret, M., Iselin, C. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=High-power+potassium-titanyl-phosphate+laser+fibres+for+endovaporization+of+benign+prostatic+hyperplasia:+How+much+do+they+deteriorate+during+the+procedure?.">High-power potassium-titanyl-phosphate laser fibres for endovaporization of benign prostatic hyperplasia: How much do they deteriorate during the procedure?.</a> BJU Int. 107 (12), 1938-1942 (2011).</li><li>Son, H., Ro, Y. K., Min, S. H., Choo, M. S., Kim, J. K., Lee, C. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Modified+vaporization-resection+for+photoselective+vaporization+of+the+prostate+using+a+GreenLight+high+-performance+system+120-W+Laser:+the+Seoul+technique.">Modified vaporization-resection for photoselective vaporization of the prostate using a GreenLight high -performance system 120-W Laser: the Seoul technique.</a> Urology. 77 (2), 427-432 (2011).</li><li>Mandal, S., Sankhwar, S. N., Kathpalia, R., Singh, M. K., Kumar, M., Goel, A., 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=Grading+complications+after+transurethral+resection+of+prostate+using+modified+Clavien+classification+system+and+predicting+complications+using+the+Charlson+comorbidity+index.">Grading complications after transurethral resection of prostate using modified Clavien classification system and predicting complications using the Charlson comorbidity index.</a> Int Urol Nephrol. 45 (2), 347-354 (2013).</li><li>Gong, Y. G., Liu, R. M., Gao, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Photoselective+vaporesection+of+the+prostate+with+a+front-firing+lithium+triborate+laser:+Surgical+technique+and+experience+after+215+procedures.">Photoselective vaporesection of the prostate with a front-firing lithium triborate laser: Surgical technique and experience after 215 procedures.</a> Eur Urol. 67 (6), 1142-1159 (2015).</li></ol>

Here, we share our experiences with PVRP. First, PVRP enabled better exposure of the prostate capsule with proper demarcation and reduced the risk of capsule perforation. Second, the tissue removal should be carried out along the surgical capsule, especially with the groove at 12 o&#39;clock, which facilitates tissue resection around the roof of the prostatic urethra and provides a satisfactory tissue removal rate. Third, it is essential to remove the middle lobe initially to acquire a wider channel in the prostatic uret...

Although transurethral resection of the prostate (TURP) is still accepted as the gold standard in benign prostatic hyperplasia (BPH) surgical treatment, laser surgeries have gradually become more popular due to the better patient tolerance, less intraoperative blood loss, satisfactory efficacy, and shorter postoperative recovery1,2,3. Currently, the most commonly used lasers for the BPH treatment worldwide are generated by lithium potassium titanyl phosphate or lithium triborate (LBO) crystals4,5. Traditionally, these are classified as sidefiring lasers compared to other types of laser, such as holmium laser and thulium laser.
Photoselective vaporization of the prostate (PVP) surgery could considerably decline TURP syndrome due to saline irrigation6,7, and compared to other types of lasers, the reliable efficacy of lower urinary tract syndrome (LUTS) by PVP was verified by a series of studies8,9,10. However, PVP associated with side-firing laser emission also has some disadvantages, including an energy loss of nearly 20% and a short lifespan of the laser fiber11,12,13. Moreover, PVP increases the possibility of missed diagnosis of prostate cancer due to complete tissue vaporization.
The introduction of Photoselective Vaporesection of the Prostate (PVRP) with an end-firing fiber successfully overcame most of the disadvantages of PVP mentioned above. First, the tip is capable of transmitting laser to the tissues with almost no energy loss intraoperatively. Second, when fiber debris collects on the tip, it is straightforward to maintain the ideal output power by simply removing the affected parts. Finally, laser resection enables the collection of specimens for postoperative pathologic examination. Hence, using this protocol in treating BPH could enhance the tissue removal rate, save the operative time and improve the intraoperative safety.

<table border="0" cellpadding="0" cellspacing="0" width="1026">
	<tbody>
		<tr height="124">
			<td height="124" style="height:124px;width:279px;">FLARE surgical Laser Fiber</td>
			<td style="width:152px;">REALTON</td>
			<td style="width:119px;"></td>
			<td style="width:477px;">The FLARE Surgical laser Fiber is a 600 micron fiber with an straight tip that transmits the laser energy directly. this product is packaged sterile for disposable use and should not be re-sterilized or reused. Dispose of properly after use.</td>
		</tr>
		<tr height="213">
			<td height="213" style="height:213px;width:279px;">AURORA Surgical Green Laser System</td>
			<td style="width:152px;">REALTON</td>
			<td style="width:119px;">pvp-160-021</td>
			<td style="width:477px;">The AURORA Surgical green laser system is a diode-pumped, frequency-doubled Nd:YAG solid state laser. The AURORA Surgical green laser system features a &#8220;Plug and Play&#8221; capability that self-adjusts to the facility&#8217;s individual voltage requirements, eliminating the need for electrical modifications. The laser system also includes an air-cooled internal mechanism, ensuring safe operating temperatures with no external water connections. Laser energy emission and system status selection is activated through a surgeon-controlled, color-coded footswitch or system touch screen feature located in the laser console.</td>
		</tr>
	</tbody>
</table>

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.

A total of 35 patients who underwent PVRP were included in one of our studies. The mean patient age was 72.1 &#177; 7.1 years (range 53-85 years).
Perioperative data are listed in Table 1. The mean laser emission time accounted for nearly 50% of the mean operative time. The blood loss in most patients was &#60; 200 mL. However, the average deviated due to some moderate bleeding cases. Almost 90% of the patients ...

Watch this Scientific Journal Video about Photoselective Vaporesection of the Prostate via an End-firing Lithium Triborate Crystal Laser at JoVE.com

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

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

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 ...

The overall goal of this procedure is to treat benign prostatic hyperplasia in a minimally invasive manner. This method can be used to effectively treat benign prostatic hyperplasia while preserving tissue for postoperative pathological examination. Other advantages of this technique include a low rate of laser energy loss and fewer intraoperative complications.The implication of this technique extend toward the therapy of benign prostatic hyperplasia as it's safer and quicker than traditional method. Generally, people new to this method will struggle until they have mastered the transurethal resection of the prostate. Visual demonstrations of this method is critical as several key steps are difficult to learn by text instruction alone.Thirty minutes before beginning the procedure, administer a preoperative antibiotic. To begin the procedure, have the patient lay down on the operating table in the dorsal lithotomy position and cover the patient with a sterile drape. Next, distend the bladder with 300 to 400 milliliters of saline and use a 26 F laser resectoscope to examine the whole bladder cavity and prostatic urethra.Use a lithium triborate crystal laser to mark two lines starting at five and seven o'clock on the bladder neck continuing along the boundaries between the median and lateral lobes and merging adjacent to the proximal margin of the verumontanum. Set the laser power to 100 watts and use laser vaporization along the lines to vaporize the prostate until white cyclic fibers are observed. Adjust the laser power to 120 watts and use the laser fiber to mark several more lines on the surface of the wedge-shaped middle lobe.Using vaporization, divide the middle lobe into several chunks along the lines splitting each chunk from the middle lobe. Then remove the whole middle lobe. For vaporesection of the lateral lobes, rotate the cytoscope 180 degrees to vaporize the tissue at 12 o'clock from the apex of the prostate to the bladder neck.When the vaporesection is complete, locate the lower margins of both lateral lobes and set another two grooves originating from the bladder neck at three and nine o'clock to the proximal end of the verumontanum. To remove the tissue of the lateral gland, use the laser fiber to mark several lines on the surface of the left lobe. Vaporize the left lobe into several chunks along the lines and split each chunk from the lobe.Then remove the whole left lobe and remove the remnant gland tissue along the existing boundary of the capsule. To enhance the integrity of the cavity, set the laser to 80 watts and vaporize any protruding tissue around the apex of the gland. Next, use a glass syringe that matches the interface of the resectoscope to remove any final tissue chunks by water flow.Use the resectoscope to confirm a lack of residual tissue in the bladder and prostatic fossa and the integrity of urethral orifices. Use the laser fiber to stop the bleeding around the surgical site. After removing the resectoscope, lubricate the urethra with iodine gel.Then insert a 22 French Foley catheter from the urethral orifice to the bladder cavity and gently fill the balloon with 30 milliliters of water. In this representative study of 35 patients who underwent photoselective vaporesection of the prostate, the mean laser emission time accounted for nearly 50%of the mean operative time and the blood loss in most patients was less than 200 milliliters. Almost 90%of the patients had the catheter removed within six days postoperatively.All patients returned to the hospital for followup examinations at one and three months postprocedure. According to the modified Clavien-Dindo classification system, only two cases of perioperative complications were grade 3b and only one case required treatment. Three patients experienced high febrility due to an acute Urinary Tract Infection or UTI on postoperative days five to six and all three patients received antibiotics and recovered rapidly.Five patients complained of urgency and frequency, but in three patients, the urine culture revealed no abnormalities allowing UTI to be excluded. The other two patients were diagnosed with UTI and recovered after effective antibiotic courses. Only a single patient experienced persistent urinary incontinence in the early postoperative period without the evidence of the UTI that was fully resolved after several weeks of pelvic floor muscles training.Another patient had difficulty voiding and was diagnosed with bladder neck contracture via cystoscopy that was resolved after a bladder neck incision under general anesthesia on day 40 after the original procedure. Once mastered, this procedure can be completed in two hours if it is performed properly. While attempting this procedure, it is important to take care to avoid the intraoperative complications.After watching this video, you should have a good understanding of how to photoselectively vaporesect prostate for the alleviation of the symptoms associated with benign prostatic hyperplasia.

photoselective-vaporesection-prostate-via-an-end-firing-lithium

Research

JoVE Journal

Medicine

Evaluation of Nanoparticle Uptake in Tumors in Real Time Using Intravital Imaging

Current technologies for tumor imaging, such as ultrasound, MRI, PET and CT, are unable to yield high-resolution images for the assessment of nanoparticle uptake in tumors at the microscopic level1,2,3, highlighting the utility of a suitable xenograft model in which to perform detailed uptake analyses. Here, we use high-resolution intravital imaging to evaluate nanoparticle uptake in human tumor xenografts in a modified, shell-less chicken embryo model. The chicken embryo model is particularly well-suited for these in vivo analyses because it supports the growth of human tumors, is relatively inexpensive and does not require anesthetization or surgery 4,5. Tumor cells form fully vascularized xenografts within 7 days when implanted into the chorioallantoic membrane (CAM) 6. The resulting tumors are visualized by non-invasive real-time, high-resolution imaging that can be maintained for up to 72 hours with little impact on either the host or tumor systems. Nanoparticles with a wide range of sizes and formulations administered distal to the tumor can be visualized and quantified as they flow through the bloodstream, extravasate from leaky tumor vasculature, and accumulate at the tumor site. We describe here the analysis of nanoparticles derived from Cowpea mosaic virus (CPMV) decorated with near-infrared fluorescent dyes and/or polyethylene glycol polymers (PEG) 7, 8, 9,10,11. Upon intravenous administration, these viral nanoparticles are rapidly internalized by endothelial cells, resulting in global labeling of the vasculature both outside and within the tumor7,12. PEGylation of the viral nanoparticles increases their plasma half-life, extends their time in the circulation, and ultimately enhances their accumulation in tumors via the enhanced permeability and retention (EPR) effect 7, 10,11. The rate and extent of accumulation of nanoparticles in a tumor is measured over time using image analysis software. This technique provides a method to both visualize and quantify nanoparticle dynamics in human tumors.

We present a novel approach to quantify nanoparticle localization in the vasculature of human xenografted tumors using dynamic, real-time intravital imaging in an avian embryo model.

Current technologies for tumor imaging, such as ultrasound, MRI, PET and CT, are unable to yield high-resolution images for the assessment of nanoparticle ...

Endotracheal Intubation in Mice via Direct Laryngoscopy Using an Otoscope

Mice, both wildtype and transgenic, are the principal mammalian model in biomedical research currently. Intubation and mechanical ventilation are necessary for whole animal experiments that require surgery under deep anesthesia or measurements of lung function. Tracheostomy has been the standard for intubating the airway in these mice to allow mechanical ventilation. Orotracheal intubation has been reported but has not been successfully used in many studies because of the substantial technical difficulty or a requirement for highly specialized and expensive equipment. Here we report a technique of direct laryngoscopy using an otoscope fitted with a 2.0 mm speculum and using a 20 G&#160;intravenous catheter as an endotracheal tube. We have used this technique extensively and reliably to intubate and conduct accurate assessments of lung function in mice. This technique has proven safe, with essentially no animal loss in experienced hands. Moreover, this technique can be used for repeated studies of mice in chronic models.

Endotracheal Intubation in Mice via Direct Laryngoscopy Using an Otoscope

We have developed a simple, reliable, and relatively inexpensive method for endotracheal intubation in mice via direct laryngoscopy using an otoscope with a 2.0 mm speculum. This technique is atraumatic and can be used for repeated measurements in chronic experiments. We find it superior to tracheostomy or previously reported nonsurgical techniques.

Mice, both wildtype and transgenic, are the principal mammalian model in biomedical research currently. Intubation and mechanical ventilation are ...

Permanent Cerebral Vessel Occlusion via Double Ligature and Transection

Stroke is a leading cause of death, disability, and socioeconomic loss worldwide. The majority of all strokes result from an interruption in blood flow (ischemia) 1. Middle cerebral artery (MCA) delivers a great majority of blood to the lateral surface of the cortex 2, is the most common site of human stroke 3, and ischemia within its territory can result in extensive dysfunction or death 1,4,5. Survivors of ischemic stroke often suffer loss or disruption of motor capabilities, sensory deficits, and infarct. In an effort to capture these key characteristics of stroke, and thereby develop effective treatment, a great deal of emphasis is placed upon animal models of ischemia in MCA.
Here we present a method of permanently occluding a cortical surface blood vessel. We will present this method using an example of a relevant vessel occlusion that models the most common type, location, and outcome of human stroke, permanent middle cerebral artery occlusion (pMCAO). In this model, we surgically expose MCA in the adult rat and subsequently occlude via double ligature and transection of the vessel. This pMCAO blocks the proximal cortical branch of MCA, causing ischemia in all of MCA cortical territory, a large portion of the cortex. This method of occlusion can also be used to occlude more distal portions of cortical vessels in order to achieve more focal ischemia targeting a smaller region of cortex. The primary disadvantages of pMCAO are that the surgical procedure is somewhat invasive as a small craniotomy is required to access MCA, though this results in minimal tissue damage. The primary advantages of this model, however, are: the site of occlusion is well defined, the degree of blood flow reduction is consistent, functional and neurological impairment occurs rapidly, infarct size is consistent, and the high rate of survival allows for long-term chronic assessment.

Permanent Cerebral Vessel Occlusion via Double Ligature and Transection

We describe a highly reproducible method for the permanent occlusion of a rodent major cerebral blood vessel. This technique can be accomplished with very little peripheral damage, minimal blood loss, a high rate of long-term survival, and consistent infarct volume commensurate with the human clinical population.

Stroke is a leading cause of death, disability, and socioeconomic loss worldwide. The majority of all strokes result from an interruption in blood flow ...

An Orthotopic Murine Model of Human Prostate Cancer Metastasis

Our laboratory has developed a novel orthotopic implantation model of human prostate cancer (PCa). As PCa death is not due to the primary tumor, but rather the formation of distinct metastasis, the ability to effectively model this progression pre-clinically is of high value. In this model, cells are directly implanted into the ventral lobe of the prostate in Balb/c athymic mice, and allowed to progress for 4-6 weeks. At experiment termination, several distinct endpoints can be measured, such as size and molecular characterization of the primary tumor, the presence and quantification of circulating tumor cells in the blood and bone marrow, and formation of metastasis to the lung. In addition to a variety of endpoints, this model provides a picture of a cells ability to invade and escape the primary organ, enter and survive in the circulatory system, and implant and grow in a secondary site. This model has been used effectively to measure metastatic response to both changes in protein expression as well as to response to small molecule therapeutics, in a short turnaround time.

This orthotopic model of human prostate cancer allows for quantification of tumor size, circulating tumor cells, and formation of distinct metastasis to the lung. As cells must escape the primary organ, enter the blood stream, and implant into a secondary site, this model effectively recapitulates the scenario in humans.

Our laboratory has developed a novel orthotopic implantation model of  human prostate cancer (PCa). As PCa death is not due to the primary tumor, but  ...

An &#8220;All-laser&#8221; Endothelial Transplant

The &#8220;all laser&#8221; assisted endothelial keratoplasty is a procedure that is performed with a femtosecond laser used to cut the donor tissue at an intended depth, and a near infrared diode laser to weld the corneal tissue. The proposed technique enables to reach the three main goals in endothelial keratoplasty: a precise control in the thickness of the donor tissue; its easy insertion in the recipient bed and a reduced risk of donor lenticule dislocation. The donor cornea thickness is measured in the surgery room with optical coherence tomography (OCT), in order to correctly design the donor tissue dimensions. A femtosecond laser is used to cut the donor cornea. The recipient eye is prepared by manual stripping of the descemetic membrane. The donor endothelium is inserted into a Busin-injector, the peripheral inner side is stained with a proper chromophore (a water solution of Indocyanine Green) and then it is pulled in the anterior chamber. The transplanted tissue is placed in the final and correct location and then diode laser welding is induced from outside the eyeball. The procedure has been performed on more than 15 patients evidencing an improvement in surgery performances, with a good recovery of visual acuity and a reduced donor lenticule dislocation event.

An &amp;#8220;All-laser&amp;#8221; Endothelial Transplant

An all laser procedure is proposed in the endothelial transplant. The surgical technique is based on the use of a femtosecond laser to prepare the donor tissue. Laser welding technique is then used to secure the donor endothelium in the correct position.

The &#8220;all laser&#8221; assisted endothelial keratoplasty is a procedure that is performed with a femtosecond laser used to cut the donor tissue at an ...

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 ...

Pre-clinical Orthotopic Murine Model of Human Prostate Cancer

To study the multifaceted biology of prostate cancer, pre-clinical in vivo models offer a range of options to uncover critical biological information about this disease. The human orthotopic prostate cancer xenograft mouse model provides a useful alternative approach for understanding the specific interactions between genetically and molecularly altered tumor cells, their organ microenvironment, and for evaluation of efficacy of therapeutic regimens. This is a well characterized model designed to study the molecular events of primary tumor development and it recapitulates the early events in the metastatic cascade prior to embolism and entry of tumor cells into the circulation. Thus it allows elucidation of molecular mechanisms underlying the initial phase of metastatic disease. In addition, this model can annotate drug targets of clinical relevance and is a valuable tool to study prostate cancer progression. In this manuscript we describe a detailed procedure to establish a human orthotopic prostate cancer xenograft mouse model.

Prostate cancer is the second most common cause of cancer-related deaths in the United States. An orthotopic cancer model provides a useful approach to understand the biology of prostate cancer and to evaluate the efficacy of therapeutic regimens. This protocol describes detailed steps necessary to establish an orthotopic prostate cancer mouse model.

To study the multifaceted biology of prostate cancer, pre-clinical in vivo models offer a range of options to uncover critical biological information ...

Surgical Treatment for Benign Prostatic Hyperplasia: Holmium Laser Enucleation of the Prostate (HoLEP).

Benign prostatic hyperplasia (BPH) commonly occurs among elderly males. The condition causes symptoms in the lower urinary tract, thereby reducing the quality of life. BPH includes 2 major treatments: medication and surgery. Surgical treatment is often the most effective and final intervention. Holmium laser enucleation of the prostate (HoLEP), one of the most efficient surgical procedures for BPH, is conducted transurethrally. During surgery, the most important and most difficult part is to locate the surgical capsule of the prostate, which is consistent to the idea of anatomic surgery. Different skills may be needed in treating different parts of the prostate. HoLEP tends to be efficient and safe with good hemostatic properties, and able to treat bladder calculus, which may be the complications of BPH. The technique is particularly suitable for prostate of varying volumes and sizes. Indeed, HoLEP also presents certain disadvantages, such as a long learning curve and costly equipment. Regardless, this method may be the "new standard" and the excellent method for the surgical treatment of BPH.

Surgical Treatment for Benign Prostatic Hyperplasia: Holmium Laser Enucleation of the Prostate HoLEP.

Here we present a safe and efficient protocol, holmium laser enucleation of the prostate, to treat benign prostatic hyperplasia.

Benign prostatic hyperplasia (BPH) commonly occurs among elderly males. The condition causes symptoms in the lower urinary tract, thereby reducing the ...

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.

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

Inducing Acute Liver Injury in Rats via Carbon Tetrachloride (CCl4) Exposure Through an Orogastric Tube

Acute liver injury (ALI) plays a crucial role in the development of hepatic failure, which is characterized by severe liver dysfunction including complications such as hepatic encephalopathy and impaired protein synthesis. Appropriate animal models are vital to test the mechanism and pathophysiology of ALI and investigate different hepatoprotective strategies. Due to its ability to perform chemical transformations, carbon tetrachloride (CCl4) is widely used in the liver to induce ALI through the formation of reactive oxygen species. CCl4 exposure can be performed intraperitoneally, by inhalation, or through a nasogastric or orogastric tube. Here, we describe a rodent model, in which ALI is induced by CCl4 exposure through an orogastric tube. This method is inexpensive, easily performed, and has minimal hazard risk. The model is highly reproducible and can be widely used to determine the efficacy of potential hepatoprotective strategies and assess markers of liver injury.

Inducing Acute Liver Injury in Rats via Carbon Tetrachloride CCl4 Exposure Through an Orogastric Tube

This protocol describes a common and feasible method of inducing acute liver injury (ALI) via CCl4 exposure through an orogastric tube. CCl4 exposure induces ALI through the formation of reactive oxygen species during its biotransformation in the liver. This method is used to analyze the pathophysiology of ALI and examine different hepatoprotective strategies.