Expresamos nuestro agradecimiento a los pacientes, cirujanos, anestesiólogos, enfermeras y técnicos que participaron activamente en este estudio. Sin su cooperación, esta investigación no habría sido posible.

Este estudio observacional prospectivo, con pacientes ambulatorios de cirugía de histeroscopia, se realizó de marzo a diciembre de 2023. Fue aprobado por el comité de ética del hospital del Shanghai JiAi Genetics & IVF Institute (número de expediente ético: JIAI E2020-09). Todos los participantes dieron su consentimiento informado antes de su inclusión en el estudio.
1. Selección y preparación del paciente
<ol><li>Elegibilidad del paciente<ol><li>Criterios de inclusión: incluir pacientes con infertilidad primaria o secundaria, con edades comprendidas entre los 18 y los 45 años, con al menos una ecografía transvaginal que sugiera un engrosamiento endometrial desigual o sospecha de pólipos endometriales.</li>
		<li>Criterios de exclusión: excluir a las personas menores de 18 años o mayores de 45 años, aquellas con comorbilidades médicas internas graves, hemodinámica inestable, enfermedades inflamatorias pélvicas agudas, infecciones no tratadas, temperatura corporal superior a 37,5 °C el día de la cirugía, mujeres embarazadas, personas con sospecha de cáncer de endometrio o de cuello uterino, hipertiroidismo no controlado, agrandamiento uterino con cavidad uterina superior a 12 cm y aquellos que no están dispuestos a dar su consentimiento informado.</li>
	</ol></li>
	<li>Preparación preoperatoria del paciente<ol><li>Realizar una evaluación exhaustiva que incluya pruebas de hepatitis B, hepatitis C, virus de inmunodeficiencia humana (VIH) y sífilis, junto con evaluaciones como un electrocardiograma, pruebas de función hepática y renal, análisis de la función de coagulación de la sangre, hemograma completo, examen de flujo vaginal y ecografía transvaginal preoperatoria.</li>
		<li>Programe la cirugía dentro de los 10 días posteriores al cese del sangrado menstrual. Prepare los siguientes instrumentos quirúrgicos: un espéculo, dilatadores Hegar, soporte para esponjas, pinzas cervicales, gasas esterilizadas, sondas y curetas, como se ilustra en la Figura 1A.</li>
	</ol></li>
</ol>2. Preparación quirúrgica
<ol><li>Preparación preoperatoria<ol><li>Reúna registros completos de historial médico que abarquen la edad de la paciente, el historial obstétrico y menstrual, las afecciones médicas subyacentes, el historial de procedimientos uterinos y abdominales y los síntomas clínicos pertinentes, como el sangrado vaginal irregular. Además, documente el tamaño uterino, la posición (antevertida o retrovertida), el grosor del endometrio, el eco endometrial y la presencia de otras enfermedades uterinas como miomas uterinos o adenomiosis a través de exámenes de ultrasonido transvaginal durante la fase folicular anterior a la cirugía.</li>
		<li>Determinar los riesgos quirúrgicos para el paciente y obtener su consentimiento informado firmado. Además, antes del procedimiento quirúrgico, evalúe los riesgos de la anestesia del paciente, obtenga su consentimiento informado firmado y permita que el paciente elija entre anestesia local y no anestesia en función de su condición individual.</li>
	</ol></li>
	<li>Campo de operación<ol><li>Pida al equipo quirúrgico que se ubique de la siguiente manera: el cirujano se sitúa a los pies del paciente, el primer asistente se sitúa a la derecha del cirujano, el anestesiólogo se sitúa en el lado izquierdo de la cabecera del paciente y la enfermera se coloca en el lado izquierdo del paciente (véase la Figura 1B).</li>
		<li>Coloque el equipo endoscópico en el lado derecho a los pies del paciente, coloque el equipo de anestesia en el lado derecho en la cabecera del paciente y sitúe el equipo de monitorización en la cabecera del paciente. Coloque al paciente en la posición de litotomía, con la parte inferior de las piernas asegurada por vendajes en ambos lados para asegurar la inmovilización durante el procedimiento.</li>
	</ol></li>
	<li>Desinfección<ol><li>Realice la desinfección de acuerdo con el principio de desinfección de arriba a abajo y de adentro hacia afuera. Use gasa de yodo para desinfectar los genitales externos, los labios, el perineo, la parte interna de los muslos y la piel perianal tres veces. Realizar la desinfección vaginal con gasa de yodo 3 veces. Complete el paño quirúrgico con paños quirúrgicos estériles.</li>
	</ol></li>
</ol>3. Procedimiento quirúrgico
<ol><li>Realizar las siguientes tareas según la especialización del personal: el anestesiólogo establece el acceso venoso periférico; El asistente quirúrgico principal es responsable de ensamblar la lente del histeroscopio, limpiar la lente, ajustar el enfoque y establecer el balance de blancos. NOTA: Todas las cirugías se realizan con un histeroscopio de 5,2 mm de diámetro por el mismo cirujano histeroscópico experimentado.</li>
	<li>Ajuste la presión del histeroscopio a 100 mmHg, con un caudal de 300 mL/min. Utilice solución salina al 0,9% como medio de distensión. Evacuar el gas de la cavidad uterina utilizando el histeroscopio. Utilice pinzas cervicales para agarrar el labio inferior derecho del cuello uterino y vuelva a realizar la desinfección con yodo de la vagina, el fórnix y el cuello uterino.</li>
	<li>Introducir el histeroscopio en la cavidad uterina a través del canal cervical. En caso de encontrar dificultades, retraiga el histeroscopio y utilice una sonda de medición con una escala para evaluar la posición y la profundidad de la cavidad uterina. A continuación, tire de la pinza cervical para aplanar el útero excesivamente curvado y facilitar la entrada del histeroscopio en la cavidad uterina.</li>
	<li>Realizar la dilatación cervical utilizando dilatadores Hegar que van desde el nº 3,5 hasta el nº 5,5. Administre floroglucinol (inyección intravenosa de 80 mg) para relajar el músculo liso cervical si es necesario.</li>
	<li>Mantenga registros detallados durante las cirugías de histeroscopia al introducir el histeroscopio en la cavidad uterina, documentando la presencia o ausencia de pólipos endometriales, junto con su ubicación, tamaño, morfología (pedunculado o de base ancha) y cualquier otra afección endometrial notable.</li>
	<li>Extirpación de pólipos<ol><li>Para pacientes con un solo pólipo uterino, realice los siguientes pasos.<ol><li>Realizar la extracción individual con micropinzas. Utilice el extremo romo de las micropinzas para identificar la capa basal del endometrio (consulte la Figura 2A). Existe un espacio anatómico entre el pólipo endometrial y la capa basal (como se ilustra en la Figura 2B); Coloque las pinzas aquí para agarrar la porción basal del pólipo endometrial.</li>
			<li>Retire rápidamente las micropinzas para asegurar la separación completa de la base del pólipo de la base endometrial (como se muestra en la Figura 2C). Lleve a cabo el procedimiento de forma gradual hasta que el pólipo se extirpe por completo. Recoger el tejido del pólipo extirpado para su examen patológico. Las imágenes típicas pre y postoperatorias se muestran en la Figura 3A, B.</li>
		</ol></li>
		<li>Para pacientes con pólipos endometriales múltiples, realice los siguientes pasos.<ol><li>En pacientes que presentan múltiples pólipos endometriales que causan efectos obstructivos durante la cirugía, emplee inicialmente microtijeras para extirpar la mayoría de los pólipos (consulte la Figura 2D). Con esta estrategia se pretende aumentar el espacio quirúrgico y mejorar la visibilidad dentro del campo operatorio. A continuación, elimine las bases de pólipos restantes utilizando el paso 3.6.1. NOTA: Se debe tener especial cuidado al usar microtijeras para evitar cortes demasiado profundos durante el procedimiento para evitar lesiones en la capa basal del endometrio.</li>
			<li>Comience la secuencia para la escisión de pólipos con la pared uterina posterior, seguida de la pared lateral uterina y las esquinas, y luego la pared uterina anterior. Este orden quirúrgico está diseñado para optimizar la claridad del campo quirúrgico.</li>
			<li>Una vez confirmada la extirpación completa de todas las bases de los pólipos, retire el histeroscopio y utilice una pequeña cureta o pinzas de esponja para asegurar la extirpación completa del tejido del pólipo. Las imágenes típicas pre y postoperatorias se muestran en la Figura 3C-E. NOTA: Para minimizar el mayor riesgo de infección asociado con las inserciones repetidas de histeroscopio, generalmente se recomienda no realizar más exploraciones histeroscópicas después de la extracción de tejido.</li>
		</ol></li>
	</ol></li>
	<li>Después de la recuperación de todos los instrumentos quirúrgicos, limpie el cuello uterino y la vagina con desinfección con yodo.</li>
</ol>4. Procedimientos postoperatorios
<ol><li>Después del procedimiento quirúrgico, documente minuciosamente todas las observaciones e intervenciones quirúrgicas realizadas. Después de esto, envíe las muestras para su evaluación patológica.</li>
	<li>Realizar un seguimiento postoperatorio durante 1 h para valorar el estado del paciente. En ausencia de complicaciones, dar de alta a los pacientes sin necesidad de medicación adicional. NOTA: El proceso quirúrgico no requiere ningún dispositivo electrónico y solo requiere el uso de microtijeras y micropinzas. Si se utilizan dispositivos electrónicos durante la cirugía, se documentará como un fracaso del procedimiento quirúrgico. Se deben documentar todas las complicaciones quirúrgicas y registrar los informes anatomopatológicos postoperatorios.</li>
</ol>5. Análisis estadístico
<ol><li>Para los datos cuantitativos, utilice estadísticos descriptivos como la media, la desviación estándar, la mediana y el intervalo de confianza; En el caso de los datos cualitativos, utilice la frecuencia y el porcentaje para la descripción.</li>
</ol>

Técnica histeroscópica con microtijeras y pinzas para la extirpación de pólipos

<ol>
	<li>Kim, K. R., Peng, R., Ro, J. Y., Robboy, S. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+diagnostically+useful+histopathologic+feature+of+endometrial+polyp:+the+long+axis+of+endometrial+glands+arranged+parallel+to+surface+epithelium.">A diagnostically useful histopathologic feature of endometrial polyp: the long axis of endometrial glands arranged parallel to surface epithelium.</a> Am J Surg Pathol. 28 (8), 1057-1062 (2004).</li><li>Check, J. H., Bostick-Smith, C. A., Choe, J. K., Amui, J., Brasile, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Matched+controlled+study+to+evaluate+the+effect+of+endometrial+polyps+on+pregnancy+and+implantation+rates+following+in+vitro+fertilization-embryo+transfer+(IVF-ET).">Matched controlled study to evaluate the effect of endometrial polyps on pregnancy and implantation rates following in vitro fertilization-embryo transfer (IVF-ET).</a> Clin Exp Obstet Gynecol. 38 (3), 206-208 (2011).</li><li>Afifi, K., Anand, S., Nallapeta, S., Gelbaya, T. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Management+of+endometrial+polyps+in+subfertile+women:+a+systematic+review.">Management of endometrial polyps in subfertile women: a systematic review.</a> Eur J Obstet Gynecol Reprod Biol. 151 (2), 117-121 (2010).</li><li>Taylor, E., Gomel, V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+uterus+and+fertility.">The uterus and fertility.</a> Fertil Steril. 89 (1), 1-16 (2008).</li><li>Spiewankiewicz, B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+effectiveness+of+hysteroscopic+polypectomy+in+cases+of+female+infertility.">The effectiveness of hysteroscopic polypectomy in cases of female infertility.</a> Clin Exp Obstet Gynecol. 30 (1), 23-25 (2003).</li><li>Yan, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Impact+of+estrogen+and+progesterone+receptor+expression+on+the+incidence+of+endometrial+polyps.">Impact of estrogen and progesterone receptor expression on the incidence of endometrial polyps.</a> Biomark Med. 17 (21), 881-887 (2023).</li><li>Shveiky, D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Complications+of+hysteroscopic+surgery:+&amp;#34;Beyond+the+learning+curve&amp;#34.">Complications of hysteroscopic surgery: &amp;#34;Beyond the learning curve&amp;#34.</a> J Minim Invasive Gynecol. 14 (2), 218-222 (2007).</li><li>Raz, N., Feinmesser, L., Moore, O., Haimovich, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endometrial+polyps:+Diagnosis+and+treatment+options-A+review+of+literature.">Endometrial polyps: Diagnosis and treatment options-A review of literature.</a> Minim. Invasive Ther. Allied Technol. 30, 278-287 (2021).</li><li>Munro, M. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Complications+of+hysteroscopic+and+uterine+resectoscopic+surgery.">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/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pain+and+operative+technologies+used+in+office+hysteroscopy:+A+systematic+review+of+randomized+controlled+trials.">Pain and operative technologies used in office hysteroscopy: A systematic review of randomized controlled trials.</a> J Minim Invasive Gynecol. 28 (10), 1699-1711 (2021).</li><li>Sharon, A., Zidane, M., Aiob, A., Apel-Sarid, L., Bornstein, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Nonelectric+shaving+of+endometrial+polyp+by+hysteroscopy+-+A+new+technique+to+eliminate+thermal+damage.">Nonelectric shaving of endometrial polyp by hysteroscopy - A new technique to eliminate thermal damage.</a> Eur J Obstet Gynecol Reprod Biol. 285, 170-174 (2023).</li><li>Mencaglia, L., Lugo, E., Consigli, S., Barbosa, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bipolar+resectoscope:+the+future+perspective+of+hysteroscopic+surgery.">Bipolar resectoscope: the future perspective of hysteroscopic surgery.</a> Gyneco Surg. 6 (1), 15-20 (2009).</li><li>Qu, D., Liu, Y., Zhou, H., Wang, Z. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Chronic+endometritis+increases+the+recurrence+of+endometrial+polyps+in+premenopausal+women+after+hysteroscopic+polypectomy.">Chronic endometritis increases the recurrence of endometrial polyps in premenopausal women after hysteroscopic polypectomy.</a> BMC Womens Health. 23 (1), 88 (2023).</li><li>Clark, T. J., Stevenson, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endometrial+polyps+and+abnormal+uterine+bleeding+(AUB-P):+what+is+the+relationship,+how+are+they+diagnosed+and+how+are+they+treated.">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/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cold+scissors+versus+electrosurgery+for+hysteroscopic+adhesiolysis:+A+meta-analysis.">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/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endometrial+polypectomy+using+tissue+removal+device+or+electrosurgical+snare:+a+randomised+controlled+trial.">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/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intrauterine+morcellator+devices:+The+icon+of+hysteroscopic+future+or+merely+a+marketing+image?+A+systematic+review+regarding+safety,+efficacy,+advantages,+and+contraindications.">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/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+use+of+the+intrauterine+morcellator:+A+single+academic+center's+experience.">Clinical use of the intrauterine morcellator: A single academic center's experience.</a> Open J Obst Gynecol. 4 (6), 326-332 (2014).</li></ol>

Los autores declaran no tener intereses contrapuestos.

Nuestra investigación presenta una nueva técnica quirúrgica para extirpar pólipos endometriales sin cortar ni causar daño eléctrico al endometrio uterino, que es especialmente beneficiosa para las mujeres con problemas de fertilidad. Sharon et al. introdujeron una técnica similar utilizando un asa no eléctrica para la extirpación de pólipos11, demostrando su eficacia y seguridad. Sin embargo, el resectoscopio tradicional tiene un diámetro mayor12, lo que requiere...

Los pólipos endometriales son crecimientos anormales de tejido en el revestimiento uterino con implicaciones significativas para la fertilidad y la salud reproductiva1. La tasa de incidencia estimada de pólipos endometriales es de aproximadamente el 35% entre las pacientes con infertilidad2, aunque esta cifra puede variar. Estos pólipos pueden interrumpir la implantación del embrión al inducir deformidades estructurales en la cavidad uterina e impactar la capacidad del endometrio para soportar la implantación 3,4,5,6. Si bien la cirugía histeroscópica es un procedimiento común para la extirpación de pólipos endometriales, no está exenta de riesgos, siendo la perforación uterina la principal complicación, particularmente durante la extirpación de pólipos múltiples7. La histeroscopia con resectoscopios y la resección mecánica clásica con tijeras y/o pinzas siguen siendo el estándar para evaluar y tratar la patología del canal cervical y la cavidad endometrial8. La aplicación de energía eléctrica durante el procedimiento puede resultar en daño endometrial, especialmente en casos que involucran variaciones anatómicas como un útero unicornio9. La tecnología mecánica, como los morceladores y las tijeras, es menos dolorosa que los dispositivos eléctricos para eliminar lesiones estructurales en el consultorio10.
En respuesta a estos desafíos, se propone un enfoque novedoso que implica el uso combinado de microtijeras y fórceps durante la histeroscopia. Esta técnica tiene como objetivo minimizar el riesgo de lesiones en el endometrio, particularmente en la capa basal, al tiempo que garantiza la extirpación completa de los pólipos para mejorar los resultados de fertilidad de las mujeres. La técnica es fácil de aprender y requiere dos médicos para realizar la operación. Los médicos con experiencia en histeroscopia son capaces de realizar este procedimiento. Se trata de una técnica nueva y única que elimina el daño térmico en una indicación ginecológica muy común.
En general, este enfoque innovador presenta un método más seguro y preciso para eliminar los pólipos endometriales, particularmente en mujeres con problemas de fertilidad, ofreciendo una alternativa valiosa a los procedimientos histeroscópicos tradicionales y potencialmente mejorando los resultados para las pacientes que requieren tratamiento para los pólipos endometriales.

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

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

Los pólipos endometriales suelen contribuir a la infertilidad femenina, y la resección histeroscópica es el enfoque quirúrgico establecido para su tratamiento. Existen numerosos métodos de resección, siendo las opciones más utilizadas y rentables la resección en frío con microtijeras o la resección en caliente con asa eléctrica. Sin embargo, ambos métodos implican una resección aguda, lo que plantea un desafío para lograr la extirpación completa del pólipo y evitar el daño al endometrio uterino. Para abordar esta cuestión, este estudio propone un enfoque innovador: el uso combinado de las microtijeras y pinzas de 6 Fr en histeroscopia. El método consiste en utilizar microtijeras de 6 Fr para extirpar inicialmente los pólipos grandes, seguido de unas micropinzas de 6 Fr para extraer el tejido de los pólipos restantes de forma rápida y sin rodeos cerca de la capa basal del endometrio. Este enfoque no solo evita el daño quirúrgico a la capa basal del endometrio, sino que también mitiga el riesgo de pólipos residuales como resultado de una resección incompleta. Este método es particularmente adecuado para mujeres con requisitos de fertilidad, ya que ofrece consideraciones adicionales para la selección de opciones de tratamiento para la resección de pólipos endometriales.

En este estudio participaron 114 pacientes con sospecha de pólipos endometriales según los hallazgos de la ecografía transvaginal (Figura 4). Todas las pacientes se sometieron a histeroscopia, con 15 pacientes diagnosticadas sin pólipos endometriales. Las 99 pacientes restantes se sometieron a resección de pólipos endometriales mediante la técnica de histeroscopia. Entre estas 99 pacientes, con edades comprendidas entre 26 y 44 años (Tabla 1), la paridad media fue de...

Autor destacado: Un enfoque de histeroscopia reproductiva para la extirpación completa de pólipos endometriales y una receptividad endometrial mejorada

La novedosa técnica presentada aquí emplea una combinación de microtijeras y pinzas de 6-Fr para el tratamiento histeroscópico de los pólipos endometriales, lo que demuestra resultados alentadores para las pacientes infértiles afectadas por esta afección.

Resección histeroscópica mejorada de pólipos endometriales con microtijeras y pinzas de 6 FR

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

463 vistas.  Shanghai Geriatrics Medical Center. Nuestra investigación se centra principalmente en la histeroscopia reproductiva, y el principal problema que queremos resolver es cómo conseguir que el entorno uterino de las pacientes endometriales logre unas condiciones óptimas de embarazo. El principal reto ahora es cómo extirpar por completo los pólipos endometriales protegiendo la fertilidad de la paciente y sin dañar la capa basal del endometrio. Nuestro protocolo quirúrgico puede asegurar la ext...

Video: Autor destacado: Un enfoque de histeroscopia reproductiva para la extirpación completa de pólipos endometriales y una receptividad endometrial mejorada

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.

Murino ileocólica Resección intestinal con anastomosis primaria

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

Investigación

Medicina

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.

Calibrado Pinzas Modelo de Lesión Medular Compresión

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

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

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

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

Resección guiada por la imagen de Glioblastoma e implantación intracraneal de andamios sembrado células madre terapéuticas

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

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

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

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

Septoplastia endoscópica con la resección limitada de dos líneas: cirugía mínimamente invasiva para la desviación Septal

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

Transaxillary First Rib Resection for Treatment of the Thoracic Outlet Syndrome

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

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

Resección transaxilar de la primera costilla para el tratamiento del síndrome de salida torácica

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

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

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

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

Pancreatosplenectomía modular de antegrade radical asistida por robot que incluye resección y reconstrucción de la unión espleno-mesentérica

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

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

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

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

Fotoablación guiada por endoscopia de quistes endometriales utilizando un láser de 980 nm con una fibra de contacto en yeguas

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

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

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

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

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

Un modelo de ratón in vivo de anestesia intravenosa total durante la cirugía de resección del cáncer

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

Improved Rodent Model of Myocardial Ischemia and Reperfusion Injury

Myocardial ischemia and reperfusion injury (MIRI), induced by coronary heart disease (CHD), causes damage to the cardiomyocytes. Furthermore, evidence suggests that thrombolytic therapy or primary percutaneous coronary intervention (PPCI) does not prevent reperfusion injury. There is still no ideal animal model for MIRI. This study aims to improve the MIRI model in rats to make surgery easier and more feasible. A unique method for establishing MIRI is developed by using a soft tube during a key step of the ischemic period. To explore this method, thirty rats were randomly divided into three groups: sham group (n = 10); experimental model group (n = 10); and existing model group (n = 10). Findings of triphenyltetrazolium chloride staining, electrocardiography, and percent survival are compared to determine the accuracies and survival rates of the operations. Based on the study results, it has been concluded that the improved surgery method is associated with a higher survival rate, elevated ST-T segment, and larger infarct size, which is expected to mimic the pathology of MIRI better.

Myocardial ischemia-reperfusion model of rat heart is improved by using a self-made retractor, polyvinyl chloride tube, and a unique knotting method. Electrocardiogram, triphenyltetrazolium chloride and histological staining, and percent survival analysis results showed that the improved model group has higher success and survival rates than the already existing model group.

Modelo mejorado de roedores de isquemia miocárdica y lesión por reperfusión

Myocardial ischemia and reperfusion injury (MIRI), induced by coronary heart disease (CHD), causes damage to the cardiomyocytes. Furthermore, evidence ...

Microscopic Cyst Resection for the Treatment of Patients Diagnosed with Epididymal Cyst

Epididymal cysts mostly occur in men aged 20-40 years old. Previous reports have covered concerns about postoperative complexes, including postoperative asoedema, hematoma, sustaining pain, and seminal tract obstruction in patients who have undertaken nonmicroscopic epididymal cyst resection or epididymal resection. Nonmicroscopic epididymal cyst surgery is suggested for patients with childbirth plans as a precaution. The treatment of male epididymal cysts via microtechnology is obviously a beneficial option; we took the lead in carrying out microscopic epididymal exploration and cyst resection surgery in China. From September 2017 to April 2021, 41 young and middle-aged male patients diagnosed with epididymal cysts underwent microtechnology treatment in a program titled &#34;microscopic epididymal exploration and cystectomy&#34;. The postoperative follow-up lasted for 3-50 months. The results confirmed that, as microscopic manipulation largely improved visualization of the subtle tissue structures of the epididymis, the cyst could be clearly dissected apart and completely removed intact under the microscope. Bleeding during the operation was significantly reduced (2-3 mL) and wound drainage was not required. According to follow-up data, microscopic treatment significantly reduced the incidence of postoperative scrotal hematoma, edema, and long-term postoperative pain, thereby promising a higher surgical success rate as well as recurrence prevention. Besides, preliminary experience and reflection suggest that microscopic epididymal exploration and cystectomy provide efficient preservation of the epididymal patency through refined treatment, while a better prognosis can be achieved. We recommend that surgery be carried out before the epididymal cyst develops to 0.8 cm in diameter, for fear that a larger epididymal cyst (&#62;0.9 cm in diameter) could cause the complete destruction of all tubules of the ipsilateral epididymis - a more severe case with damage to the testicular output network.

Here, we present a protocol to treat patients diagnosed with an epididymal cyst using microscopic cyst resection. Based on microscopic manipulation, a largely improved visualization of the subtle tissue structures of the epididymis was obtained, so the cyst could be clearly dissected apart and completely removed intact.

Resección microscópica de quistes para el tratamiento de pacientes diagnosticados con quiste epididimario

Epididymal cysts mostly occur in men aged 20-40 years old. Previous reports have covered concerns about postoperative complexes, including postoperative ...