Los autores no tienen ninguna agradecimientos.

Todos los métodos aquí descritos han sido aprobados por el Comité de ética del Hospital de Beijing. Indicaciones para la cirugía según las directrices de la Asociación Europea de Urología para LUTS masculinos nonneurogenic. Las contraindicaciones incluyen sospecha disfunción próstata de cáncer o detrusor.
1. instrumentos para la operación
<ol><li>Asegurar la disponibilidad de un láser de cristal LBO con una potencia máxima de 160 w.</li>
	<li>Emplear una solución endfiring láser de fibra y solución salina para irrigar la vejiga intraoperatoria.</li>
	<li>Utilizar un resectoscopio de láser 26F adquirir buena visión y mejorar la eficacia de la resección.</li>
</ol>2. preparación para la operación
<ol><li>Proporcionar un antibiótico intravenoso preoperatorio (administración intravenosa de Cefuroxima sódica 1,5 g con solución de cloruro de 0.9%sodium de 100 mL 30 minutos antes de la operación) a todos los pacientes.</li>
	<li>Antes de la anestesia, hacer que el paciente Coloque abajo en la tabla de operación. Nota: Anestesia general es eficaz y apropiado para esta operación, anestesista determinará finalmente el modo de anestesia dependiendo de la condición general del paciente.</li>
	<li>Cuelgue a los pacientes de manera estéril en la posición de litotomía dorsal. No realizar cualquier preparación de la piel.</li>
</ol>3. pasos del procedimiento
<ol><li>
Vaporesection del lóbulo medio
	<ol>
<li>Examinar la cavidad entera vejiga y uretra prostática cuidadosamente a través del resectoscopio después de que la vejiga se dilata. Nota: Este paso ayuda a urólogo para localizar algunos canta anatómica clave incluyendo el verumontanum y orificio ureteral bilateral.</li>
		<li>Marca dos líneas inicialmente. Asegúrese de que estas líneas se originan en el 5:00 y 7:00 en el cuello de la vejiga y continúan a lo largo de las fronteras entre la mediana y los lóbulos laterales, terminando finalmente en el margen proximal del verumontanum.</li>
		<li>Set láser potencia 80 w. Preestablezca el tejido de la próstata a través de una fibra por la vaporización del laser a lo largo de estas líneas hasta que las fibras blancas del cíclicas se ven. Nota: Esta es la señal de la cápsula prostática. Las dos líneas se fusionan en la línea junto al verumontanum.</li>
		<li>Coloque energía del laser 80 a 100 w. marca varias líneas sobre la superficie del lóbulo medio a través de la fibra láser. Luego dividir el lóbulo medio de la cuña en varios trozos según estas líneas mediante la técnica de vaporización. Luego divide cada trozo del lóbulo medio. Finalmente, retirar el lóbulo entero medio.</li>
	</ol>
</li>
	<li>
Vaporesection de los lóbulos laterales
	<ol>
<li>Vaporizar el tejido en 12:00 desde el ápice de la próstata al cuello de la vejiga por el cistoscopio 180 ° de rotación. No deje que la fibra láser ir demasiado cerca del ápice en 12:00 que pueden causar incontinencia de orina postoperatoria. Nota: Esta técnica mejora la tasa de resección del tejido alrededor de la azotea de la próstata.</li>
		<li>Identificar claramente el margen inferior de los lóbulos ambos laterales una vez completada la vaporesection.</li>
		<li>Antes de retirar los lóbulos laterales, establecer otro 2 ranuras similares que se originan en el cuello de la vejiga en el 3:00 y 9:00 hasta el extremo proximal del verumontanum.</li>
		<li>Eliminar el tejido de la glándula lateral. La potencia del láser en 80 a 100 W y marcar varias líneas en la superficie de la fibra a través de láser de lóbulo izquierdo que separa el lóbulo izquierdo en varios trozos según estas líneas mediante la técnica de vaporización. Luego divide cada trozo del lóbulo y finalmente retirar el lóbulo izquierdo entero. Repita este procedimiento para quitar el lóbulo derecho.</li>
		<li>Eliminar el tejido de la glándula remanente a lo largo de los límites existentes de la cápsula.</li>
	</ol>
</li>
	<li>
Ajuste del canal
	<ol>
<li>No olvide recortar algunos tejidos que sobresale alrededor del ápice de la glándula, para mejorar la integridad de la cavidad.</li>
		<li>Para evitar complicaciones intraoperatorias (es decir, lesiones de perforación o esfínter cápsula), utilizar la técnica de vaporización en lugar de la resección para recortar el tejido cerca del esfínter uretral externo y bajar la potencia a menos de 80 vatios.</li>
	</ol>
</li>
	<li>
La hemostasia y la cateterización
	<ol>
<li>Emplear una jeringa de cristal que coincida con la interfaz del resectoscopio para extraer trozos de tejido por flujo de agua. Asegúrese de que no existe evidencia del tejido residual en la vejiga y de la fosa prostática mediante resectoscopio e identificar la intacta de los orificios ureterales.</li>
		<li>Emplear una láser una energía más baja (30 a 50 W) para detener el sangrado alrededor del sitio quirúrgico. Mantenga una distancia apropiada generalmente 3 a 5 mm entre la fibra y los vasos adquieren un efecto satisfactorio de la hemostasia.</li>
		<li>Retire el resectoscopio de la uretra. Coloque un catéter de Foley francés 22 del orificio uretral a la cavidad vesical con 30 mL de agua en el globo después de lubricar suficientemente la uretra por el gel de lidocaína.</li>
	</ol>
</li>
	<li>
Cuidados postoperatorios
	<ol>
<li>Que el paciente Coloque abajo en la cama durante aproximadamente 3 horas postoperatoriamente en la unidad de cuidados hasta que completamente se despiertan de la anestesia. Mientras tanto, asegúrese de monitores de paciente y médico del oxígeno están disponibles durante este tiempo.</li>
		<li>Al despertar completamente, volver al paciente a la sala. Que el paciente comience a beber agua y tomar algunos alimentos. Grabar la salida de orina y prestar atención al color de la orina.</li>
	</ol>
</li>
</ol>

<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>

Este estudio fue patrocinado por la nacional clave de R & D programa de China (2017YFC0840100 y 2017YFC0840102).

Aquí, compartimos nuestras experiencias con el programa PVRP. En primer lugar, programa PVRP permitió mejor exposición de la cápsula de la próstata con la demarcación adecuada y reduce el riesgo de perforación de cápsula. En segundo lugar, la eliminación de tejido debe realizarse a lo largo de la cápsula quirúrgica, especialmente con la ranura en el 12:00, que facilita la resección de tejido alrededor de la cubierta de la uretra prostática y proporciona una tasa de eliminación de tejido satisfactoria. En te...

Aunque la resección transuretral de la próstata (RTUP) todavía es aceptada como el estándar de oro en el tratamiento quirúrgico de la hiperplasia prostática benigna (HPB), cirugías con láser poco a poco se han vuelto más populares debido a la tolerancia del paciente mejor, menos intraoperatoria la pérdida de sangre, la eficacia satisfactoria y recuperación postoperatoria más corta1,de2,3. Actualmente, los láseres más utilizados para el tratamiento de la HBP en todo el mundo son generados por fosfato del titanilo del potasio del litio o litio triborate (LBO) cristales4,5. Tradicionalmente, estos se clasifican como sidefiring láser en comparación con otros tipos de láser como el láser de holmio y Tulio láser.
Vaporización fotoselectiva de la cirugía de la próstata (PVP) podría disminuir considerablemente el síndrome de RTUP debido a una irrigación salina6,7y en comparación con otros tipos de láser, la eficacia fiable del síndrome de tracto urinario inferior (STUI) por PVP fue verificado por una serie de estudios8,9,10. Sin embargo, PVP asociada con la emisión de láser de lado disparar también tiene algunas desventajas, incluyendo una pérdida energética de casi el 20% y una vida corta de la fibra de láser11,12,13. Por otra parte, PVP aumenta la posibilidad de diagnosis faltada del cáncer de próstata debido a la vaporización del tejido completo.
La introducción de Photoselective Vaporesection de la próstata (PVRP) con una fibra de disparo final superó con éxito la mayoría de las desventajas de PVP antes mencionados. En primer lugar, la punta es capaz de láser que transmite a los tejidos casi sin pérdida de energía intraoperatively. En segundo lugar, cuando residuos de fibra se recoge en la punta, es muy fácil mantener la potencia de salida ideal simplemente quitando las partes afectadas. Finalmente, la resección con láser permite la recogida de muestras para la examinación patológica postoperatoria. Por lo tanto, utilizar este protocolo en el tratamiento de HBP podría mejorar la tasa de eliminación de tejido, ahorrar el tiempo operativo y mejorar la seguridad intraoperatoria.

<table><tbody><tr><td>FLARE surgical Laser Fiber</td><td>REALTON</td><td></td><td>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><td>AURORA Surgical Green Laser System</td><td>REALTON</td><td>pvp-160-021</td><td>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 &amp;ldquo;Plug and Play&amp;rdquo; capability that self-adjusts to the facility&amp;rsquo;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

La ocurrencia de síntomas del tracto urinario inferiores (STUI) causada por hiperplasia prostática benigna (HPB) es un problema común con una alta incidencia en el envejecimiento de la población masculina. Aunque no es una enfermedad potencialmente mortal, HPB ocasiona problemas que afectan seriamente la calidad de vida. Aquí, presentamos una nueva técnica llamada vaporesection fotoselectiva de la próstata (PVRP) en el tratamiento de HBP, que puede ser visto como una variación de vaporización fotoselectiva de la próstata (PVP). Este procedimiento presenta varias ventajas en comparación con la técnica PVP como menos pérdida de energía láser, menos complicaciones intraoperatorias más tasa de resección de tejido.

En uno de nuestros estudios se incluyeron un total de 35 pacientes que experimentaron el programa PVRP. La edad promedio del paciente fue de 72,1 ± 7,1 años (rango 53-85 años).
Datos perioperatorios se enumeran en la tabla 1. El tiempo de emisión láser media representaron casi el 50% del tiempo quirúrgico promedio. La pérdida de sangre en la mayoría de los pacientes fue de < 200 mL. Sin embargo, la media...

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

Aquí presentamos un protocolo para realizar Photoselective Vaporesection de la próstata (PVRP) para el tratamiento de la hiperplasia prostática benigna (HPB).

Vaporesection fotoselectiva de la próstata a través de un láser de cristal Triborate litio de disparo final

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 ...

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

Research

JoVE Journal

Medicine

7.9K vistas.  Beijing Hospital, National Center of Gerontology. Aquí presentamos un protocolo para realizar Photoselective Vaporesection de la próstata (PVRP) para el tratamiento de la hiperplasia prostática benigna (HPB).

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

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.

Evaluación de la absorción de nanopartículas en los tumores en tiempo real utilizando intravital imagen

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

Investigación

Medicina

Probe-based Confocal Laser Endomicroscopy of the Urinary Tract: The Technique

Probe-based confocal laser endomicroscopy (CLE) is an emerging optical imaging technology that enables real-time in vivo microscopy of mucosal surfaces during standard endoscopy. With applications currently in the respiratory1 and gastrointestinal tracts,2-6 CLE has also been explored in the urinary tract for bladder cancer diagnosis.7-10 Cellular morphology and tissue microarchitecture can be resolved with micron scale resolution in real time, in addition to dynamic imaging of the normal and pathological vasculature.7
The probe-based CLE system (Cellvizio, Mauna Kea Technologies, France) consists of a reusable fiberoptic imaging probe coupled to a 488 nm laser scanning unit. The imaging probe is inserted in the working channels of standard flexible and rigid endoscopes. An endoscope-based CLE system (Optiscan, Australia), in which the confocal endomicroscopy functionality is integrated onto the endoscope, is also used in the gastrointestinal tract. Given the larger scope diameter, however, application in the urinary tract is currently limited to ex vivo use.11 Confocal image acquisition is done through direct contact of the imaging probe with the target tissue and recorded as video sequences. As in the gastrointestinal tract, endomicroscopy of the urinary tract requires an exogenenous contrast agent&mdash;most commonly fluorescein, which can be administered intravenously or intravesically. Intravesical administration is a well-established method to introduce pharmacological agents locally with minimal systemic toxicity that is unique to the urinary tract. Fluorescein rapidly stains the extracellular matrix and has an established safety profile.12 Imaging probes of various diameters enable compatibility with different caliber endoscopes. To date, 1.4 and 2.6 mm probes have been evaluated with flexible and rigid cystoscopy.10 Recent availability of a &lt; 1 mm imaging probe13 opens up the possibility of CLE in the upper urinary tract during ureteroscopy. Fluorescence cystoscopy (i.e. photodynamic diagnosis) and narrow band imaging are additional endoscope-based optical imaging modalities14 that can be combined with CLE to achieve multimodal imaging of the urinary tract. In the future, CLE may be coupled with molecular contrast agents such as fluorescently labeled peptides15 and antibodies for endoscopic imaging of disease processes with molecular specificity.

Probe-based confocal laser endomicroscopy enables real-time microscopy of the human urinary tract during cystoscopy, providing dynamic, intravital imaging of pathological states such as bladder cancer with cellular resolution. Endomicroscopy may augment the diagnostic accuracy of standard white light endoscopy and provide intraoperative image guidance to improve surgical resection.

Basada en sondeos endomicroscopía Láser Confocal del tracto urinario: la técnica

Probe-based  confocal laser endomicroscopy (CLE) is an emerging optical imaging technology  that enables real-time in vivo microscopy of mucosal surfaces ...

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.

Intubación endotraqueal en ratones<em&gt; Vía</em&gt; La laringoscopia directa utilizando un otoscopio

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

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.

Tratamiento quirúrgico de la hiperplasia prostática benigna: Holmium láser enucleación de la próstata (HoLEP).

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.

Enucleación de la próstata para el tratamiento de la hiperplasia prostática benigna mediante un láser de diodo de 980 nm

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

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. ...

Focal Laser Ablation of Prostate Cancer: An Office Procedure

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

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

Ablación focal del laser del cáncer de próstata: Un procedimiento de la oficina

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

Cirugía asistida por láser con vesiculoscopio seminal para tratar la obstrucción del conducto eyaculatorio

Treatment of Ejaculatory Duct Obstruction by Seminal Vesiculoscopy Assisted Flow Modification

Transurethral resection of ejaculatory duct (TURED) is a primary surgical approach to treat ejaculatory duct obstruction (EDO) caused by the ejaculatory duct cyst. Intraoperative excision of the verumontanum is usually required to expose the ejaculatory ducts. However, preserving the verumontanum structure allows for a better simulation of normal physiological anatomy. Maintaining the verumontanum may increase the risk of postoperative distal ejaculatory duct scarring, leading to recurrent obstruction or reduced semen volume. Therefore, we attempted a novel technique that preserves the verumontanum, which is relatively easier and safer compared to TURED. The following were the procedural steps: 1. A 6F seminal vesiculoscope was introduced through the external urethral orifice to the vicinity of the verumontanum, locating the opening of the affected-side ejaculatory duct and introducing a guidewire into the cyst. This successful step preserved the verumontanum, maximizing the retention of the anti-reflux mechanism in the distal ejaculatory duct. 2. The holmium laser enlarged the affected-side ejaculatory duct opening to 5 mm, decreasing the likelihood of postoperative closure of the ejaculatory duct opening and simplifying the procedure. 3. A window was created within the cyst to access the contralateral seminal vesicle, and then a holmium laser was used to burn and dilate the opening to 5 mm, redirecting the contralateral ejaculatory duct into the cystic cavity. This modification preserved the opening of the healthy-side ejaculatory duct and provided a new outflow passage for semen, reducing the risk of decreased semen volume postoperatively. The patients experienced no complications postoperatively, had shorter hospital stays, and showed improvement in semen volume. Hence, this surgical approach is simple yet effective.

Autor destacado: Tratamiento avanzado de la obstrucción del conducto seminal mediante refluviación del canal de semen mediada por endoscopia 

This protocol introduces the clinical application of seminal vesicle endoscopy combined with holmium laser in the treatment of ejaculatory duct obstruction caused by ejaculatory duct cyst.

Tratamiento de la obstrucción del conducto eyaculatorio mediante vesiculoscopia seminal Modificación del flujo asistida

Transurethral resection of ejaculatory duct (TURED) is a primary surgical approach to treat ejaculatory duct obstruction (EDO) caused by the ejaculatory ...

Vaporesection fotoselectiva de la próstata a través de un láser de cristal Triborate litio de disparo final

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Intubación endotraqueal en ratones

Tratamiento quirúrgico de la hiperplasia prostática benigna: Holmium láser enucleación de la próstata (HoLEP).

Enucleación de la próstata para el tratamiento de la hiperplasia prostática benigna mediante un láser de diodo de 980 nm

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

Ablación focal del laser del cáncer de próstata: Un procedimiento de la oficina

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Tratamiento de la obstrucción del conducto eyaculatorio mediante vesiculoscopia seminal Modificación del flujo asistida

Tratamiento de la obstrucción del conducto eyaculatorio mediante vesiculoscopia seminal Modificación del flujo asistida