Los autores desean agradecer el apoyo del Programa Nacional de Investigación y Desarrollo Clave de China (Subvención 2017YFC840102).

Todos los métodos descritos aquí han sido aprobados por el comité de ética del Hospital de Beijing. Las indicaciones para la cirugía se realizan de acuerdo con las directrices de la Asociación Europea de Urología para los STUI masculinos no neurogénicos. Las contraindicaciones incluyen sospecha de cáncer de próstata o disfunción del detrusor.
1. Instrumentos de funcionamiento
<ol><li>Asegurar la disponibilidad de equipos de láser de diodo (980 nm) con una potencia que incluye modo continuo (80-100 W).</li>
	<li>Emplee una fibra láser y una solución salina al 0,9% para la irrigación intraoperatoria de la vejiga.</li>
	<li>Utilice un resectoscopio láser de 26 F para adquirir una buena visualización y mejorar la eficiencia.</li>
</ol>2. Preparación para la operación
<ol><li>Realice la preparación de la piel el día de la operación.</li>
	<li>Proporcionar un antibiótico intravenoso preoperatorio a todos los pacientes10. NOTA: Cefuroxima sódica (1,5 g en 100 mL de cloruro sódico al 0,9%) se suministra 30 min antes de la operación.</li>
	<li>Antes de la anestesia, haga que el paciente se acueste en la mesa de operaciones. NOTA: La anestesia general es efectiva y apropiada para esta operación. Los anestesistas deben determinar el modo de anestesia en función del estado general del paciente.</li>
	<li>Cubrir al paciente de forma estéril en la posición de litotomía dorsal.</li>
</ol>3. Pasos del procedimiento
<ol><li>Observación<ol><li>Observar directamente la uretra, verumontanum, cuello vesical, orificios ureterales, mucosa vesical e hiperplasia trabecular mediante resectoscopio (15-30°).</li>
	</ol></li>
	<li>Diseña el rango de enucleación (flecha de Cupido).<ol><li>Incidir circularmente (profundidad a la glándula, ancho alrededor de 3-4 mm) la mucosa del cuello de la vejiga con un láser (Figura 1).</li>
		<li>Incidir circularmente (profundidad a la glándula, ancho de unos 3-4 mm) la mucosa de la uretra prostática en el extremo proximal del verumontano con un láser (Figura 2). NOTA: Confirme la marca anatómica antes de la incisión para evitar lesiones en la mucosa del cuello de la vejiga y la uretra del esfínter. Utilice una potencia láser de 80-100 W durante la operación, excepto para la hemostasia.</li>
		<li>Conecte los círculos concéntricos del cuello de la vejiga y el ápice de la próstata en la uretra posterior a las 12 en punto.</li>
		<li>Incidir el lóbulo izquierdo y el lóbulo derecho con el láser (Figura 3). NOTA: Una vez preincidida la posición de la uretra posterior a las 12 horas, retener la mucosa distal. Los círculos concéntricos que se forman en el cuello de la vejiga y el vértice de la próstata se llaman flechas de Cupido.</li>
	</ol></li>
	<li>Creación de un canal<ol><li>Encuentre la cápsula quirúrgica en las posiciones de las 5 y 7 en punto del ápice de la próstata.</li>
		<li>Encuentre la cápsula quirúrgica en las posiciones de la cápsula quirúrgica de las 5 y 7 en punto.</li>
		<li>Conecte las posiciones de la cápsula quirúrgica a las 5 y 7 en punto con un láser (Figura 4).</li>
		<li>A las 6 en punto del ápice de la próstata, separar el lóbulo mediano de la cápsula quirúrgica desde el ápice de la próstata hasta el cuello de la vejiga con un láser (Figura 5). NOTA: Si el volumen de la próstata es de >80 mL, los lóbulos mediano y lateral se separarán completamente en las posiciones de las 5 y 7 en punto del ápice de la próstata.</li>
	</ol></li>
	<li>Enucleación de los lóbulos izquierdo y derecho<ol><li>En sentido contrario a las agujas del reloj, enuclear el lóbulo derecho a las 6 y a las 12 horas desde el ápice de la próstata hasta el cuello de la vejiga con un resectoscopio (Figura 6).</li>
		<li>En el sentido de las agujas del reloj, enuclear el lóbulo izquierdo a las 6 y a las 12 horas desde el ápice de la próstata hasta el cuello de la vejiga (Figura 7).</li>
		<li>Empuje todas las glándulas hacia la vejiga después de la enucleación. NOTA: Si el volumen de la próstata es de >80 mL, enuclee los lóbulos mediano y lateral en la secuencia adecuada; Luego, empuje hacia la vejiga.</li>
	</ol></li>
	<li>Hemostasia<ol><li>Utilice una potencia láser más baja (50 W) para detener el sangrado alrededor del sitio quirúrgico. Mantenga una distancia adecuada (es decir, 1-3 mm).</li>
	</ol></li>
	<li>Morcelar el tejido prostático.<ol><li>Morcelar el tejido prostático enucleado en pedazos pequeños (lo más pequeños posible) con un morcelador y luego extraer el tejido de la vejiga (Figura 8).</li>
	</ol></li>
	<li>Cateterismo<ol><li>Retire el morcelador de la uretra.</li>
		<li>Coloque suavemente un catéter Foley 22 F a través del orificio uretral hasta la cavidad de la vejiga con 30 ml de agua en el balón después de lubricar suficientemente la uretra con gel de lidocaína.</li>
	</ol></li>
	<li>Cuidados postoperatorios10<ol><li>Deje que el paciente permanezca acostado en la cama durante aproximadamente 3 h en el postoperatorio en la unidad de cuidados hasta que despierte completamente de la anestesia. Asegúrese de que los monitores de los pacientes y el oxígeno medicinal estén disponibles durante este tiempo.</li>
		<li>Una vez que el paciente se haya despertado por completo, devuélvalo a la sala. Deje que el paciente comience a beber un poco de agua y a ingerir algo de alimento. Registre cualquier producción de orina y preste atención al color de la orina.</li>
	</ol></li>
</ol>

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(135), e57336 (2018).</li><li>Shigemura, K., Tanaka, K., Yamamichi, F., Chiba, K., Fujisawa, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+Predictive+Factors+for+Postoperative+Incontinence+of+Holmium+Laser+Enucleation+of+the+Prostate+by+the+Surgeons'+Experience+During+Learning+Curve.">Comparison of Predictive Factors for Postoperative Incontinence of Holmium Laser Enucleation of the Prostate by the Surgeons' Experience During Learning Curve.</a> International Neurourology Journal. 20 (1), 59-68 (2016).</li><li>Stroman, L., Ellis, D., Toomey, R., Mazaris, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=An+18-month+Audit+of+TURP+Complications+using+the+Clavien-Dindo+Classification+System.">An 18-month Audit of TURP Complications using the Clavien-Dindo Classification System.</a> Journal of Urology. 1 (3), 3 (2013).</li><li>Li, B., Xu, A., Zou, Y., Liu, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+Randomized+Trial+Comparing+Diode+Laser+Enucleation+of+the+Prostate+with+Plasmakinetic+Enucleation+and+Resection+of+the+Prostate+for+the+Treatment+of+Benign+Prostatic+Hyperplasia.">A Randomized Trial Comparing Diode Laser Enucleation of the Prostate with Plasmakinetic Enucleation and Resection of the Prostate for the Treatment of Benign Prostatic Hyperplasia.</a> Journal of Endourology. 27 (10), 1254-1260 (2013).</li><li>Lerner, L. B., Rajender, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laser+prostate+enucleation+techniques.">Laser prostate enucleation techniques.</a> Canadian Journal of Urology. 22 (5 Suppl 1), 53 (2015).</li><li>Wu, G., 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+comparative+study+of+diode+laser+and+plasmakinetic+in+transurethral+enucleation+of+the+prostate+for+treating+large+volume+benign+prostatic+hyperplasia:+a+randomized+clinical+trial+with+12-month+follow-up.">A comparative study of diode laser and plasmakinetic in transurethral enucleation of the prostate for treating large volume benign prostatic hyperplasia: a randomized clinical trial with 12-month follow-up.</a> Lasers in Medical Science. 31 (4), 599-604 (2016).</li><li>Xu, 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=A+randomized+trial+comparing+diode+laser+enucleation+of+the+prostate+with+plasmakinetic+enucleation+and+resection+of+the+prostate+for+the+treatment+of+benign+prostatic+hyperplasia.">A randomized trial comparing diode laser enucleation of the prostate with plasmakinetic enucleation and resection of the prostate for the treatment of benign prostatic hyperplasia.</a> Journal of Endourology. 27 (10), 1254-1260 (2013).</li><li>Yang, S. S., Hsieh, C. H., Lee, Y. S., Chang, S. 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M., Pimentel, M. A., Gilling, P. 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+Review+of+Laser+Treatment+for+Symptomatic+BPH+(Benign+Prostatic+Hyperplasia).">A Review of Laser Treatment for Symptomatic BPH (Benign Prostatic Hyperplasia).</a> Current Urology Reports. 17 (6), 1-8 (2016).</li><li>Cho, M. 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=Predictor+of+de+novo+urinary+incontinence+following+holmium+laser+enucleation+of+the+prostate.">Predictor of de novo urinary incontinence following holmium laser enucleation of the prostate.</a> Neurourology, Urodynamics. 30 (7), 1343-1349 (2011).</li><li>Herrmann, T. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Long-term+outcome+after+endoscopic+enucleation+of+the+prostate:+From+monopolar+enucleation+to+HoLEP+and+from+HoLEP+to+EEP.">Long-term outcome after endoscopic enucleation of the prostate: From monopolar enucleation to HoLEP and from HoLEP to EEP.</a> Der Urologe. Ausg. A. 55 (11), 1446 (2016).</li></ol>

Los autores no tienen nada que revelar.

En la actualidad, el láser de diodo de 980 mm se está empezando a utilizar para el tratamiento de la HPB5. Pocos informes han descrito estudios clínicos relacionados. En comparación con el efecto de la RTUP en el tratamiento de la HPB, muchos estudios han demostrado que DiLEP causa menos pérdida de sangre, logra una mejor función miccional y tiene tiempos de retención del catéter más cortos 9,13,14,15....

En comparación con la resección transuretral tradicional de la próstata (RTUP), las cirugías con láser se han vuelto gradualmente más populares debido a su mejor tolerancia del paciente, menores cantidades de pérdida de sangre intraoperatoria, eficacia y menor recuperación postoperatoria 4,5.
En los últimos años, las técnicas de más rápido crecimiento han implicado el uso de láseres de varias longitudes de onda. En la actualidad, se pueden utilizar muchos tipos de láseres con diferentes características para completar la enucleación prostática. Desde que el láser de diodo fue aprobado por la FDA de EE.UU. para la hiperplasia prostática en 2007, su uso ha aumentado gradualmente en el tratamiento de la HPB debido a su extraordinaria capacidad de corte y efecto hemostásico6. La longitud de onda del láser determina el grado de absorción por el agua y la hemoglobina. Un láser de diodo con una longitud de onda de 980 nm proporciona la tasa de absorción combinada más alta de agua y hemoglobina. La capacidad de penetración tisular es de 0,5 mm, y puede producir efectos de coagulación en tejidos más profundos, lo que hace que tenga una muy buena capacidad de ablación y hemostasia tisular 7,8.
Muchos centros de investigación han comenzado a utilizar DiLEP para el tratamiento de la hiperplasia prostática benigna. En la práctica, el DiLEP tradicional tiene una curva de aprendizaje más larga y no presenta ventajas obvias relacionadas con la protección del esfínter urinario9. Con base en las razones anteriores, se modificó el DiLEP tradicional en nuestro centro para mejorar el valor del tratamiento con láser de diodo en pacientes con HBP.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>HU Diode Laser</td>
			<td>Beijing L.H.H.Medical Science Development Co., Ltd</td>
			<td>HU-150</td>
			<td>Wavelength: 980nm 
			Maximum Power: 150W 
			Operation Mode: Continuous and pulsed</td>
		</tr>
		<tr>
			<td>Optical Fiber</td>
			<td>Beijing L.H.H.Medical Science Development Co., Ltd</td>
			<td>YYGX600</td>
			<td>Fiber core diameter: 
			600 &#956;m 
			Fiber length: 2m</td>
		</tr>
		<tr>
			<td>Morcellator System</td>
			<td>Beijing L.H.H.Medical Science Development Co., Ltd</td>
			<td>PXQ-01</td>
			<td>Rotate Speed: 100-3000rpm 
			MAX. Vacuum Pressure: -80KPa 
			Rated Output Torque: 12mNm 
			Blade Size: &#934;5.0*390mm; &#934;3.5*390mm 
			Blade Work Mode: Corotation alternates reversal</td>
		</tr>
	</tbody>
</table>

enucleation of the prostate for the treatment of benign prostatic hyperplasia using a 980 nm diode laser

En la población masculina de edad avanzada, la aparición de síntomas del tracto urinario inferior (STUI) causados por la hiperplasia prostática benigna (HPB) es un problema común. Aquí, presentamos una nueva técnica llamada enucleación con láser de diodo de 980 nm (DiLEP) para tratar la HPB1. Los láseres de diodo pueden absorber agua y hemoglobina al mismo tiempo, por lo que son buenos para el corte y la hemostasia. El láser de diodo fue aprobado por la FDA en 2007 y se ha utilizado en el tratamiento de la HPB debido a sueficaz efecto de corte y hemostasia. DiLEP presenta varias ventajas sobre otras técnicas, como TURP, HoLEP y PVP. Durante el procedimiento, definimos el límite de una próstata de alto volumen y la separamos en tres lóbulos con un láser de diodo quemando dos anillos y una ranura (como una flecha de Cupido). En comparación con otros procedimientos, mDiLEP tiene menos complicaciones intraoperatorias, una curva de aprendizaje más corta y logra una mayor resección de tejido.

Un total de 40 pacientes con HBP que se sometieron a DiLEP fueron incluidos en uno de nuestros estudios. Como método estadístico se utilizó una prueba t de muestra independiente. Todos los pacientes completaron con éxito la operación. A casi todos los pacientes se les retiró el catéter dentro de los 5 días posteriores a la cirugía (Tabla 1). Todos los pacientes regresaron al hospital para exámenes de seguimiento en el1º,3º y12º</sup...

Watch this Scientific Journal Video about Enucleation of the Prostate for the Treatment of Benign Prostatic Hyperplasia Using a 980 nm Diode Laser at JoVE.com

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

Aquí, presentamos un protocolo para la enucleación con láser de diodo de 980 nm modificado para tratar la hiperplasia prostática benigna de gran volumen.

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. ...

enucleation-prostate-for-treatment-benign-prostatic-hyperplasia-using

Research

JoVE Journal

Medicine

2.0K vistas.  Beijing Hospital. Aquí, presentamos un protocolo para la enucleación con láser de diodo de 980 nm modificado para tratar la hiperplasia prostática benigna de gran volumen.

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

Renal Capsule Xenografting and Subcutaneous Pellet Implantation for the Evaluation of Prostate Carcinogenesis and Benign Prostatic Hyperplasia

New therapies for two common prostate diseases, prostate cancer (PrCa) and benign prostatic hyperplasia (BPH), depend critically on experiments evaluating their hormonal regulation. Sex steroid hormones (notably androgens and estrogens) are important in PrCa and BPH; we probe their respective roles in inducing prostate growth and carcinogenesis in mice with experiments using compressed hormone pellets. Hormone and/or drug pellets are easily manufactured with a pellet press, and surgically implanted into the subcutaneous tissue of the male mouse host. We also describe a protocol for the evaluation of hormonal carcinogenesis by combining subcutaneous hormone pellet implantation with xenografting of prostate cell recombinants under the renal capsule of immunocompromised mice. Moreover, subcutaneous hormone pellet implantation, in combination with renal capsule xenografting of BPH tissue, is useful to better understand hormonal regulation of benign prostate growth, and to test new therapies targeting sex steroid hormone pathways.

We describe the manufacture of compressed hormone pellets, as well as subcutaneous surgical implantation into mice. This strategy can be combined with the growth of cell and tissue xenografts under the renal capsule of athymic nude mice to evaluate hormonal carcinogenesis and regulation of benign prostate growth.

Renal Cápsula xenotrasplante y subcutánea Pellet Implantación para la Evaluación de la próstata Carcinogénesis y la hiperplasia prostática benigna

New therapies for two common prostate diseases,  prostate cancer (PrCa) and benign prostatic hyperplasia (BPH), depend  critically on experiments ...

Investigación

Medicina

Laser-capture Microdissection of Human Prostatic Epithelium for RNA Analysis

The prostate gland contains a heterogeneous milieu of stromal, epithelial, neuroendocrine and immune cell types. Healthy prostate is comprised of fibromuscular stroma surrounding discrete epithelial-lined secretory lumens and a very small population of immune and neuroendocrine cells. In contrast, areas of prostate cancer have increased dysplastic luminal epithelium with greatly reduced or absent stromal population. Given the profound difference between stromal and epithelial cell types, it is imperative to separate the cell types for any type of downstream molecular analysis. Despite this knowledge, the bulk of gene expression studies compare benign prostate to cancer without micro-dissection, leading to stromal bias in the benign samples. Laser-capture micro-dissection (LCM) is an effective method to physically separate different cell types from a specimen section. The goal of this protocol is to show that RNA can be successfully isolated from LCM-collected human prostatic epithelium and used for downstream gene expression studies such as RT-qPCR and RNAseq.

The goal of this protocol is to use laser-capture micro-dissection as an effective method to isolate pure populations of cell types from heterogeneous prostate tissues for downstream RNA analysis.

Laser-captura microdisección de Human Prostática epitelio de Análisis de ARN

The prostate gland contains a heterogeneous milieu of stromal, epithelial, neuroendocrine and immune cell types.  Healthy prostate is comprised of ...

Network Analysis of Foramen Ovale Electrode Recordings in Drug-resistant Temporal Lobe Epilepsy Patients

Approximately 30% of epilepsy patients are refractory to antiepileptic drugs. In these cases, surgery is the only alternative to eliminate/control seizures. However, a significant minority of patients continues to exhibit post-operative seizures, even in those cases in which the suspected source of seizures has been correctly localized and resected. The protocol presented here combines a clinical procedure routinely employed during the pre-operative evaluation of temporal lobe epilepsy (TLE) patients with a novel technique for network analysis. The method allows for the evaluation of the temporal evolution of mesial network parameters. The bilateral insertion of foramen ovale electrodes (FOE) into the ambient cistern simultaneously records electrocortical activity at several mesial areas in the temporal lobe. Furthermore, network methodology applied to the recorded time series tracks the temporal evolution of the mesial networks both interictally and during the seizures. In this way, the presented protocol offers a unique way to visualize and quantify measures that considers the relationships between several mesial areas instead of a single area.

This protocol describes a procedure to track the evolution of mesial network measures in temporal lobe epilepsy (TLE) patients. It is based on the combination of intracranial recordings with a novel numerical technique for data analysis. Specifically, we present a protocol for network analyses of foramen ovale recordings.

Análisis de la red de foramen oval de electrodos Grabaciones en epilepsia del lóbulo temporal pacientes resistentes a los medicamentos

Approximately 30% of epilepsy patients are refractory to antiepileptic drugs. In these cases, surgery is the only alternative to eliminate/control ...

Transcanalicular Diode Laser-assisted Dacryocystorhinostomy for the Treatment of Primary Acquired Nasolacrimal Duct Obstruction

Today&#39;s gold standard in the treatment of infrasaccal primary acquired nasolacrimal duct obstruction (PANDO) is external dacryocystorhinostomy (DCR), a relatively invasive procedure that can be performed after failure of recanalizing treatments. However, with progress in the field of diode laser technology, new approaches have emerged. Laser-assisted transcanalicular DCR with subsequent bicanalicular silicon intubation is a new option showing great promise as a viable minimally invasive procedure. Under permanent endoscopic visual control from the nasal cavity, a diode laser fiber is inserted into the lacrimal sac and laser energy is applied to create a bony ostium between the lacrimal sac and the nasal cavity. Since no skin incision needs to be made, advantages of this method comprise the sparing of the skin as well as the medial palpebral structures and the physiological palpebral-canalicular pump mechanism. The duration of surgery as well as reconvalescence is generally shorter than with external DCR. Complications include silicon tube prolapse, mild swelling and, rarely, canalicular infection and thermal injury. One-year functional success rates, defined as complete resolution of symptoms and ostium patency, are high, yet still range behind those of external DCR. However, secondary external DCR after failure of laser-assisted DCR can be performed without difficulty. Thus, laser-assisted transcanalicular DCR is a valid option that should be considered as a second-step procedure after failure of recanalization procedures and before external DCR.

The goal of this protocol is to present transcanalicular laser-assisted dacryocystorhinostomy as a minimally invasive approach in the treatment of primary acquired nasolacrimal duct obstruction.

Dacriocistorinostomía diodo dacriocistorrinostomía láser-asistida para el tratamiento de primaria adquirió la obstrucción del conducto nasolagrimal

Today&#39;s gold standard in the treatment of infrasaccal primary acquired nasolacrimal duct obstruction (PANDO) is external dacryocystorhinostomy (DCR), ...

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 ...

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

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

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

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 ...

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 ...

Adjunctive Diode Laser Therapy and Probiotic Lactobacillus Therapy in the Treatment of Periodontitis and Peri-Implant Disease

Periodontal and peri-implant diseases are plaque-induced infections with a high prevalence, seriously impairing people&#39;s quality of life. The diode laser has long been recommended as adjunctive therapy in treating periodontitis. However, the optimal combination of usage mode (inside or outside periodontal pocket) and application regimen (single or multiple sessions of appointment) has not been described in detail. Meanwhile, probiotic Lactobacillus is regarded as a potential adjuvant in the management of the peri-implant disease. Nonetheless, a detailed protocol for an effective probiotic application is lacking. This article aims to summarize two clinical protocols. For periodontitis, the optimal collaboration of laser usage mode and application regimen was identified. Regarding peri-implant mucositis, a combined therapy containing professional topical use and home administration of probiotic Lactobacillus was established. This updated laser protocol clarifies the relationship between the treatment mode (inside or outside the periodontal pocket) and the number of laser appointments, further refining the existing diode laser therapy. For inside pocket irradiation, a single session of laser treatment is suggested whereas, for outside pocket irradiation, multiple sessions of laser treatment provide better effects. The improved probiotic Lactobacillus therapy resulted in the disappearance of swelling of the peri-implant mucosa, a reduced bleeding on probing (BOP), and an obvious reduction and good control of plaque and pigmentation; however, probing pocket depth (PPD) had limited improvement. The current protocol should be regarded as preliminary and could be further enhanced.

Adjunctive Diode Laser Therapy and Probiotic Lactobacillus Therapy in the Treatment of Periodontitis and Peri-Implant Disease

This article describes two protocols: 1) adjunctive diode laser therapy for treating periodontitis and 2) probiotic Lactobacillus therapy for treating peri-implant disease, with emphasis on the laser usage mode (inside or outside pocket), laser application regimen (single or multiple sessions), and a probiotic protocol of professional and home administration.

Terapia con láser de diodo adyuvante y terapia con lactobacilos probióticos en el tratamiento de la periodontitis y la enfermedad periimplantaria

Periodontal and peri-implant diseases are plaque-induced infections with a high prevalence, seriously impairing people&#39;s quality of life. The diode ...

Laparoscopic Duodenum-Preserving Pancreatic Head Resection via Inferior Infracolic Approach: A Surgical Approach for Benign Lesions

Minimally invasive pancreatic resections are gaining popularity despite being technically demanding. However, in contrast to laparoscopic pancreatoduodenectomy (LPD), laparoscopic duodenum-preserving pancreatic head resection (LDPPHR) has not yet obtained wide acceptance. This could be attributed to the technical challenges involved in preserving the blood supply of the duodenum and bile duct.
This study describes and demonstrates all the steps of LDPPHR. A 48-year-old woman was diagnosed with a 3.0 cm x 2.5 cm pancreatic head cystic mass, which was detected unexpectedly. The surgery was performed using the 3D laparoscopy via an inferior infracolic approach. The operation lasted approximately 310 min with 100 mL of blood loss. Postoperatively, the patient experienced no complications and was discharged 5 days later. Pathology revealed intraductal papillary mucinous neoplasms.
LDPPHR via an inferior infracolic approach is feasible and safe when performed by experienced surgeons in selected patients with thin mesenteric fat layers. The described technique for LDPPHR via inferior infracolic approach should be well standardized and performed at high-volume centers with experienced surgeons in both open and laparoscopic pancreatology.

This article provides a whole technical process of laparoscopic duodenum-preserving pancreatic head resection via an inferior infracolic approach. This is a surgical approach for benign tumors without intraoperative fluorescence image guidance.

Resección laparoscópica de la cabeza pancreática con preservación del duodeno mediante abordaje infracólico inferior: un abordaje quirúrgico para las lesiones benignas