Les auteurs tiennent à souligner le soutien du Programme national de recherche et de développement clés de la Chine (subvention 2017YFC840102).

Toutes les méthodes décrites ici ont été approuvées par le comité d’éthique de l’hôpital de Pékin. Les indications de la chirurgie sont conformes aux directives de l’Association européenne d’urologie pour les SBAU masculins non neurogènes. Les contre-indications comprennent une suspicion de cancer de la prostate ou un dysfonctionnement du détrusor.
1. Instruments de fonctionnement
<ol><li>Assurer la disponibilité d’équipements laser à diode (980 nm) d’une puissance incluant le mode continu (80-100 W).</li>
	<li>Utilisez une fibre laser et une solution saline à 0,9 % pour l’irrigation peropératoire de la vessie.</li>
	<li>Utilisez un résectoscope laser 26 F pour acquérir une bonne visualisation et améliorer l’efficacité.</li>
</ol>2. Préparation à l’opération
<ol><li>Effectuer la préparation de la peau le jour de l’opération.</li>
	<li>Fournir un antibiotique intraveineux en préopératoire à tous les patients10. REMARQUE : Le céfuroxime sodique (1,5 g dans 100 ml de chlorure de sodium à 0,9%) est fourni 30 min avant l’opération.</li>
	<li>Avant l’anesthésie, faites allonger le patient sur la table d’opération. REMARQUE : L’anesthésie générale est efficace et appropriée pour cette opération. Les anesthésistes doivent déterminer le mode d’anesthésie en fonction de l’état général du patient.</li>
	<li>Drapez le patient de manière stérile en position de lithotomie dorsale.</li>
</ol>3. Étapes de la procédure
<ol><li>Observation<ol><li>Observez directement l’urètre, le verumontanum, le col de la vessie, les orifices urétéraux, la muqueuse de la vessie et l’hyperplasie trabéculaire à l’aide d’un résectoscope (15-30°).</li>
	</ol></li>
	<li>Concevez la plage d’énucléation (flèche de Cupidon).<ol><li>Inciser circulairement (profondeur jusqu’à la glande, largeur d’environ 3-4 mm) la muqueuse du col de la vessie à l’aide d’un laser (Figure 1).</li>
		<li>Inciser circulairement (profondeur jusqu’à la glande, largeur d’environ 3-4 mm) la muqueuse prostatique de l’urètre à l’extrémité proximale du verumontanum à l’aide d’un laser (Figure 2). REMARQUE : Confirmez la marque anatomique avant l’incision afin d’éviter de blesser la vessie, le cou, la muqueuse et le sphincter urétral. Utilisez une puissance laser de 80 à 100 W pendant l’opération, à l’exception de l’hémostase.</li>
		<li>Reliez les cercles concentriques du col de la vessie et l’apex de la prostate dans l’urètre postérieur à 12 heures.</li>
		<li>Incisez le lobe gauche et le lobe droit avec le laser (Figure 3). REMARQUE : Une fois que la position 12 heures de l’urètre postérieur est pré-incisée, conservez la muqueuse distale. Les cercles concentriques formés au niveau du col de la vessie et de l’apex de la prostate sont appelés flèches de Cupidon.</li>
	</ol></li>
	<li>Création d’une chaîne<ol><li>Retrouvez la capsule chirurgicale aux positions 5 et 7 heures de l’apex de la prostate.</li>
		<li>Retrouvez la capsule chirurgicale aux positions capsule chirurgicale 5 et 7 heures.</li>
		<li>Connectez les positions de la capsule chirurgicale à 5 et 7 heures à l’aide d’un laser (Figure 4).</li>
		<li>À la position 6 heures de l’apex de la prostate, séparez le lobe médian de la capsule chirurgicale de l’apex de la prostate au col de la vessie à l’aide d’un laser (Figure 5). REMARQUE : Si le volume de la prostate est de >80 mL, les lobes médian et latéral seront complètement séparés aux positions 5 et 7 heures de l’apex de la prostate.</li>
	</ol></li>
	<li>Énucléation des lobes gauche et droit<ol><li>Dans le sens inverse des aiguilles d’une montre, énucléez le lobe droit à 6 et 12 heures de l’apex de la prostate jusqu’au col de la vessie à l’aide d’un résectoscope (Figure 6).</li>
		<li>Dans le sens des aiguilles d’une montre, énucléez le lobe gauche à 6 et 12 heures de l’apex de la prostate jusqu’au col de la vessie (figure 7).</li>
		<li>Poussez toutes les glandes dans la vessie après l’énucléation. REMARQUE : Si le volume de la prostate est de >80 mL, énucléer les lobes médian et latéral dans le bon ordre ; Ensuite, poussez dans la vessie.</li>
	</ol></li>
	<li>Hémostase<ol><li>Utilisez une puissance laser plus faible (50 W) pour arrêter le saignement autour du site chirurgical. Maintenez une distance appropriée (c’est-à-dire 1-3 mm).</li>
	</ol></li>
	<li>Morceller le tissu de la prostate.<ol><li>Morcellez le tissu prostatique énucléé en petits morceaux (aussi petits que possible) à l’aide d’un morcellateur, puis retirez le tissu de la vessie (figure 8).</li>
	</ol></li>
	<li>Cathétérisme<ol><li>Retirez le morcellateur de l’urètre.</li>
		<li>Placez doucement un cathéter de Foley 22 F à travers l’orifice urétral dans la cavité de la vessie avec 30 ml d’eau dans le ballonnet après avoir suffisamment lubrifié l’urètre avec du gel de lidocaïne.</li>
	</ol></li>
	<li>Soins postopératoires10<ol><li>Laissez le patient s’allonger sur le lit pendant environ 3 heures postopératoires dans l’unité de soins jusqu’à ce qu’il se réveille complètement de l’anesthésie. Assurez-vous que les moniteurs du patient et l’oxygène médical sont disponibles pendant cette période.</li>
		<li>Une fois que le patient s’est complètement réveillé, ramenez-le dans le service. Laissez le patient commencer à boire de l’eau et à manger de la nourriture. Enregistrez tout débit d’urine et faites attention à la couleur de l’urine.</li>
	</ol></li>
</ol>

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K., 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+retrospective+comparison+of+diode+to+holmium+for+laser+enucleation+of+the+prostate.">A retrospective comparison of diode to holmium for laser enucleation of the prostate.</a> Canadian Journal of Urology. 26 (4), 9836-9842 (2019).</li><li>Hruby, S., 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=Eraser+Laser+Enucleation+of+the+Prostate:+Technique+and+Results.">Eraser Laser Enucleation of the Prostate: Technique and Results.</a> European Urology. 63 (2), 341-346 (2013).</li><li>Lerner, L. 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E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=New+techniques+for+laser+prostatectomy:+an+update.">New techniques for laser prostatectomy: an update.</a> Therapeutic Advances in Urology. 1 (2), 85-97 (2014).</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>Wang, X., 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=Photoselective+Vaporesection+of+the+Prostate+via+an+End-firing+Lithium+Triborate+Crystal+Laser.">Photoselective Vaporesection of the Prostate via an End-firing Lithium Triborate Crystal Laser.</a> Journal of Visualized Experiments. (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. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diode+laser+(980+nm)+enucleation+of+the+prostate:+a+promising+alternative+to+transurethral+resection+of+the+prostate.">Diode laser (980 nm) enucleation of the prostate: a promising alternative to transurethral resection of the prostate.</a> Lasers in Medical Science. 28 (2), 353-360 (2013).</li><li>Liu, L., Cheng, F., Li, H., Yu, W., Rao, T. <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+Clinical+Effect+Between+Transurethral+1+470+nm+Diode+Laser+Enucleation+of+the+Prostate+and+Transurethral+Bipolar+Plasmakinetic+Resection+of+Prostate.">Comparison of Clinical Effect Between Transurethral 1 470 nm Diode Laser Enucleation of the Prostate and Transurethral Bipolar Plasmakinetic Resection of Prostate.</a> Medical Journal of Wuhan University. 39 (5), 809-812 (2018).</li><li>Nair, S. 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>

Les auteurs n’ont rien à divulguer.

À l’heure actuelle, le laser à diode de 980 mm commence à être utilisé pour le traitement de l’HBP5. Peu de rapports ont décrit des études cliniques connexes. Par rapport à l’effet de la TURP dans le traitement de l’HBP, de nombreuses études ont montré que DiLEP provoque moins de perte de sang, atteint une meilleure fonction de miction et a des temps de rétention de cathéter plus courts 9,13,14,15.<sup class=...

Par rapport à la résection transurétrale traditionnelle de la prostate (RTUP), les chirurgies au laser sont progressivement devenues plus populaires en raison de leur meilleure tolérance chez les patients, de leur perte de sang peropératoire plus faible, de leur efficacité et de leur récupération postopératoire plus courte 4,5.
Ces dernières années, les techniques qui se sont développées le plus rapidement ont impliqué l’utilisation de lasers de différentes longueurs d’onde. À l’heure actuelle, de nombreux types de lasers aux caractéristiques différentes peuvent être utilisés pour compléter l’énucléation de la prostate. Depuis que le laser à diode a été approuvé par la FDA américaine pour l’hyperplasie de la prostate en 2007, son utilisation a progressivement augmenté dans le traitement de l’HBP en raison de sa capacité de coupe exceptionnelle et de son effet d’hémostase6. La longueur d’onde du laser détermine le degré d’absorption par l’eau et l’hémoglobine. Un laser à diode d’une longueur d’onde de 980 nm offre le taux d’absorption combiné le plus élevé d’eau et d’hémoglobine. La capacité de pénétration tissulaire est de 0,5 mm, et il peut produire des effets de coagulation dans les tissus plus profonds, ce qui lui confère une très bonne capacité d’ablation tissulaire et d’hémostase 7,8.
De nombreux centres de recherche ont commencé à utiliser DiLEP pour le traitement de l’hyperplasie bénigne de la prostate. En pratique, le DiLEP traditionnel a une courbe d’apprentissage plus longue et ne présente pas d’avantages évidents liés à la protection du sphincter urinaire9. Sur la base des raisons ci-dessus, le DiLEP traditionnel a été modifié dans notre centre pour améliorer la valeur du traitement au laser à diode chez les patients atteints d’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

Dans la population masculine vieillissante, l’apparition de symptômes des voies urinaires inférieures (SBAU) causés par l’hyperplasie bénigne de la prostate (HBP) est un problème courant. Ici, nous présentons une nouvelle technique appelée énucléation laser à diode 980 nm (DiLEP) pour traiter l’HBP1. Les lasers à diode peuvent absorber à la fois l’eau et l’hémoglobine, ils sont donc bons pour la coupe et l’hémostase2. Le laser à diode a été approuvé par la FDA en 2007 et a été utilisé dans le traitement de l’HBP en raison de son effet de coupe et d’hémostase efficace3. DiLEP présente plusieurs avantages par rapport à d’autres techniques, telles que TURP, HoLEP et PVP. Au cours de la procédure, nous définissons la limite d’une prostate de haut volume et la séparons en trois lobes à l’aide d’un laser à diode en brûlant deux anneaux et un sillon (comme une flèche de Cupidon). Par rapport à d’autres procédures, mDiLEP présente moins de complications peropératoires, une courbe d’apprentissage plus courte et permet une plus grande résection tissulaire.

Au total, 40 patients atteints d’HBP ayant subi une DiLEP ont été inclus dans l’une de nos études. Un test t d’échantillon indépendant a été utilisé comme méthode statistique. Tous les patients ont terminé l’opération avec succès. Presque tous les patients ont eu le cathéter retiré dans les 5 jours suivant l’opération (tableau 1). Tous les patients sont retournés à l’hôpital pour des examens de suivi au cours des1er, 3e et</su...

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

Ici, nous présentons un protocole pour l’énucléation laser à diode modifiée de 980 nm pour traiter l’hyperplasie bénigne de la prostate de grand volume.

Enucléation de la prostate pour le traitement de l’hyperplasie bénigne de la prostate à l’aide d’un laser à diode 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 vues.  Beijing Hospital. Ici, nous présentons un protocole pour l’énucléation laser à diode modifiée de 980 nm pour traiter l’hyperplasie bénigne de la prostate de grand volume.

Vidéo: 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.

Rénale Capsule xénogreffe sous-cutanée et Pellet implantation pour l&#39;évaluation de la carcinogenèse prostatique et l&#39;hyperplasie prostatique bénigne

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

Recherche

Médecine

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-microdissection de la prostate humaine épithélium pour l&#39;analyse de l&#39;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.

Analyse du réseau de foramen ovale électrodes Recordings en résistant aux médicaments épilepsies temporales patients

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.

Transcanalicular Diode Laser-assisted Dacryocystorhinostomy pour le traitement primaire a acquis l’Obstruction du canal lacrymo-nasal

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.

Traitement chirurgical de l’hyperplasie bénigne de la prostate : énucléation Laser Holmium de la Prostate (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 de Photoselective de la Prostate par un tir à bout Lithium Triborate cristal 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 ...

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.

Photoablation guidée par endoscopie de kystes de l’endomètre à l’aide d’un laser de 980 nm avec une fibre de contact chez les juments

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.

Ablation focale de laser du cancer de la prostate : Une procédure de bureau

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.

Thérapie au laser à diode d’appoint et thérapie par lactobacilles probiotiques dans le traitement de la parodontite et de la maladie péri-implantaire

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.

Résection laparoscopique de la tête pancréatique préservant le duodénum par voie infracolique inférieure : une approche chirurgicale pour les lésions bénignes