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Tutti i metodi descritti qui sono stati approvati dal comitato etico dell'ospedale di Pechino. Indicazioni per la chirurgia sono secondo gli orientamenti dell'associazione europea di urologia per nonneurogenic maschio LUTS. Le controindicazioni includono sospetta disfunzione della prostata cancro o detrusore.
1. gli strumenti per il funzionamento
<ol><li>Garantire la disponibilità di un laser di cristallo di LBO con una potenza massima di 160 w.</li>
	<li>Adottare un endfiring laser fibra e salino soluzione per l'irrigazione della vescica intraoperatoria.</li>
	<li>Utilizzare un resettoscopio laser 26F per acquisire buona visione e migliorare l'efficienza di resezione.</li>
</ol>2. preparazione per il funzionamento
<ol><li>Fornire un antibiotico per via endovenosa prima dell'intervento (somministrazione endovenosa di cefuroxima sodica 1,5 g con 100 mL 30 min prima dell'operazione di soluzione di cloruro di 0.9%sodium) a tutti i pazienti.</li>
	<li>Prima l'anestesia, rendere il paziente sdraiò sul tavolo operatorio. Nota: L'anestesia generale è efficace e appropriato per questa operazione, anestesista infine determinerà la modalità di anestesia a seconda delle condizioni generali del paziente.</li>
	<li>Drappo i pazienti in modo sterile nella posizione di lithotomy dorsa. Non eseguire alcuna preparazione della pelle.</li>
</ol>3. procedura
<ol><li>
Vaporesection del lobo mediano
	<ol>
<li>Esaminare la cavità intera vescica e l'uretra prostatica con attenzione attraverso il resettoscopio dopo la vescica si distende. Nota: Questo passaggio consente di urologo per individuare alcune chiave canta anatomica tra cui verumontanum e orifizio ureterale bilaterale.</li>
		<li>Segnare due linee inizialmente. Assicurarsi che queste linee hanno origine a 5 e 7 al collo della vescica e proseguire lungo i confini tra i mediani e lobi laterali, infine terminare presso il margine prossimale della verumontanum.</li>
		<li>Set laser potenza a 80 w. vaporizzazione del tessuto della prostata tramite una fibra della vaporizzazione del laser lungo queste linee fino a quando non si vedono le fibre bianche cicliche. Nota: Questo è il segno della capsula prostatica. Le due linee sono fuse in linea singola adiacente al verumontanum.</li>
		<li>Regolare la potenza laser a 80-100 w. Mark parecchie linee sulla superficie del lobo centrale tramite fibra laser. Poi dividere il lobo centrale cuneiforme in più porzioni secondo queste linee attraverso la tecnica di vaporizzazione. Quindi dividere ogni blocco da lobo medio. Infine, rimuovere il complesso centrale del lobo.</li>
	</ol>
</li>
	<li>
Vaporesection di lobi laterali
	<ol>
<li>Vaporizzare il tessuto alle 12 dall'apice della prostata al collo della vescica ruotando il cistoscopio 180 °. Non lasciare che la fibra laser andare troppo vicino all'apice alle 12 che può causare incontinenza postoperatoria dell'urina. Nota: Questa tecnica aumenta il tasso di resezione del tessuto intorno al tetto della prostata.</li>
		<li>Identificare chiaramente il margine inferiore di entrambi i lobi laterali una volta completata la vaporesection.</li>
		<li>Prima di rimuovere i lobi laterali, impostare un altro 2 scanalature simili che provengono dal collo vescicale al 3 e 9 all'estremità prossimale della verumontanum.</li>
		<li>Rimuovere il tessuto della ghiandola laterale. Impostare la potenza del laser alle 80-100 W e contrassegnare parecchie linee sulla superficie del lobo di sinistra tramite laser fibra che divide il lobo sinistro in diversi blocchi secondo queste linee attraverso la tecnica di vaporizzazione. Quindi dividere ogni blocco dal lobo e infine rimuovere l'intera sinistra del lobo. Ripetere questa procedura per rimuovere il lobo di destra.</li>
		<li>Rimuovere il tessuto ghiandolare residuo lungo il confine esistente della capsula.</li>
	</ol>
</li>
	<li>
Canale taglio
	<ol>
<li>Ricordarsi di tagliare alcuni tessuti sporgente attorno all'apice della ghiandola, per migliorare l'integrità della cavità.</li>
		<li>Per evitare complicanze intraoperatorie (cioè, capsula lesioni dello sfintere o perforazione), utilizzare tecnica di vaporizzazione, piuttosto che la resezione di tagliare il tessuto vicino allo sfintere uretra esterno e abbassare la potenza a meno di 80 Watt.</li>
	</ol>
</li>
	<li>
Emostasi e cateterizzazione
	<ol>
<li>Impiegare una siringa di vetro che corrisponde all'interfaccia del resettoscopio per rimuovere il pezzo di tessuto dal flusso d'acqua. Assicurarsi che non ci è prova del tessuto residuo nella vescica e fossa prostatico attraverso resettoscopio e identificare l'intatta degli orifizi ureterali.</li>
		<li>Impiegare una bassa potenza del laser (da 30 a 50 W) per fermare l'emorragia intorno al sito chirurgico. Mantenere una distanza adeguata di solito 3-5 mm tra fibra e vasi di acquisire un effetto soddisfacente di emostasi.</li>
		<li>Rimuovere il resettoscopio dall'uretra. Posizionare un catetere di Foley francese 22 dall'orifizio uretra alla cavità della vescica delicatamente con 30 mL di acqua nel palloncino dopo aver sufficientemente lubrificato uretra dal gel di lidocaina.</li>
	</ol>
</li>
	<li>
Cura postoperatoria
	<ol>
<li>Lasciare che il paziente si sdraiò sul letto per circa 3 h postoperatorio nell'unità di cure fino a quando sono completamente svegli dall'anestesia. Nel frattempo, assicurarsi di monitor paziente e medico dell'ossigeno sono disponibili in questo periodo.</li>
		<li>Al risveglio di completamente, è necessario restituire il paziente al reparto. Che il paziente cominci a bere un po' acqua e prendere qualcosa da mangiare. Registrare l'uscita di urina e prestare attenzione al colore dell'urina.</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>

Questo studio è stato sponsorizzato dalla National Key R & D programma della Cina (2017YFC0840100 e 2017YFC0840102).

Qui, condividiamo le nostre esperienze con PVRP. In primo luogo, PVRP abilitato migliore esposizione della capsula della prostata con adeguata delimitazione e ridotto il rischio di perforazione capsula. In secondo luogo, la rimozione di tessuto dovrebbe essere effettuata lungo la capsula chirurgica, soprattutto con la scanalatura a 12, che facilita la resezione del tessuto intorno al tetto dell'uretra prostatica e fornisce un tasso di rimozione del tessuto soddisfacente. In terzo luogo, è essenziale per rimuovere il lob...

Sebbene la resezione transuretrale della prostata (TURP) è ancora accettata come il gold standard nel trattamento chirurgico di iperplasia prostatica benigna (BPH), interventi chirurgici laser gradualmente sono diventati più popolari a causa della tolleranza del paziente migliore, meno intraoperatoria perdita di sangue, un'efficacia soddisfacente e più breve recupero postoperatorio1,2,3. Attualmente, i laser più comunemente utilizzati per il trattamento di BPH in tutto il mondo sono generati da litio potassio titanil fosfato o litio triborate (LBO) cristalli4,5. Tradizionalmente, questi sono classificati come sidefiring laser rispetto ad altri tipi di laser, come il laser a olmio e Tulio laser.
Fotoselettive vaporizzazione della chirurgia della prostata (PVP) potrebbe diminuire considerevolmente sindrome TURP dovuto irrigazione salina6,7e rispetto ad altri tipi di laser, l'efficacia affidabile della sindrome più bassa dell'apparato urinario (LUTS) da PVP è stata verificata da una serie di studi8,9,10. Tuttavia, PVP associati con emissione laser lato-infornamento ha anche alcuni svantaggi, tra cui una perdita di energia di quasi il 20% e una durata breve del laser della fibra11,12,13. Inoltre, PVP aumenta la possibilità di mancata diagnosi di carcinoma della prostata a causa di vaporizzazione completa del tessuto.
L'introduzione di Photoselective Vaporesection della prostata (PVRP) con una fibra fine-infornamento superato con successo la maggior parte degli svantaggi di PVP di cui sopra. In primo luogo, la punta è in grado di trasmissione laser ai tessuti con quasi nessuna perdita di energia intraoperatively. In secondo luogo, quando i detriti fibra raccoglie sulla punta, è semplice per mantenere la potenza di uscita ideale semplicemente rimuovendo le parti interessate. Infine, la resezione del laser consente la raccolta di campioni per esame patologico postoperatorio. Quindi, utilizzando questo protocollo nel trattamento di BPH potrebbe che permettono di migliorare il tasso di rimozione del tessuto, salvare il tempo operatorio e migliorare la sicurezza 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

L'avvenimento dei sintomi più bassi dell'apparato urinario (LUTS) causato da iperplasia prostatica benigna (BPH) è un problema comune con un'alta incidenza nella popolazione maschio di invecchiamento. Anche se non si tratta di una malattia pericolosa, BPH provoca problemi che incidono gravemente la qualità della vita. Qui, presentiamo una nuova tecnica chiamata fotoselettive vaporesection della prostata (PVRP) nel trattamento di BPH, che può essere visto come una variante di fotoselettive vaporizzazione della prostata (PVP). Questa procedura presenta diversi vantaggi rispetto alla tecnica PVP tra cui minore perdita di energia laser, meno complicanze intraoperatorie, nonché più tasso di resezione del tessuto.

Un totale di 35 pazienti che hanno subito il PVRP sono stati inclusi in uno dei nostri studi. L'età paziente media era di 72,1 ± 7,1 anni (range 53-85 anni).
Dati di Perioperative sono elencati nella tabella 1. Il tempo di emissione del laser media hanno rappresentato quasi il 50% del tempo operatorio medio. La perdita di sangue nella maggior parte dei pazienti era < 200 mL. Tuttavia, la media deviato a causa ...

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

Qui presentiamo un protocollo per eseguire Photoselective Vaporesection della prostata (PVRP) per trattamento di iperplasia prostatica benigna (BPH).

Fotoselettive Vaporesection della prostata tramite un Laser di cristallo Triborate litio fine-infornamento

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 Views.  Beijing Hospital, National Center of Gerontology. Qui presentiamo un protocollo per eseguire Photoselective Vaporesection della prostata (PVRP) per trattamento di iperplasia prostatica benigna (BPH).

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.

Valutazione della captazione nanoparticelle nei tumori in tempo reale utilizzando intravitale 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 ...

Ricerca

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.

Probe-based Endomicroscopy laser confocale del tratto urinario: La Tecnica

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.

Intubazione endotracheale in Mouse<em&gt; Via</em&gt; Laringoscopia diretta usando 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.

Trattamento chirurgico per l'iperplasia prostatica benigna: Holmium Laser Enucleation della prostata (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.

Enucleazione della prostata per il trattamento dell'iperplasia prostatica benigna mediante laser a diodi da 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.

Fotoablazione guidata da endoscopia di cisti endometriali utilizzando un laser a 980 nm con una fibra di contatto in mares

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.

Ablazione laser focale del cancro alla prostata: una procedura d'ufficio

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

Vesiculoscopio seminale Chirurgia laser-assistita per il trattamento dell'ostruzione del dotto eiaculatorio

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.

Autore in primo piano: Trattamento avanzato dell'ostruzione del dotto seminale mediante rifluviazione del canale seminale mediata dall'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.

Trattamento dell'ostruzione del dotto eiaculatorio mediante vescicoloscopia seminale Modifica del flusso assistito

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

Fotoselettive Vaporesection della prostata tramite un Laser di cristallo Triborate litio fine-infornamento

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Valutazione della captazione nanoparticelle nei tumori in tempo reale utilizzando intravitale Imaging

Probe-based Endomicroscopy laser confocale del tratto urinario: La Tecnica

Intubazione endotracheale in Mouse

Trattamento chirurgico per l'iperplasia prostatica benigna: Holmium Laser Enucleation della prostata (HoLEP).

Enucleazione della prostata per il trattamento dell'iperplasia prostatica benigna mediante laser a diodi da 980 nm

Fotoablazione guidata da endoscopia di cisti endometriali utilizzando un laser a 980 nm con una fibra di contatto in mares

Ablazione laser focale del cancro alla prostata: una procedura d'ufficio

Trattamento dell'ostruzione del dotto eiaculatorio mediante vescicoloscopia seminale Modifica del flusso assistito

Trattamento dell'ostruzione del dotto eiaculatorio mediante vescicoloscopia seminale Modifica del flusso assistito

Trattamento dell'ostruzione del dotto eiaculatorio mediante vescicoloscopia seminale Modifica del flusso assistito