1。症例提示<ol><li>患者は出血性疾患の発生により、多くの場合、婦人科クリニックでの訪問のために設定されています。身体検査が行われます。 <ol><li>適切と判断した場合、患者は子宮摘出のために予定されています。書類が調製され、患者は手術の日の前投薬が与えられる。 </li><li>患者は60歳以上では、最初の血液サンプルを提出し、手続きの前に心電図（ECGまたは）によって監視されなければなりません。 </li></ol></li><li>手術当日、患者はアドミタンス前に6時間、口から何を消費することはできません。 <ol><li>例外はアドミタンスの前に2時間まで許可されている果肉なしの甘い明確なドリンク、のために作られます。 </li><li>患者は最後のドリンクを飲みながら前投薬（t.Paracetemol 1グラム+ t.Etodolac 300mgの+ t.Dexamethason 8 mg）を取ります。 </li></ol></li><li>患者はアプリを認めている。一時間前に手術のスケジュールされた時間。 <ol><li>病棟看護師は、最初の手術のために患者を準備します。 </li><li>麻酔科医は、患者を検査し、麻酔のための書類を準備します。 </li></ol></li><li>手術室を調製し、チームの準備ができているときに、婦人科医は、手術室に患者を搬送する。 <ol><li>患者は手術台上に横たわり、外科ブランケットで覆われている。 </li><li>四線は左手に配置され、生理食塩水1,000 mlを開始する。監視装置が装着されている。 </li><li>麻酔は意識消失（LOC）が発生するまで、プロポフォールとレミフェンタニルで誘導し、TOFを使用して維持されている。 </li><li>挿管を容易にするため、ロクロニウム（15mg）を少量の用量が投与される。 </li><li>直接喉頭鏡検査が行われます。それは声帯を視覚化することは困難である場合には、マクvideolaryngoscopが使用される。挿管は、続いて行われる。 </li></ol></li><li>吹送腹部の12ミリメートルHgのCO 2で開始されます。 <ol><li>ポートが配置されます。 </li><li>プロシージャが開始される。 </li><li>外科医は4（TOF）の比の列車&gt;神経筋封鎖に対応する90％が、離乳あるオフのときに言われた。 </li><li>グラスパーの首には岬から臍の皮膚の表面までの距離がマークされています。 </li><li>把持器は、手術台上に載置される。テープを測定すると、グラスパの端部と把持器のネック（外科医の指で）との間の距離がマークされ、次いで、算出された距離をセンチメートル単位で測定される。 </li></ol></li><li> CO 2のinsufflations圧力は、8ミリメートルHgのに下げた。 <ol><li>グラスパーの首には岬から臍の皮膚の表面までの距離がマークされています。 </li><li>グラスパーは、テーブルに置かれます。測定テープが付いている距離はセンチメートルに解釈されます。 </li></ol></li><li&gt;のCO 2ガス注入圧力は、12ミリメートルHgのに調整される。 <ol><li>深い筋弛緩はポストテタヌスカウント（PTC）&lt;2に適用されます。 </li><li>グラスパーの首には岬から臍の皮膚の表面までの距離がマークされています。 </li><li>グラスパーは、テーブルに置かれます。測定テープが付いている距離がセンチメートルに測定されます。 </li></ol></li><li> CO 2ガス注入圧力は、8ミリメートルHgのに下げた。 <ol><li>グラスパーの首には岬から臍の皮膚の表面までの距離がマークされています。 </li><li>グラスパーの首には岬から臍の皮膚の表面までの距離がマークされています。 </li></ol></li><li>手順は終了する。 <ol><li>プロポフォールとレミフェンタニルの注入が終了します。 </li><li>患者は目覚め、彼または彼女のベッドに移動されます。 </li><li>患者が回復室に転送される。 </li></oL&gt; </li></ol>

<ol>
	<li>Jones, R. K., Caldwell, J. E., Sorin, C. B., Brull, J., Soto, R. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reversal+of+Profound+Rocuronium-induced+Blockade+with+Sugammadex.">Reversal of Profound Rocuronium-induced Blockade with Sugammadex.</a> Anesthesiology. 109, 816-824 (2008).</li><li>Berg, H., Roed, J., Viby-Mogensen, J., Mortensen, C. R., Enfbaek, J., Skovgaard, L. T., Krintel, J. 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Urol. 20 (3), 330-336 (2012).</li><li>Drahonovsky, J., Haakova, L., Otcenasek, M., Krofta, L., Kucera, E., Feyereisl, 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+prospective+randomized+comparison+of+vaginal+hysterectomy,+laparoscopically+assisted+vaginal+hysterectomy,+and+total+laparoscopic+hysterectomy+in+women+with+benign+uterine+disease.">A prospective randomized comparison of vaginal hysterectomy, laparoscopically assisted vaginal hysterectomy, and total laparoscopic hysterectomy in women with benign uterine disease.</a> Eur. J. Obstet. Gynecol. Reprod. Biol. 148 (2), 172-176 (2010).</li></ol>

利害の衝突は宣言されていない。

<html>直接腹腔鏡手術の使用可能な作業量を算出することは困難であるが、吹込みCO 2圧力および腹部の容積との関係は9を測定することが容易である。ここでは、ガス注入されたCO 2の量を記録する方法の代替手段として、通気中に腹部内の ​​領域を推定するために外科用グラスパーを使用する方法を提案する。 これらの測定は、通気圧力を下げ...

神経筋遮断薬は、一般に気管挿管を容易にするために、そして、麻酔中、手術を容易にするために使用される。腹腔鏡手順を通して深いリラクゼーションを達成するための薬剤の使用は、より良い手術条件の恩恵を受け、または外科的合併症のリスクを下げるために通気圧力を下げながらどちら外科医がCO 2ガス注入と同じレベルで進行することができます。いくつかの研究は、作動圧力を低下させる5,6,7の正の効果を示している。しばしば腹腔鏡下子宮摘出後に見ているものの症状は、フォローアップで患者に話すとき、多くの場合、主要な問題は、最も重要な課題として記載されて肩の痛み、です。8 より保守的な方法は子宮筋腫によって引き起こされる症状を制御するために失敗したときに腹腔鏡筋腫摘出術または子宮摘出術は、通常は推奨されます。当院では、これらの手順があります12ミリメートルHgの通気CO 2圧力で実施。すべての婦人科症例を行う2経験豊富な産婦人科があります。すべての私たちのケースは、プロポフォールとレミフェンタニルで麻酔され、挿管はしばしばロクロニウムの低用量（15mg）をで促進される。 私たちの毎日の臨床業務から、我々は文献8でサポートされている腹腔鏡下子宮摘出後の最も不穏な副作用の一つとして、肩の痛みを同定した。研究では、腹腔内圧を低減することも肩の痛みを減らすことができることが示されている。手順中に手術野と視認性が損なわれるならばCO 2通気圧力を減らすための努力で、我々の前に懸念のひとつだった。手順中に概要を決定しようとすると、我々は腹腔内作業スペースを比較する方法を設定します。しかし、シュル中に患者内の正確な腹腔ボリュームをモニターすることは非常に困難であり得るゲリー。ベルギーの研究では、ボリュームの圧力の関係は説明するが、著者らは、主要なインター個人差が9あると結論されています。腹腔内のスペースのより信頼性の高い文を得るために、私たちは、岬からメトリックなどの皮膚までの距離を使用しています。

deep neuromuscular blockade leads to a larger intraabdominal volume during laparoscopy

肩の痛みは、例えば筋腫または子宮摘出などの腹腔鏡手順に従って一般的に報告症状であり、最近の研究では、手術中にガス注入圧力を下げると、術後の痛みのリスクを減らすことが示されている。このパイロット研究では、この方法は、深い筋弛緩によって生成された緩和CO 2の削減を可能にするのに十分な作業スペース手術を増加させることができるかどうかを調べるために、laproscopy間に外科医に提供腹腔内のスペースを測定するために提示される通気圧力。 8ミリメートルHgの、12 mmHgで：腹腔鏡把持器を用いて、皮膚への岬までの距離は、2つの異なる通気圧力で測定される。初期測定の後に、神経筋遮断剤（筋弛緩）が患者に投与され、腹腔内容積が再度測定される。 15人の患者から採取されたパイロットデータがBLOと8ミリメートルHgのでその腹腔スペースを示していckadeは封鎖せずにHgの12ミリメートルで測定された腹腔内の空間に匹敵する。神経筋遮断の影響は、患者の身長、体重、BMI、年齢と相関しなかった。従って、通気圧力を低減しつつ安定した体積を維持するために筋弛緩を使用して改善された患者の転帰を生成することができる。

15人の患者のこのパイロット研究は腹腔鏡手術中に深い筋弛緩の影響を評価するために行った。 ここに示す方法は、腹腔鏡下子宮摘出（ 図1）を受けている患者における腹腔内空間の測定値を得た。封鎖せずに8ミリHgの、封鎖の12のmm Hgの、深い筋弛緩せず12ミリメートルHgの圧力、および封鎖の8ミリメートルHgの：それぞれの患者では、腹腔内のスペースの?...

Watch this Scientific Journal Video about Deep Neuromuscular Blockade Leads to a Larger Intraabdominal Volume During Laparoscopy at JoVE.com

Deep Neuromuscular Blockade Leads to a Larger Intraabdominal Volume During Laparoscopy

この記事では、手術グラスパーを使って腹腔鏡筋腫摘出時に作業腹部の体積を測定するための方法を提示し、深い筋弛緩（NMB）が低く通気圧力の使用を有効にすることができますかどうかにパイロットデータを取得するためにこの技術を適用します。腹腔鏡手術中に低減通気圧力は、術後の痛みを軽減することが示されているので、手術中NMBの使用が改善された患者の予後を可能にすることができる。

深い神経筋遮断は腹腔鏡の間大きな腹腔内容積につながる

Shoulder pain is a commonly reported symptom following laparoscopic procedures such as myomectomy or hysterectomy, and recent studies have shown that ...

deep-neuromuscular-blockade-leads-to-larger-intraabdominal-volume

Research

JoVE Journal

Medicine

13.0K ビュー.  Aleris-Hamlet Hospitals, Soeborg, Denmark. この記事では、手術グラスパーを使って腹腔鏡筋腫摘出時に作業腹部の体積を測定するための方法を提示し、深い筋弛緩（NMB）が低く通気圧力の使用を有効にすることができますかどうかにパイロットデータを取得するためにこの技術を適用します。腹腔鏡手術中に低減通気圧力は、術後の痛みを軽減することが示されているので、手術中NMBの使用が改?...

ビデオ: Deep Neuromuscular Blockade Leads to a Larger Intraabdominal Volume During Laparoscopy

Intra-Operative Behavioral Tasks in Awake Humans Undergoing Deep Brain Stimulation Surgery

Deep brain stimulation (DBS) is a surgical procedure that directs chronic, high frequency electrical stimulation to specific targets in the brain through implanted electrodes. Deep brain stimulation was first implemented as a therapeutic modality by Benabid et al. in the late 1980s, when he used this technique to stimulate the ventral intermediate nucleus of the thalamus for the treatment of tremor 1. Currently, the procedure is used to treat patients who fail to respond adequately to medical management for diseases such as Parkinson's, dystonia, and essential tremor. The efficacy of this procedure for the treatment of Parkinson's disease has been demonstrated in well-powered, randomized controlled trials 2. Presently, the U.S. Food and Drug Administration has approved DBS as a treatment for patients with medically refractory essential tremor, Parkinson's disease, and dystonia. Additionally, DBS is currently being evaluated for the treatment of other psychiatric and neurological disorders, such as obsessive compulsive disorder, major depressive disorder, and epilepsy. 
DBS has not only been shown to help people by improving their quality of life, it also provides researchers with the unique opportunity to study and understand the human brain. Microelectrode recordings are routinely performed during DBS surgery in order to enhance the precision of anatomical targeting. Firing patterns of individual neurons can therefore be recorded while the subject performs a behavioral task. Early studies using these data focused on descriptive aspects, including firing and burst rates, and frequency modulation 3. More recent studies have focused on cognitive aspects of behavior in relation to neuronal activity 4,5. This article will provide a description of the intra-operative methods used to perform behavioral tasks and record neuronal data with awake patients during DBS cases. Our exposition of the process of acquiring electrophysiological data will illuminate the current scope and limitations of intra-operative human experiments.

Deep brain stimulation surgery offers a unique opportunity to examine information encoding in the awake human brain. This article will describe intra-operative methods used to perform cognitive and behavioral tasks while simultaneously acquiring physiological data such as EMG, single-unit neuronal activity and/or local field potentials.

脳深部刺激術を受けた覚醒ヒトにおける術中行動作業

Deep brain stimulation (DBS) is a surgical procedure that directs chronic, high frequency electrical stimulation to specific targets in the brain through ...

医学

Dorsal Column Steerability with Dual Parallel Leads using Dedicated Power Sources:  A Computational Model

In spinal cord stimulation (SCS), concordance of stimulation-induced paresthesia over painful body regions is a necessary condition for therapeutic efficacy. Since patient pain patterns can be unique, a common stimulation configuration is the placement of two leads in parallel in the dorsal epidural space. This construct provides flexibility in steering stimulation current mediolaterally over the dorsal column to achieve better pain-paresthesia overlap. Using a mathematical model with an accurate fiber diameter distribution, we studied the ability of dual parallel leads to steer stimulation between adjacent contacts on dual parallel leads using (1) a single source system, and (2) a multi-source system, with a dedicated current source for each contact. The volume conductor model of a low-thoracic spinal cord with epidurally-positioned dual parallel (2 mm separation) percutaneous leads was first created, and the electric field was calculated using ANSYS, a finite element modeling tool. The activating function for 10 um fibers was computed as the second difference of the extracellular potential along the nodes of Ranvier on the nerve fibers in the dorsal column. The volume of activation (VOA) and the central point of the VOA were computed using a predetermined threshold of the activating function. The model compared the field steering results with single source versus dedicated power source systems on dual 8-contact stimulation leads. The model predicted that the multi-source system can target more central points of stimulation on the dorsal column than a single source system (100 vs. 3) and the mean steering step for mediolateral steering is 0.02 mm for multi-source systems vs 1 mm for single source systems, a 50-fold improvement. The ability to center stimulation regions in the dorsal column with high resolution may allow for better optimization of paresthesia-pain overlap in patients.

Using a mathematical model of spinal cord stimulation, we found that a multi-source system with independent power sources for each contact can target more central points of stimulation on the dorsal column (100 vs 3) and has 50-fold more field steering resolution (0.02mm vs 1mm) than a single-source system.

専用電源を使用してデュアルパラレルのリードで脊柱の操縦：計算モデル

In spinal cord stimulation (SCS), concordance of stimulation-induced paresthesia over painful body regions is a necessary condition for therapeutic ...

Utilizing Transcranial Magnetic Stimulation to Study the Human Neuromuscular System

Transcranial magnetic stimulation (TMS) has been in use for more than 20 years 1, and has grown exponentially in popularity over the past decade. While the use of TMS has expanded to the study of many systems and processes during this time, the original application and perhaps one of the most common uses of TMS involves studying the physiology, plasticity and function of the human neuromuscular system. Single pulse TMS applied to the motor cortex excites pyramidal neurons transsynaptically 2 (Figure 1) and results in a measurable electromyographic response that can be used to study and evaluate the integrity and excitability of the corticospinal tract in humans 3. Additionally, recent advances in magnetic stimulation now allows for partitioning of cortical versus spinal excitability 4,5. For example, paired-pulse TMS can be used to assess intracortical facilitatory and inhibitory properties by combining a conditioning stimulus and a test stimulus at different interstimulus intervals 3,4,6-8. In this video article we will demonstrate the methodological and technical aspects of these techniques. Specifically, we will demonstrate single-pulse and paired-pulse TMS techniques as applied to the flexor carpi radialis (FCR) muscle as well as the erector spinae (ES) musculature. Our laboratory studies the FCR muscle as it is of interest to our research on the effects of wrist-hand cast immobilization on reduced muscle performance6,9, and we study the ES muscles due to these muscles clinical relevance as it relates to low back pain8. With this stated, we should note that TMS has been used to study many muscles of the hand, arm and legs, and should iterate that our demonstrations in the FCR and ES muscle groups are only selected examples of TMS being used to study the human neuromuscular system.

Transcranial magnetic stimulation (TMS) is a non-invasive tool to gain insight on the physiology and function of the human nervous system. Here, we present our TMS techniques to study cortical excitability of the upper limb and lumbar musculature.

人間の神経筋システムを研究するために経頭蓋磁気刺激の活用

Transcranial magnetic stimulation (TMS) has been in use for more than 20 years 1, and has grown exponentially in popularity over the past decade.  While ...

Construction of Vapor Chambers Used to Expose Mice to Alcohol During the Equivalent of all Three Trimesters of Human Development

Exposure to alcohol during development can result in a constellation of morphological and behavioral abnormalities that are collectively known as Fetal Alcohol Spectrum Disorders (FASDs). At the most severe end of the spectrum is Fetal Alcohol Syndrome (FAS), characterized by growth retardation, craniofacial dysmorphology, and neurobehavioral deficits. Studies with animal models, including rodents, have elucidated many molecular and cellular mechanisms involved in the pathophysiology of FASDs. Ethanol administration to pregnant rodents has been used to model human exposure during the first and second trimesters of pregnancy. Third trimester ethanol consumption in humans has been modeled using neonatal rodents. However, few rodent studies have characterized the effect of ethanol exposure during the equivalent to all three trimesters of human pregnancy, a pattern of exposure that is common in pregnant women. Here, we show how to build vapor chambers from readily obtainable materials that can each accommodate up to six standard mouse cages. We describe a vapor chamber paradigm that can be used to model exposure to ethanol, with minimal handling, during all three trimesters. Our studies demonstrate that pregnant dams developed significant metabolic tolerance to ethanol. However, neonatal mice did not develop metabolic tolerance and the number of fetuses, fetus weight, placenta weight, number of pups/litter, number of dead pups/litter, and pup weight were not significantly affected by ethanol exposure. An important advantage of this paradigm is its applicability to studies with genetically-modified mice. Additionally, this paradigm minimizes handling of animals, a major confound in fetal alcohol research.

We demonstrate the construction of alcohol vapor chambers using readily available materials that simultaneously house 6 mouse cages. We further describe their use in a mouse model of fetal alcohol exposure equivalent to all 3&#160;trimesters of human pregnancy. This paradigm exposes animals during gestation and postnatal days 1-12.

人間開発の3つのすべての学期の等価時にはアルコールにマウスを公開するために使用蒸気チェンバースの建設

Exposure to alcohol during development can result in a constellation of morphological and behavioral abnormalities that are collectively known as Fetal ...

Clinical Assessment of Spatiotemporal Gait Parameters in Patients and Older Adults

Spatial and temporal characteristics of human walking are frequently evaluated to identify possible gait impairments, mainly in orthopedic and neurological patients1-4, but also in healthy older adults5,6. The quantitative gait analysis described in this protocol is performed with a recently-introduced photoelectric system (see&#160;Materials table) which has the potential to be used in the clinic because it is portable, easy to set up (no subject preparation is required before a test), and does not require maintenance and sensor calibration. The photoelectric system consists of series of high-density floor-based photoelectric cells with light-emitting and light-receiving diodes that are placed parallel to each other to create a corridor, and are oriented perpendicular to the line of progression7. The system simply detects interruptions in light signal, for instance due to the presence of feet within the recording area. Temporal gait parameters and 1D spatial coordinates of consecutive steps are subsequently calculated to provide common gait parameters such as step length, single limb support and walking velocity8, whose validity against a criterion instrument has recently been demonstrated7,9. The measurement procedures are very straightforward; a single patient can be tested in less than 5 min&#160;and a comprehensive report can be generated in less than 1&#160;min.

This protocol is used to evaluate spatial and temporal gait variables of neurological/orthopedic patients and older persons by means of a recently-introduced floor-based photocell system.

患者と高齢者における時空間歩行パラメータの臨床的評価

Spatial and temporal characteristics of human walking are frequently evaluated to identify possible gait impairments, mainly in orthopedic and ...

Using Saccadometry with Deep Brain Stimulation to Study Normal and Pathological Brain Function

The oculomotor system involves a large number of brain areas including parts of the basal ganglia, and various neurodegenerative diseases including Parkinson's and Huntington's can disrupt it. People with Parkinson's disease, for example, tend to have increased saccadic latencies. Consequently, the quantitative measurement of saccadic eye movements has received considerable attention as a potential biomarker for neurodegenerative conditions. A lot more can be learned about the brain in both health and disease by observing what happens to eye movements when the function of specific brain areas is perturbed. Deep brain stimulation is a surgical intervention used for the management of a range of neurological conditions including Parkinson's disease, in which stimulating electrodes are placed in specific brain areas including several sites in the basal ganglia. Eye movement measurements can then be made with the stimulator systems both off and on and the results compared. With suitable experimental design, this approach can be used to study the pathophysiology of the disease being treated, the mechanism by which DBS exerts it beneficial effects, and even aspects of normal neurophysiology.

This paper describes the use of quantitative measurement of eye movements in conjunction with stimulation of focal areas of the deep brain in order to study physiology, pathophysiology, and the mechanisms of deep brain stimulation.

正常および病的脳機能を研究するために脳深部刺激でSaccadometryを使用します

The oculomotor system involves a large number of brain areas including parts of the basal ganglia, and various neurodegenerative diseases including ...

Assessment of Pulmonary Capillary Blood Volume, Membrane Diffusing Capacity, and Intrapulmonary Arteriovenous Anastomoses During Exercise

Exercise is a stress to the pulmonary vasculature. With incremental exercise, the pulmonary diffusing capacity (DLCO) must increase to meet the increased oxygen demand; otherwise, a diffusion limitation may occur. The increase in DLCO with exercise is due to increased capillary blood volume (Vc) and membrane diffusing capacity (Dm). Vc and Dm increase secondary to the recruitment and distension of pulmonary capillaries, increasing the surface area for gas exchange and decreasing pulmonary vascular resistance, thereby attenuating the increase in pulmonary arterial pressure. At the same time, the recruitment of intrapulmonary arteriovenous anastomoses (IPAVA) during exercise may contribute to gas exchange impairment and/or prevent large increases in pulmonary artery pressure.
We describe two techniques to evaluate pulmonary diffusion and circulation at rest and during exercise. The first technique uses multiple-fraction of inspired oxygen (FIO2) DLCO breath holds to determine Vc and Dm at rest and during exercise. Additionally, echocardiography with intravenous agitated saline contrast is used to assess IPAVAs recruitment.
Representative data showed that the DLCO, Vc, and Dm increased with exercise intensity. Echocardiographic data showed no IPAVA recruitment at rest, while contrast bubbles were seen in the left ventricle with exercise, suggesting exercise-induced IPAVA recruitment.
The evaluation of pulmonary capillary blood volume, membrane diffusing capacity, and IPAVA recruitment using echocardiographic methods is useful to characterize the ability of the lung vasculature to adapt to the stress of exercise in health as well as in diseased groups, such as those with pulmonary arterial hypertension and chronic obstructive pulmonary disease.

To assess the pulmonary diffusion and vasculature responses to exercise, we describe the multiple-inspired oxygen diffusion capacity technique to determine capillary blood volume and membrane diffusing capacity, as well as agitated saline contrast echocardiography to assess the recruitment of intrapulmonary arteriovenous anastomoses.

トレーニング中の肺毛細管血液量、膜拡散能力、及び肺内動静脈吻合の評価

Exercise is a stress to the pulmonary vasculature. With incremental exercise, the pulmonary diffusing capacity (DLCO) must increase to meet the increased ...

Surgical Techniques to Optimize Ovarian Reserve during Laparoscopic Cystectomy for Ovarian Endometrioma

Surgical management of ovarian endometrioma in patients desiring fertility is complicated by the need to balance maximal resection of disease with efforts to spare normal ovarian cortex. Optimization of tubal anatomy is another frequent consideration. Fertility-sparing laparoscopic techniques at the time of cystectomy for ovarian endometrioma seek to limit iatrogenic surgical damage to the ovarian cortex and strategically assess and respond to genital tract patency. Surgical candidates frequently desire relief from endometriosis-associated pain while also seeking to optimize spontaneous or assisted conception rates. Operative benefits include potential for surgical and histopathologic diagnosis of endometriosis, evaluation of genital tract patency, and treatment of visualized lesions. Resection of ovarian endometrioma nonetheless poses significant risks, including surgical injury, blood loss, post-surgical decline in ovarian reserve and post-operative inflammation with adhesion formation, both of which may impair folliculogenesis.
We present the case of a 32-year-old woman with known endometriosis and continued pain refractory to medical management who opted for surgical management of her disease tailored toward optimizing her chances at future conception. Using this case as an example, we describe techniques and considerations for diagnostic laparoscopy, adhesiolysis, ovarian cystectomy, chromopertubation, and salpingectomy with a focus on maintaining a fertility-preserving approach.

This protocol presents techniques to laparoscopically excise ovarian endometrioma, to perform adhesiolysis with sparing electrosurgical application, and to employ intraoperative chromopertubation to assess for genital tract patency. This systematic approach will facilitate optimal endometriosis management, guide concomitant adnexal surgeries, and enhance post-surgical fertility outcomes.

卵巣子宮内膜症の腹腔鏡下膀胱切除術中に卵巣予備を最適化する外科技術

Surgical management of ovarian endometrioma in patients desiring fertility is complicated by the need to balance maximal resection of disease with efforts ...

Laparoscopy-endoscopy Cooperative Surgery for the Treatment of Gastric Gastrointestinal Stromal Tumors

In view of the shortcomings of endoscopic or laparoscopic surgeries alone in the treatment of gastric gastrointestinal stromal tumors (G-GISTs), this approach makes an innovative improvement in the treatment of G-GISTs that are less than 5 cm in size. Laparoscopy-endoscopy cooperative surgery (LECS) is used to combine endoscopic and laparoscopic surgeries, fully realizing their respective advantages and avoiding their drawbacks. The main steps are as follows. First, gastroscopy and laparoscopy are combined to confirm the location and boundary of the tumor. Tumor resection is carried out laparoscopically, guided by a gastroscope. The specimen is removed orally and the gastric wound closed laparoscopically. Then, gastroscopy and laparoscopy are combined to determine whether there is wound bleeding, if the suture is satisfactory, and if the gastric cavity is deformed.
LECS has natural advantages in the treatment of G-GISTs that are less than 5 cm in size. The accurate estimation of tumor location and boundary greatly improves the complete resection rate of tumors. The risk of tumor rupture is substantially reduced, and the long-term prognosis of patients is significantly improved. The process allows for accurate resection of the tumor, maximum preservation of normal gastric tissue and organ function, and avoids postoperative gastric deformation. The patient's postoperative rehabilitation is greatly accelerated, and oral feeding can resume on the day of the operation. The specimen is taken out through the mouth to avoid the need for an extended abdominal incision. This greatly reduces the patient's postoperative pain and scarring. The method greatly shortens the postoperative hospital stay (i.e., discharge is possible on the day after the operation), increasing the turnover of hospital beds.

Laparoscopy-endoscopy cooperative surgery is appropriate for the treatment of gastric gastrointestinal stromal tumors less than 5 cm in size. It can achieve the respective advantages of endoscopic and laparoscopic surgeries while avoiding their drawbacks.

胃腸間質腫瘍の治療のための腹腔鏡内視鏡検査共同外科

In view of the shortcomings of endoscopic or laparoscopic surgeries alone in the treatment of gastric gastrointestinal stromal tumors (G-GISTs), this ...

Functional Assessment of the Donor Heart During Ex Situ Perfusion: Insights from Pressure-Volume Loops and Surface Echocardiography

Heart transplantation remains the gold standard treatment for advanced heart failure. However, the current critical organ shortage has resulted in the allocation of a growing number of donor hearts with extended criteria. These marginal grafts are associated with a high risk of primary graft failure and may benefit from ex situ perfusion before transplant. This technology allows for extended organ preservation using warm oxygenated blood perfusion with continuous metabolic monitoring. The only NESP device currently available for clinical practice perfuses the organ in an unloaded non-working state, which does not allow for functional assessment of the beating heart. We therefore developed an original platform of NESP in working mode conditions with adjustment of left ventricular preload and afterload. This protocol was applied in porcine hearts. Ex situ functional assessment of the heart was achieved with intracardiac conductance catheterization and surface echocardiography. Along with a description of the experimental protocol, we herein report the main results, as well as pearls and pitfalls associated with the acquisition of pressure-volume loops and myocardial power during NESP. Correlations between hemodynamic findings and ultrasound variables are of major interest, especially for further rehabilitation of donor hearts before transplantation. This protocol aims to improve the assessment of donor hearts to both increase the donor pool and reduce the incidence of primary graft failure.

Functional Assessment of the Donor Heart During Ex Situ Perfusion: Insights from Pressure-Volume Loops and Surface Echocardiography

A reliable noninvasive approach for functional assessment of the donor heart during normothermic ex situ heart perfusion (NESP) is lacking. We herein describe a protocol for ex situ assessment of myocardial performance using the epicardial echocardiography and conductance catheter method.

Ex-situ灌流中のドナー心臓の機能評価:圧力-体積ループと表面心エコー検査からの洞察

Heart transplantation remains the gold standard treatment for advanced heart failure. However, the current critical organ shortage has resulted in the ...