著者らは、National Key Research and Development Program of China(Grant 2017YFC840102)の支援に感謝します。

ここに記載されているすべての方法は、北京病院の倫理委員会によって承認されています。手術の適応は、非神経原性男性のLUTSに関する欧州泌尿器科学会のガイドラインに従っています。禁忌には、前立腺がんまたは排尿筋機能障害の疑いが含まれます。
1.操作用機器
<ol><li>連続モード(80-100 W)を含む電力を備えたダイオードレーザー(980 nm)機器の可用性を確保します。</li>
	<li>レーザーファイバーと0.9%生理食塩水を使用して、術中の膀胱洗浄を行います。</li>
	<li>26 Fレーザー切除鏡を使用して、良好な視覚化を取得し、効率を高めます。</li>
</ol>2. 運用準備
<ol><li>手術当日に皮膚の準備を行ってください。</li>
	<li>術前にすべての患者に静脈内抗生物質を提供します10. 注:セフロキシムナトリウム(0.9%塩化ナトリウム100mLに1.5 g)は、手術の30分前に提供されます。.</li>
	<li>麻酔の前に、患者を手術台に横たえさせます。 注:全身麻酔は、この手術に効果的で適切です。麻酔科医は、患者の全身状態に応じて麻酔のモードを決定する必要があります。</li>
	<li>背側結石切開位置で患者を無菌状態でドレープします。</li>
</ol>3. 手順手順
<ol><li>観察<ol><li>尿道、膀胱頸部、尿管開口部、膀胱粘膜、および小柱過形成を切除鏡(15-30°)で直接観察します。</li>
	</ol></li>
	<li>除核の範囲をデザインします(キューピッドの矢)。<ol><li>レーザーで膀胱頸部粘膜を円形に切開(腺までの深さ、幅約3〜4mm)します(図1)。</li>
		<li>レーザーでverumontanumの近位端にある前立腺尿道粘膜を円形に切開します(腺までの深さ、幅約3〜4 mm)。 注:膀胱頸部粘膜と括約筋尿道の損傷を避けるために、切開前に解剖学的マークを確認してください。止血を除いて、手術中は80〜100Wのレーザー出力を使用してください。</li>
		<li>膀胱頸部の同心円と後部尿道の前立腺の頂点を12時の位置で接続します。</li>
		<li>レーザーで左葉と右葉を切開します(図3)。 注:後部尿道の12時の位置が事前に切開されたら、遠位粘膜を保持します。膀胱の首と前立腺の頂点に形成される同心円は、キューピッドの矢と呼ばれます。</li>
	</ol></li>
	<li>チャンネルを作る<ol><li>前立腺の頂点の5時と7時の位置で手術用カプセルを見つけます。</li>
		<li>5時と7時の手術用カプセルの位置で手術用カプセルを見つけます。</li>
		<li>5時と7時の手術用カプセルの位置をレーザーで接続します(図4)。</li>
		<li>前立腺の頂点の6時の位置で、レーザーを使用して前立腺の頂点から膀胱頸部までの手術カプセルから正中葉を分離します(図5)。 注:前立腺の容積が>80 mLの場合、正中葉と側葉は前立腺の頂点の5時位置と7時位置で完全に分離されます。</li>
	</ol></li>
	<li>左右の葉の摘出<ol><li>反時計回りに、前立腺の頂点から膀胱頸部までの6時と12時の右葉を切除鏡で核開栓します(図6)。</li>
		<li>時計回りに、前立腺の頂点から膀胱頸部までの6時と12時の左葉を核開栓します(図7)。</li>
		<li>除核後、すべての腺を膀胱に押し込みます。 注:前立腺の容積が>80 mLの場合は、正中葉と側葉を適切な順序で核開栓します。次に、膀胱に押し込みます。</li>
	</ol></li>
	<li>止血<ol><li>低出力のレーザー出力(50 W)を使用して、手術部位の周囲の出血を止めます。適切な距離(つまり、1〜3 mm)を維持します。</li>
	</ol></li>
	<li>前立腺組織をモルセレートします。<ol><li>除核した前立腺組織をモルセレーターで(できるだけ小さく)小片にモルセレートし、膀胱から組織を取り出します(図8)。</li>
	</ol></li>
	<li>カテーテル 検査<ol><li>モルセレーターを尿道から取り外します。.</li>
		<li>尿道をリドカインゲルで十分に潤滑した後、バルーン内に30 mLの水を入れて、22 F Foleyカテーテルを尿道口から膀胱腔に静かに留置します。</li>
	</ol></li>
	<li>術後ケア10<ol><li>術後約3時間、患者が麻酔から完全に目覚めるまで、ケアユニットでベッドに横たわらせます。この間、患者モニターと医療用酸素が利用可能であることを確認してください。</li>
		<li>患者が完全に目を覚ましたら、患者を病棟に戻します。患者に水を飲み始めさせ、食べ物を食べさせます。尿量を記録し、尿の色に注意してください。</li>
	</ol></li>
</ol>

<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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J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Enucleation+techniques+for+benign+prostate+obstruction:+Which+one+and+why?.">Enucleation techniques for benign prostate obstruction: Which one and why?.</a> Current Opinion in Urology. 24 (1), 49-55 (2013).</li><li>Chung, D. E., Te, A. 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>

著者は何も開示していません。

現在、980mmのダイオードレーザーはBPH5の治療に使用され始めています。関連する臨床研究について記述した報告はほとんどありません。BPHの治療におけるTURPの効果と比較して、多くの研究は、DiLEPが失血を減らし、より良い排尿機能を達成し、カテーテル保持時間が短いことを示しています9,13,14,15。...

従来の経尿道的前立腺切除術 (TURP) と比較して、レーザー手術は、患者の耐性が高く、術中の失血量が少なく、有効性が低く、術後の回復が短いため、徐々に人気が高まっています 4,5。
近年、最も急速に成長している技術は、さまざまな波長のレーザーの使用を含んでいます。現在、前立腺摘出術を完了するために、さまざまな特性を持つ多くの種類のレーザーを使用できます。ダイオードレーザーは、2007年に前立腺肥大症に対して米国FDAによって承認されて以来、その優れた切断能力と止血効果6のために、BPHの治療でその使用が徐々に増加しています。レーザーの波長は、水とヘモグロビンによる吸収の程度を決定します。波長980nmのダイオードレーザーは、水とヘモグロビンの組み合わせ吸収率が最も高いです。組織浸透能力は0.5mmで、より深い組織で凝固効果を生み出すことができるため、非常に優れた組織アブレーションおよび止血能力7,8が得られます。
多くの研究センターでは、良性前立腺肥大症の治療にDiLEPを使用し始めています。実際には、従来のDiLEPは学習曲線が長く、尿括約筋の保護に関連する明らかな利点はありません9。以上の理由から、当センターでは従来のDiLEPを改良し、BPH患者におけるダイオードレーザー治療の価値を向上させました。

<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

高齢化する男性人口では、良性前立腺肥大症(BPH)によって引き起こされる下部尿路症状(LUTS)の発生が一般的な問題です。ここでは、BPH1を治療するための980 nmダイオードレーザー核摘出術(DiLEP)という新しい技術を紹介します。ダイオードレーザーは、水とヘモグロビンの両方を同時に吸収できるため、切断や止血に適しています2。ダイオードレーザーは2007年にFDAによって承認され、その効果的な切断および止血効果3のためにBPHの治療に使用されてきました。DiLEPには、TURP、HoLEP、PVPなどの他の手法に比べていくつかの利点があります。手順では、大量の前立腺の境界を定義し、ダイオードレーザーで2つのリングと1つの溝(キューピッドの矢のように)を燃焼させることにより、前立腺を3つの葉に分離します。mDiLEPは、他の手技と比較して、術中の合併症が少なく、学習曲線が短く、より多くの組織切除を実現します。

DiLEPを受けたBPH患者の合計40人が、私たちの研究の1つに含まれていました。統計的手法として、独立したサンプルのt検定を使用しました。すべての患者が無事に手術を完了しました。ほぼ全ての患者様が術後5日以内にカテーテルを抜去されました(表1)。すべての患者は、術後 1か月目、3か月目、および 12か月目に フォローアップ...

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

ここでは、大量の良性前立腺肥大症を治療するための修正された980nmダイオードレーザー除核術のプロトコルを紹介します。

980 nm ダイオード レーザーを使用した良性前立腺肥大症の治療のための前立腺の摘出術

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 ビュー.  Beijing Hospital. ここでは、大量の良性前立腺肥大症を治療するための修正された980nmダイオードレーザー除核術のプロトコルを紹介します。

ビデオ: 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.

前立腺発がんおよび良性前立腺過形成の評価のための腎皮膜異種移植および皮下ペレット移植

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

医学

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.

RNA分析のためのヒト前立腺上皮のレーザーキャプチャーマイクロダイセクション

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.

薬剤耐性側頭葉てんかん患者における孔開存電極レコーディングのネットワーク解析

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.

プライマリの治療のための Transcanalicular ダイオード レーザ リノストーミー取得鼻涙管閉塞

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.

前立腺肥大症の外科治療: ホルミウム レーザー核出術 (HoLEP) 前立腺の。

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.

最後発火リチウム三ほう酸結晶レーザーを介して前立腺の Photoselective Vaporesection

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 ...

Evaluation of Cerebral Blood Flow Autoregulation in the Rat Using Laser Doppler Flowmetry

When investigating the body&#39;s mechanisms for regulating cerebral blood flow, a relative measurement of microcirculatory blood flow can be obtained using laser Doppler flowmetry (LDF). This paper demonstrates a closed skull preparation that allows cerebral blood flow to be assessed without penetrating the skull or installing a chamber or cerebral window. To evaluate autoregulatory mechanisms, a model of controlled blood pressure reduction via graded hemorrhage can be utilized while simultaneously employing LDF. This enables the real time tracking of the relative changes in the blood flow in response to reductions in arterial blood pressure produced by the withdrawal of circulating blood volume. This paradigm is a valuable approach to study cerebral blood flow autoregulation during reductions in arterial blood pressure and, with minor modifications in the protocol, is also valuable as an experimental model of hemorrhagic shock. In addition to evaluating autoregulatory responses, LDF can be used to monitor the cortical blood flow when investigating metabolic, myogenic, endothelial, humoral, or neural mechanisms that regulate cerebral blood flow and the impact of various experimental interventions and pathological conditions on cerebral blood flow.

This article demonstrates the use of laser Doppler flowmetry to evaluate the ability of the cerebral circulation to autoregulate its blood flow during reductions in arterial blood pressure.

レーザードップラー流量測定を用いたラットにおける脳血流自動調節の評価

When investigating the body&#39;s mechanisms for regulating cerebral blood flow, a relative measurement of microcirculatory blood flow can be obtained ...

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.

マレスの接触繊維を用いた980 nmレーザーを用いた子宮内膜嚢胞の導き光化による内視鏡検査

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.

前立腺がんの焦点レーザーアブレーション:事務処置

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

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 ...

980 nm ダイオード レーザーを使用した良性前立腺肥大症の治療のための前立腺の摘出術

980 nm ダイオードレーザーを使用した良性前立腺肥大症の治療のための前立腺の摘出術