著者は、パスカル・レジューン氏がすべての手順で彼の技術サポートに感謝したいと思います。

提示されたプロトコルは馬の病院で提示されるマレスのために使用され、制度的な動物の心配のガイドラインに従う。
注:アネストラスの前に子宮内膜嚢胞光化を行う:したがって、7月下旬または8月に観察された熱は、したがって、最も信頼性が高いように見えます。潜在的な内性炎を治療するために利用可能なエストルの数を制限することができるので、繁殖期に遅すぎるこの手順を実行しないでください。
1. 前のエストラスの間
<ol><li>処置後に、雌が妊娠する可能性があることを確認するために、子宮内膜生検1( ここでは説明しない)を含む、雌の完全な繁殖健全性検査を行う。</li>
	<li>ケニーの分類1に従って悪い子宮内膜生検のステージングの場合、子宮内膜嚢胞の光化よりも胚移植または細胞質内精子注射(ICSI)プログラムの好みを与える。</li>
</ol>2. 前のダイストルの間
<ol><li>直腸が空になったら、7.5または5MHzの線形直腸プローブとカリパーを画面上に導いた経腸直腸超音波検査を使用して子宮内の雌の子宮内嚢胞を数え、測定し、マッピングする(図3)。</li>
	<li>250 μgのクロプロステノール筋肉内投与して、排卵後6日または3日後に2〜3日以内に発情を誘導する。</li>
	<li>日常的に、重要な子宮外浮腫、35mmのアンタル卵胞、軟化して開いた子宮頸部を含む、発情徴候を観察するために、一般的な日常的な超音波検査および子宮頸部触診を行う。</li>
</ol>3. マレが熱中のときの準備
<ol><li>手術室へのアクセスを、眼鏡をかけている人に制限します。</li>
	<li>直腸を空にした後、尾を包み、ヨウ素ポビトンを使用して外陰部を無菌できれいにします。</li>
	<li>容易な操作および気性を保障するために、21G針の頸静脈のデトミジン(10 μg/kg)およびブトルファンノール(0.1mg/kg)を静脈内に投与する。</li>
	<li>膣ごとに、子宮頸部を通して胚採取カテーテルを取り付け、40 mLの空気でバルーンを吸湿する。</li>
	<li>子宮を膨らませる1.5Lの無菌生理液(0.9%NaCl)を注入する。</li>
	<li>バルーンを収縮させ、カテーテルを取り外します。</li>
	<li>無菌の袖の中に子宮頸部を通して無菌の内視鏡を渡す。</li>
</ol>4. テクニック
<ol><li>600 μm の石英繊維を 980 nm で動作するダイオードレーザーに接続します。20\u201225 W の電源を連続モードに設定します。</li>
	<li>3\u20124 cmのフリーファイバーが画面で識別されるまで、直径10 mmのビデオ内視鏡の生検チャネルを介して柔軟な石英繊維を渡します。繊維の端から最低10 mmが見えるはずです。</li>
	<li>レーザーをアクティブにして、理想的には頂点で嚢胞を穿刺する:専用のペダルは、手を自由に保つためにデバイス上で利用可能です。場合によっては、嚢胞の完全な空隙を達成するために様々な場所で複数の穿刺が必要である。嚢胞性流体は受動的に子宮に排出される。</li>
	<li>嚢胞の内層が繊維の周りに崩壊した後、膜が縮小するまでレーザーを展開する。</li>
	<li>子宮内膜嚢胞が消失したことを確認するために、処置中に子宮の経腸超音波検査を必要な回数だけ行う。</li>
</ol>5. 術後治療
<ol><li>一般的な抗生物質治療を投与する:22,000 UI/kgペニシリンプロカイン懸濁液、筋肉内、1日2回、3日間。</li>
	<li>介入の直後に、上記のように子宮洗浄を行う(ステップ3.4-3.6を参照)。<ol>
<li>無菌カフカテーテルを介して内視鏡的処置の前に子宮に注入された液体を収集する。</li>
		<li>透明な液体が回収されるまで、1 L無菌等張液(0.9%NaCl)の連続した吸入で子宮を洗い流します。</li>
		<li>手順の最後に、20 IUのオキシトシンを静脈内投与する。</li>
		<li>翌日に、気の小膜の経腸超音波検査を行う:内膜遊離液が頻繁に観察される(ステップ2.1参照)。</li>
	</ol>
</li>
	<li>無自由な発光中流体が経直腸超音波検査によって観察され、熱の終わりまで観察される限り、上記の手順で毎日子宮洗浄を行う(ステップ3.4-3.6)。時には、血清状、リンピッドおよび黄色の染色された液体が数日間収集される。 注:マレが発情状態にある場合、4時間以下のオキシトシン(20 IU)の筋肉内注射を繰り返すと、体液の蓄積を避け、子宮内の細菌汚染のリスクを低減することができます。</li>
	<li>子宮内膜嚢胞の消失および内膜遊離液の欠如を確認するために、以下のダイスの間に経腸子宮超音波検査を行う。 注:遊離内皮液が観察される場合、プロスタグランジン注入は、最終的な後続の子宮内膜炎を診断し、それを治療するために、新しい発情を誘発することをお勧めします。</li>
</ol>

<ol>
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P., Weinstock, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effects+of+neodymium:yttrium+aluminum+garnet+laser+irradiation+on+endometrium+and+on+endometrial+cysts+in+six+mares.">Effects of neodymium:yttrium aluminum garnet laser irradiation on endometrium and on endometrial cysts in six mares.</a> Veterinary Surgery. 22 (5), 351-356 (1993).</li><li>Bartmann, C. P., Stief, B., Schoon, H. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Thermal+injury+and+wound+healing+of+the+endometrium+subsequent+to+minimally+invasive+transendoscopic+use+of+Nd:YAG-laser-and+electrosurgery+in+horses.">Thermal injury and wound healing of the endometrium subsequent to minimally invasive transendoscopic use of Nd:YAG-laser-and electrosurgery in horses.</a> Dtsch Tierarztl Wochenschr. 110 (7), 271-280 (2003).</li><li>Conley, A. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Review+of+the+reproductive+endocrinology+of+the+pregnant+and+parturient+mare.">Review of the reproductive endocrinology of the pregnant and parturient mare.</a> Theriogenology. 86 (1), 355-365 (2016).</li><li>Guzeloglu, 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=Expression+of+enzymes+and+receptors+of+leukotriene+pathway+genes+in+equine+endometrium+during+the+estrous+cycle+and+early+pregnancy.">Expression of enzymes and receptors of leukotriene pathway genes in equine endometrium during the estrous cycle and early pregnancy.</a> Theriogenology. 80 (2), 145-152 (2013).</li><li>Senger, P. 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すべての著者は、リエージュ大学の馬クリニックによって完全に雇用されており、上記の製品の1つを取引する会社との利益相反はありません。

子宮内膜嚢胞の子宮鏡検査およびレーザー光化は、前に示唆された14のように、マレの大きな発光性嚢胞を減らすための容易な処置である。技術的には、この方法は、発情の中でマレに対して行われると改善される。無菌生理液で子宮を膨らませ、処置を行っている間の空気充填および連続吸引と比較した場合の可視性が向上した。 小さな頭頂嚢胞(<10mm)は、到達し、治療す...

マレスの子宮内膜嚢胞は、ケニー1によって70年代に組織病理学的に記述された。80年代後半には、ヒステロスコピーと超音波検査の使用は、彼らの臨床記述につながり、不妊治療2、3、4、5に彼らの結果を理解するのに役立ちました。
初期段階では、子宮内膜嚢胞は現在子宮内膜の変性に関連しており、現在では子宮内膜1、3、4、6、7、8と呼ばれ、より大きな嚢胞がリンパ性拡張に関連する場合、小さな(<1cm)嚢胞が子宮内膜腺線維症に関連することが現在受け入れられている.これらの大きな嚢胞は、6.5日目から17日目の間にウマの胚移動を妨げる可能性が最も高く、母親の認識を損なうことによって生殖能力を低下させる1、3、4、6、8である。子宮内膜嚢胞はまた、特に円形で、胚小胞3、4、6、9と同様の大きさを有する場合、妊娠初期の診断を妨げる可能性がある(図1参照)。したがって、最初の胚超音波検査と双子の妊娠評価を遅らせることによって、2つの授精間の間隔を長くする可能性があります(図2を参照)。子宮内膜嚢胞はまた、子宮内膜炎を治療したり、胚を収集するために行う子宮洗浄中に流体採取に機械的に干渉する可能性がある。その結果、子宮内膜嚢胞は観察されたマレの生殖能力に影響を及ぼすため、繁殖農場では経済的に影響を及ぼす可能性がある。
基礎となる内経経10を治療する試みに加えて、嚢胞の内視鏡的に導かれた焦点治療が提案されている。電気手術用焼灼法が説明されているが、熱暴露は嚢胞11の周囲の子宮内膜を傷つける可能性がある。嚢胞の吸引は、穿刺12の時点で分泌構造がもはや活発でない場合にのみ有効である。接触繊維を用いた980 nmダイオードレーザーによるレーザー照射は、その後の子宮内膜瘢痕6,13を小さく示すようだ。レーザー装置および手順6の改善は今私達が馬の臨床の練習のこの安全で、有効な技術を提案することを可能にする。ただし、このオプションの制限について、mareの所有者に通知する必要があります。嚢胞の光化は、いくつかのマレスで胚認識を増加させ、場合によっては妊娠診断を進め、子宮内膜炎を治療したり胚を収集するために行われた子宮内膜嚢胞の負の機械的効果を制限する可能性がある。しかし、それに伴う子宮内膜症や子宮内膜炎は治療しません。
本報告書は、マレスにおけるヒステロスコピー誘導ダイオードレーザー嚢胞切れ切れを行う効率的な手順を説明することを目的としている。臨床応用に関する準備および手順について、実用説明する。

<table><tbody><tr><td>Butorphanol</td><td>Animedica</td><td>Morphasol 10 mg/mL</td><td></td></tr><tr><td>Detomidine</td><td>Dechra</td><td>Domidine 10 mg/mL</td><td></td></tr><tr><td>Endoscope</td><td>Olympus</td><td>Vet 170-10 SN2012729</td><td></td></tr><tr><td>Endoscope Vid&amp;eacute;o Tower</td><td>Olympus</td><td>CLE-E &amp;amp; CV-E</td><td></td></tr><tr><td>Laser device</td><td>Wuhan Giga Optronics</td><td>Velas II-60B GA19-V3186</td><td></td></tr><tr><td>NaCl 0.9%</td><td>Baxter</td><td></td><td></td></tr><tr><td>P&amp;eacute;nicilline-proca&amp;iuml;ne</td><td>Kela</td><td>PENI-Kel 300.00 UI/ml</td><td></td></tr><tr><td>Ultrasonography</td><td>Aloka</td><td>Aloka 500 &amp;amp; 5mHz transrectal probe</td><td></td></tr></tbody></table>

endoscopy guided photoablation of endometrial cysts using a 980 nm laser with a contact fiber in mares

マレスでは、子宮内膜嚢胞は子宮内膜症に関連しており、母親の認識障害または妥協を引き起こし、妊娠診断を遅らせる可能性があります。歴史的治療は侵襲的であり、子宮内膜に悪影響を及ぼした。子宮体腔内誘導レーザー療法は、子宮内膜嚢胞切除に容易かつ有効であり、子宮内膜に有害な影響はない。
長さ110cm、幅1.0cmの内視鏡は、外陰部洗浄後のエストルスマレの開放性子宮頸部を通して子宮内に無菌で導入される。子宮は、生理学的溶液の1L未満をゆっくりと注入し、レーザー繊維は、内視鏡の生検運河に挿入される。嚢胞は、連続モードで20\u20122 5Wに設定された接触ファイバを備えた980 nmダイオードレーザーで焼灼されます。各嚢胞は、嚢胞の完全な空隙および線維の周りの嚢胞壁の縮小まで穿刺される。生殖不能生理食液を伴う子宮洗浄は、手術後直ちに、非炎症性液が観察されるように1〜2日間行われる。
この手順は、明らかな有害な効果を持たない、簡単かつ迅速に実行されます。嚢胞切除は超音波妊娠診断を容易にし、場合によっては6.5日目から17日目の間に子宮角の適切な胚移動を回復させる可能性がある。しかし、この治療は子宮内膜症に関連する基礎組織学的病変を改善しない。これらの考慮事項は、この手順の前にブリーダーに明確に表現する必要があります。

手術は、15mm以上の直径を有する嚢胞を有するマレスに対して行われた。しかし、他の小さな嚢胞も存在する場合、他の嚢胞の光化が試みられた。一般的に、これらの大きな嚢胞は分岐または角の基礎にあった。しかし、そのうちのいくつかは子宮の体内に存在し、同様に治療された。
私たちの経験では、内皮嚢胞は内視鏡で局地化するのが非常に簡単です。さらに、生?...

Watch this Scientific Journal Video about Endoscopy Guided Photoablation of Endometrial Cysts using a 980 nm Laser with a Contact Fiber in Mares at JoVE.com

Endoscopy Guided Photoablation of Endometrial Cysts using a 980 nm Laser with a Contact Fiber in Mares

本報告の目的は、内視鏡的レーザー装置を用いた、血中の子宮内膜嚢胞の光化を説明し、低い不妊の問題に対処するためのこの新しいアプローチの関心と限界について議論することである。

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. ...

endoscopy-guided-photoablation-endometrial-cysts-using-980-nm-laser

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4.3K ビュー.  Liège University. 本報告の目的は、内視鏡的レーザー装置を用いた、血中の子宮内膜嚢胞の光化を説明し、低い不妊の問題に対処するためのこの新しいアプローチの関心と限界について議論することである。

ビデオ: Endoscopy Guided Photoablation of Endometrial Cysts using a 980 nm Laser with a Contact Fiber in Mares

Photoacoustic Cystography

Conventional pediatric cystography, which is based on diagnostic X-ray using a radio-opaque dye, suffers from the use of harmful ionizing radiation. The risk of bladder cancers in children due to radiation exposure is more significant than many other cancers. Here we demonstrate the feasibility of nonionizing and noninvasive photoacoustic (PA) imaging of urinary bladders, referred to as photoacoustic cystography (PAC), using near-infrared (NIR) optical absorbents (i.e. methylene blue, plasmonic gold nanostructures, or single walled carbon nanotubes) as an optical-turbid tracer. We have successfully imaged a rat bladder filled with the optical absorbing agents using a dark-field confocal PAC system. After transurethral injection of the contrast agents, the rat's bladders were photoacoustically visualized by achieving significant PA signal enhancement. The accumulation was validated by spectroscopic PA imaging. Further, by using only a laser pulse energy of less than 1 mJ/cm2 (1/20 of the safety limit), our current imaging system could map the methylene-blue-filled-rat-bladder at the depth of beyond 1 cm in biological tissues in vivo. Both in vivo and ex vivo PA imaging results validate that the contrast agents were naturally excreted via urination. Thus, there is no concern regarding long-term toxic agent accumulation, which will facilitate clinical translation.

Photoacoustic cystography (PAC) has a great potential to map urinary bladders, a radiation sensitive internal organ in pediatric patients, without using any ionizing radiation or toxic contrast agent. Here we demonstrate the use of PAC for mapping urinary bladders with an injection of optical-opaque tracers in rats in vivo.

光音響膀胱造影

Conventional pediatric cystography, which is based on diagnostic X-ray using a radio-opaque dye, suffers from the use of harmful ionizing radiation. The ...

生物工学

One Minute, Sub-One-Watt Photothermal Tumor Ablation Using Porphysomes, Intrinsic Multifunctional Nanovesicles

We recently developed porphysomes as intrinsically multifunctional nanovesicles. A photosensitizer, pyropheophorbide &alpha;, was conjugated to a phospholipid and then self-assembled to liposome-like spherical vesicles. Due to the extremely high density of porphyrin in the porphyrin-lipid bilayer, porphysomes generated large extinction coefficients, structure-dependent fluorescence self-quenching, and excellent photothermal efficacy. In our formulation, porphysomes were synthesized using high pressure extrusion, and displayed a mean particle size around 120 nm. Twenty-four hr post-intravenous injection of porphysomes, the local temperature of the tumor increased from 30 &deg;C to 62 &deg;C rapidly upon one minute exposure of 750 mW (1.18 W/cm2), 671 nm laser irradiation. Following the complete thermal ablation of the tumor, eschars formed and healed within 2 weeks, while in the control groups the tumors continued to grow and all reached the defined end point within 3 weeks. These data show how porphysomes can be used as potent photothermal therapy (PTT) agents.

We developed novel intrinsic multifunctional nanovesicles called porphysomes, which have structure-dependent fluorescence self-quenching and unique photothermal properties, thus functioning as potent photothermal therapy agents. We formulated porphysomes using high pressure extrusion and investigated their photothermal therapy efficacy in a xenograft tumor model.

1分Porphysomesを使用してサブワンワット光熱腫瘍焼灼、真性多機能ナノベシクル

We recently developed porphysomes as intrinsically multifunctional nanovesicles. A photosensitizer, pyropheophorbide &alpha;, was conjugated to a ...

Multi-Photon Laser Ablation of Cytoplasmic Microtubule Organizing Centers in Mouse Oocytes

The fidelity of oocyte meiosis is critical for generating developmentally competent euploid eggs. In mammals, the oocyte undergoes a lengthy arrest at prophase I of the first meiotic division. After puberty and upon meiotic resumption, the nuclear membrane disassembles (nuclear envelope breakdown), and the spindle is assembled mainly at the oocyte center. Initial central spindle positioning is essential to protect against abnormal kinetochore-microtubule (MT) attachments and aneuploidy. The centrally positioned spindle migrates in a time-sensitive manner toward the cortex, and this is a necessary process to extrude a tiny polar body. In mitotic cells, spindle positioning relies on the interaction between centrosome-mediated astral MTs and the cell cortex. On the contrary, mouse oocytes lack classic centrosomes and, instead, contain numerous acentriolar MT organizing centers (MTOCs). At the metaphase I stage, mouse oocytes have two different sets of MTOCs: (1) MTOCs that are clustered and sorted to assemble spindle poles (polar MTOCs), and (2) metaphase cytoplasmic MTOCs (mcMTOCs) that remain in the cytoplasm and do not contribute directly to spindle formation but play a crucial role in regulating spindle positioning and timely spindle migration. Here, a multi-photon laser ablation method is described to selectively deplete endogenously labeled mcMTOCs in oocytes collected from Cep192-eGfp reporter mice. This method contributes to the understanding of the molecular mechanisms underlying spindle positioning and migration in mammalian oocytes.

An optimized protocol is presented that enables the depletion of cytoplasmic microtubule organizing centers in mouse oocytes during metaphase I using a near-infrared femtosecond laser.

マウス卵母細胞における細胞質微小管組織化中心の多光子レーザーアブレーション

The fidelity of oocyte meiosis is critical for generating developmentally competent euploid eggs. In mammals, the oocyte undergoes a lengthy arrest at ...

発生生物学

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 ...

医学

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.

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. ...

Development of a Noninvasive, Laser-Assisted Experimental Model of Corneal Endothelial Cell Loss

Nd:YAG lasers have been used to perform noninvasive intraocular surgery, such as capsulotomy for several decades now. The incisive effect relies on the optical breakdown at the laser focus. Acoustic shock waves and cavitation bubbles are generated, causing tissue rupture. Bubble sizes and pressure amplitudes vary with pulse energy and position of the focal point. In this study, enucleated porcine eyes were positioned in front of a commercially available Nd:YAG laser. Variable pulse energies as well as different positions of the focal spots posterior to the cornea were tested. Resulting lesions were evaluated by two-photon microscopy and histology to determine the best parameters for an exclusive detachment of corneal endothelial cells (CEC) with minimum collateral damage. The advantages of this method are the precise ablation of CEC, reduced collateral damage, and above all, the non-contact treatment.

Here, we present a protocol to detach corneal endothelial cells (CEC) from Descemet&#8217;s membrane (DM) using a neodymium:YAG (Nd:YAG) laser as an ex vivo disease model for bullous keratopathy (BK).

角膜内皮細胞損失の非侵襲的レーザー支援実験モデルの開発

Nd:YAG lasers have been used to perform noninvasive intraocular surgery, such as capsulotomy for several decades now. The incisive effect relies on the ...

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 ...

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 ...

Fertility Sparing Procedure using Carbon Dioxide Fiber Laser Vaporization of Ovarian Endometrioma

The surgical management of endometrioma is still a matter of debate. Cystectomy, which is recognized as the standard technique, seems to be associated with a potential reduction in the ovarian reserve due to the inadvertent removal and thermal damage of healthy ovarian tissue. New ablative techniques with reduced tissue penetration depth and less thermal spread to the surrounding parenchyma may represent a viable alternative to cystectomy. For these reasons, the aim of this manuscript is to demonstrate the ablation of the endometrioma capsule using a CO2 fiber laser technique and discuss the clinical outcomes. Once the cyst has been drained and washed, a biopsy is taken. After cyst eversion, vaporization of the inner surface of the cyst is performed using a CO2 fiber laser. The technique is simple and reproducible as even young surgeons without any surgical experience were more confident in performing laser CO2 vaporization instead of cystectomy. The positive effects of CO2 technology are reported in a randomized controlled trial, where the postoperative changes in the antral follicular count (AFC) and antimullerian hormone (AMH) levels were compared between patients who had their endometrioma excised (cystectomy) and those who had undergone endometrioma vaporization with CO2 laser. The patients treated with CO2 laser showed significantly increased AFC without a reduction in serum AMH levels as compared to the cystectomy group, in which both parameters were significantly reduced. The postoperative pregnancy rate was also assessed, and comparable pregnancy rates were found after both treatments. On the contrary, patients treated with the CO2 fiber laser technique had more favorable in-vitro fertilization (IVF) outcomes compared to cystectomy.
In conclusion, the CO2 fiber laser technique may represent a viable alternative to cystectomy in the surgical treatment of endometrioma in terms of ovarian preservation, pregnancy rates, and IVF outcomes. Moreover, it has the advantage of being independent of the surgeon's skills and personal experience.

In this protocol, CO2 fiber laser technique is demonstrated for the surgical treatment of ovarian endometriosis, which represents a viable alternative in terms of fertility preservation with the major advantage of not being dependent on the surgeon's skills and personal experience.

卵巣子宮内膜腫の二酸化炭素ファイバーレーザー気化を用いた不妊治療手順

The surgical management of endometrioma is still a matter of debate. Cystectomy, which is recognized as the standard technique, seems to be associated ...

ポリープ除去のためのマイクロハサミと鉗子による子宮鏡技術

Improved Hysteroscopic Resection of Endometrial Polyps Using 6-Fr Micro-Scissors and Forceps

Endometrial polyps commonly contribute to female infertility, and hysteroscopic resection is the established surgical approach for their treatment. Numerous resection methods are available, with the most used and cost-effective options being cold resection employing micro-scissors or hot resection using an electric loop. However, both methods involve sharp resection, posing a challenge in achieving complete polyp removal while avoiding damage to the uterine endometrium. To address this issue, this study proposes an innovative approach: the combined use of the 6 Fr micro-scissors and forceps under hysteroscopy. The method entails utilizing 6 Fr micro-scissors to initially remove large polyps, followed by using 6 Fr micro-forceps to extract the remaining polyp tissue expeditiously and bluntly near the basal layer of the endometrium. This approach not only prevents surgical damage to the basal layer of the endometrium but also mitigates the risk of residual polyps resulting from incomplete resection. This method is particularly suitable for women with fertility requirements, offering additional considerations for the selection of treatment options for endometrial polyp resection.

著者スポットライト:子宮内膜ポリープの完全除去と子宮内膜受容性の向上のための生殖子宮鏡検査アプローチ

The novel technique presented here employs a combination of 6-Fr micro-scissors and forceps for hysteroscopic treatment of endometrial polyps, demonstrating encouraging outcomes for infertile patients afflicted with this condition.

6-FRマイクロハサミと鉗子を使用した子宮内膜ポリープの子宮鏡下切除の改善

Endometrial polyps commonly contribute to female infertility, and hysteroscopic resection is the established surgical approach for their treatment. ...

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

要約

さらに動画を探す

光音響膀胱造影

1分Porphysomesを使用してサブワンワット光熱腫瘍焼灼、真性多機能ナノベシクル

マウス卵母細胞における細胞質微小管組織化中心の多光子レーザーアブレーション

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

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

角膜内皮細胞損失の非侵襲的レーザー支援実験モデルの開発

前立腺がんの焦点レーザーアブレーション:事務処置

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

卵巣子宮内膜腫の二酸化炭素ファイバーレーザー気化を用いた不妊治療手順

6-FRマイクロハサミと鉗子を使用した子宮内膜ポリープの子宮鏡下切除の改善

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

要約

さらに動画を探す

光音響膀胱造影

1分Porphysomesを使用してサブワンワット光熱腫瘍焼灼、真性多機能ナノベシクル

マウス卵母細胞における細胞質微小管組織化中心の多光子レーザーアブレーション

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

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

角膜内皮細胞損失の非侵襲的レーザー支援実験モデルの開発

前立腺がんの焦点レーザーアブレーション:事務処置

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

卵巣子宮内膜腫の二酸化炭素ファイバーレーザー気化を用いた不妊治療手順

6-FRマイクロハサミと鉗子を使用した子宮内膜ポリープの子宮鏡下切除の改善

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