Name: endoscopy guided photoablation of endometrial cysts using a 980 nm laser with a contact fiber in mares
Uploaded: 2020-07-16T14:30:00.000+00:00
Duration: 7 min 7 s
Description: 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

저자는 모든 절차 동안 자신의 기술 지원에 대한 씨 파스칼 Lejeune 감사하고 싶습니다.

제시된 프로토콜은 말 병원에 제시된 말 병원에 제출된 말 병원에 있는 말에 쓰이는 말에 이용되고 기관 동물 배려 지침에 따릅니다.
참고: anestrus 전에 자궁내막 낭종 광절을 수행: 7 월 말이나 8 월에 관찰 된 열따라서 가장 신뢰할 수있는 것 같습니다. 잠재적인 자궁내막염을 치료하는 데 사용할 수 있는 에스트레우스의 수를 제한할 수 있으므로 번식 기에 너무 늦게 이 절차를 수행하지 마십시오.
1. 앞의 에스루치 중
<ol><li>암말의 완전한 사육 건전성 검사를 수행, 자궁 내막생검을 포함 1 (여기에 설명되지 않음) 암말 잠재적으로 절차 후 임신 할 수 있는지 확인하기 위해.</li>
	<li>케니의 분류1에따른 자궁내막 생검 이 불량한 경우, 자궁내막 낭종 광분화에 대한 배아 전달 또는 세포질 내 정자 주사(ICSI) 프로그램 선호도를 부여한다.</li>
</ol>2. 선행 다이스트루트 중
<ol><li>직장이 비어 나면, 자궁내암의 자궁 내막 낭종을 7.5 또는 5MHz 선형 직장 프로브와 캘리퍼로 동사 심혈을 사용하여 자궁내막 낭종을 검사한다(그림3)경합 스톡에.</li>
	<li>250 μg의 클로프로스테놀을 근육질로 투여하여 6\u20127 후 배란 후 2 일 또는 3 일 이내에 에스트루스를 유도하십시오.</li>
	<li>매일, 일반적인 일상적인 초음파 검사 및 자궁 경부 심포피를 수행하여 중요한 자궁내막 부종, 35mm의 개미 여포 및 연화 및 개동 자궁 경부를 포함하여 estrus 징후를 관찰하십시오.</li>
</ol>3. 말의 열에 있을 때 준비
<ol><li>안구 보호 안경을 착용한 사람들에게 수술실에 대한 접근을 제한합니다.</li>
	<li>직장을 비운 후 꼬리를 감싸고 요오드 포비도네를 사용하여 부음부를 무부로 청소하십시오.</li>
	<li>암말의 조작과 편안함을 보장하기 위해 21 G 바늘로 경정맥에서 디토미딘 (10 μg /kg)과 부안소롤 (0.1 mg /kg)을 정맥으로 투여하십시오.</li>
	<li>질당, 자궁 경부를 통해 배아 수집 카테터를 설치하고 공기의 40mL와 풍선을 부류.</li>
	<li>자궁을 팽창시키기 위해 멸균 식염수 용액(0.9% NaCl)을 1.5L로 주입합니다.</li>
	<li>풍선을 수축하고 카테터를 제거합니다.</li>
	<li>멸균 슬리브 내의 자궁 경부를 통해 내시경을 무균적으로 전달합니다.</li>
</ol>4. 기술
<ol><li>600 μm 쿼츠 섬유를 980 nm에서 작동하는 다이오드 레이저에 연결합니다. 연속 모드에서 20\u201225 W로 전원을 설정합니다.</li>
	<li>3\u20124cm의 자유 섬유가 화면에 식별할 때까지 직경 10mm 직경의 비디오 내시경의 생검 채널을 통해 유연한 석영 섬유를 전달합니다. 섬유 의 끝에서 최소 10mm가 표시되어야한다.</li>
	<li>레이저를 활성화하여 정점에 낭종을 이상적으로 뚫기 위해 전용 페달을 사용하여 손을 자유롭게 사용할 수 있습니다. 경우에 따라 낭종의 완전한 무효화를 달성하기 위해 다양한 위치에서 여러 천개가 필요합니다. 낭포성 액체는 수동적으로 자궁으로 배수됩니다.</li>
	<li>낭종 안감이 섬유 주위에 붕괴 된 후 멤브레인이 수축 될 때까지 레이저를 배포하십시오.</li>
	<li>자궁 내막 낭종이 사라졌음을 확인하기 위해 절차 중에 필요한 만큼 자궁의 경직 초음파 검사를 수행하십시오.</li>
</ol>5. 수술 후 치료
<ol><li>일반적인 항생제 치료 관리: 22,000 UI/kg 페니실린-프로카인 현탁액, 근육질, 하루에 두 번, 3 일 동안.</li>
	<li>개입 직후, 위에서 설명한 바와 같이 자궁 용암을 수행하십시오(3.4-3.6단계 참조).<ol>
<li>멸균 커프카테터를 통해 내시경 시술 전에 자궁에 주입된 액체를 수집합니다.</li>
		<li>맑은 액체가 수집될 때까지 1 L 멸균 동소용액(0.9% NaCl)의 연속적인 주입으로 자궁을 플러시합니다.</li>
		<li>절차가 끝나면 옥시토신 20 IU를 정맥내투여한다.</li>
		<li>다음 날 암말 자궁의 경상 외 초음파 검사를 수행 : 인트라무럴 프리 액이 자주 관찰됩니다 (단계 2.1 참조).</li>
	</ol>
</li>
	<li>경상 외 유동유체가 경상 외 초음파에 의해 관찰되고 열이 끝날 때까지, 상술한 절차(단계 3.4-3.6)로 매일 자궁 용암을 수행한다. 때로는 혈청과 같은 림프 및 노란색 스테인드 액체가 며칠 동안 수집됩니다. 참고: 소말이 에스트루스에 있을 때 4시간 이하의 옥시토신(20 IU)의 근육 내 주사를 반복하면 유체 축적을 방지하고 자궁내 세균 오염의 위험을 줄일 수 있습니다.</li>
	<li>자궁 내막 낭종의 실종과 내루무액의 부재를 확인하기 위해 다음과 같은 diestrus 동안 트랜스 직장 자궁 초음파 검사를 수행합니다. 참고: 무료 장루유체가 관찰되면 프로스타글란딘 주사는 새로운 에스트루스를 유도하고 최종 적인 자궁내막염을 진단하고 치료하는 것이 좋습니다.</li>
</ol>

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모든 저자는 완전히 리에주 대학의 말 클리닉에 의해 고용되고 위에서 언급 한 제품 중 하나를 거래하는 회사와 이해 상충이 없습니다.

자궁내막 낭종의 히스테리시피 및 레이저 광절은 이전에 제안된 바와 같이, 말에서 큰 발광 낭종을 감소시키는 쉬운 절차이다14. 기술적으로, 이 방법은 estrus의 말마에서 수행 될 때 향상됩니다. 멸균 식염수 용액으로 자궁을 팽창시키는 것은 절차를 수행하는 동안 공기 충전 및 지속적인 포부에 비해 가시성을 향상시다.  작은 정수리 낭종 (<10 mm)은 도달하고 치료하기가 더 어렵...

암을 통해 자궁내막 낭종은 케니1에의해 70년대에 조직병리학적으로 설명되었다. 80 년대 후반에, 히스테리 와 초음파의 사용은 그들의 임상 설명으로 이끌어 내고불임에그들의 결과를 이해하는 것을 도왔습니다2,3,4,5.
초기 단계에서 자궁내막 낭종은 현재 자궁 내측소라고 불리는 내막낭의 변성과관련이 있으며, 현재 작은(<1cm) 낭종은 더 큰 낭종이 림프증 팽창과 관련이 있을 때 자궁내막 땀샘 섬유증과 관련이 있는 것으로 받아들여지고 있습니다. . 이러한 큰 낭종은 6.5일과 17일 사이에 말 배아 이동을 방해할 가능성이 가장 높으며, 따라서 모계 인식1,3,4,6,8을손상시켜 불임을 감소시킨다. 자궁내막 낭종은 또한 초기 임신 진단을 방해할 수 있습니다, 특히 그(것)들이 둥글고 배아 소포3의것과 유사한 크기를 가지고 있는경우에,4,6,9 (그림 1참조). 따라서, 그(것)들은 잠재적으로 첫번째 태아 초음파학 및 쌍둥이 임신 평가를 연기하여 2개의 수정 사이 간격을 증가시킬 수 있습니다 (그림 2 참조). 자궁내막 낭종은 자궁내막염을 치료하거나 배아를 수집하기 위해 수행된 자궁 용암 중에 유체 수집을 기계적으로 방해할 수 있다. 따라서 자궁내막 낭종은 사육 농장에서 잠재적인 경제적 결과와 함께 관찰된 암말의 불임에 영향을 미칩니다.
근본적인 내구체를 치료하는 시도 외에10,낭종의 내시경 유도 초점 치료가 제안되었습니다. 전기 외과 소생술이 설명되었지만 열 노출은 낭종11주위의 내메트리움을 손상시킬 수 있습니다. 낭종의 포부는 분비 구조가천자(12)의시간에 더 이상 활성화되지 않는 경우에만 효율적입니다. 접촉 섬유와 980 nm 다이오드 레이저와 레이저 조사는 작은 후속 자궁 내막흉터를표시하는 것 같다6,13. 레이저 장치 및 절차의 개선6 지금 우리가 말 임상 연습에서이 안전 하 고 효율적인 기술을 제안 할 수 있습니다. 그러나, mare 소유자는이 옵션의 한계에 대해 통보해야합니다. 낭종의 광절은 일부 암말에서 배아 인식을 증가시킬 것이며, 어떤 경우에는 임신 진단을 진행하고 자궁 내막 낭종의 부정적인 기계적 효과를 자궁 내막염을 치료하거나 배아를 수집하기 위해 수행 된 자궁 내막 낭종의 부정적인 기계적 효과를 제한 할 수 있습니다. 그러나, 그것은 결코 수반 되는 기본 자궁 내막증 또는 자궁 내막염을 치료 하지 않습니다.
이 보고서는 말에서 히스테리 시세 유도 다이오드 레이저 낭종 절제를 수행하는 효율적인 절차를 설명하는 것을 목표로합니다. 준비 및 절차는 임상 적용을 위해 실질적으로 설명될 것입니다.

<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

암말에서 자궁 내막 낭종은 자궁 내막증과 관련이 있으며 모계 인식 실패 또는 타협및 임신 진단을 지연시킬 수 있습니다. 역사적인 치료는 침략적이고 자궁 내분에 불리한 효력이 있었습니다. 히스테리스코피토리 유도 레이저 요법은 자궁내막 낭종 절제술에 쉽고 효과적이며 자궁 내막에 대한 해로운 효과는 없습니다.
길이 110cm, 폭 1.0cm의 내시경은 외음부 세척 후 에스트라스 마레의 열린 자궁 경부를 통해 자궁에 살균적으로 도입된다. 자궁은 천천히 1 L 미만의 생리용액으로 주입되고 레이저 섬유는 내시경의 생검 운하에 삽입됩니다. 낭종은 연속 모드에서 20\u2012 25W로 설정된 접점 섬유로 980 nm 다이오드 레이저로 소생됩니다. 각 낭종은 낭종의 완전한 무효화와 섬유 주위의 낭종 벽의 축소 될 때까지 천공됩니다. 멸균 식염수용을 가진 자궁용암은 수술 후 직접 수행되며 비염증성 유체로서 1~2일 동안 수행된다.
이 절차는 명백한 해로운 효과없이 쉽고 신속하게 수행됩니다. 낭종 절제술은 초음파 임신 진단을 쉽게 하고, 어떤 경우에는, 6.5와 17 일 사이 자궁 뿔에 있는 적당한 태아 이주를 복구할 수 있었습니다. 그러나, 이 치료는 자궁 내막증과 관련된 근본적인 조직학적 병변을 개선하지 않습니다. 이러한 고려 사항은이 절차 전에 개종에 명확하게 표현되어야한다.

수술은 15mm 이상의 직경을 가진 낭종을 가진 말바닥에 수행되었습니다. 그러나 다른 작은 낭종도 존재한다면 다른 낭종의 광절을 시도했습니다. 일반적으로, 이 큰 낭종은 양면 또는 뿔의 기초에 있었다. 그러나, 그들 중 일부는 자궁의 몸에 존재하고 동등하게 취급되었다.
우리의 경험에서, 내루 낭종은 내시경으로 국소화하기가 매우 쉽습니다. 더욱이, 식염수 용액에서이 절...

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

이 보고서의 목적은 내시경 레이저 장치를 사용하여 암을 통해 자궁 내막 낭종의 광절을 설명하고 낮은 불임 문제를 다루는이 새로운 접근 방식의 관심과 한계를 논의하는 것입니다.

내시경 검사 유도 자궁 내막 낭종의 980 nm 레이저를 사용 하 여 Mares에 접촉 섬유와

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

Research

JoVE Journal

Medicine

4.3K 조회수.  Liège University. 이 보고서의 목적은 내시경 레이저 장치를 사용하여 암을 통해 자궁 내막 낭종의 광절을 설명하고 낮은 불임 문제를 다루는이 새로운 접근 방식의 관심과 한계를 논의하는 것입니다.

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

Thermal Ablation for the Treatment of Abdominal Tumors

Percutaneous thermal ablation is an emerging treatment option for many tumors of the abdomen not amenable to conventional treatments. During a thermal ablation procedure, a thin applicator is guided into the target tumor under imaging guidance. Energy is then applied to the tissue until temperatures rise to cytotoxic levels (50-60 &deg;C). Various energy sources are available to heat biological tissues, including radiofrequency (RF) electrical current, microwaves, laser light and ultrasonic waves. Of these, RF and microwave ablation are most commonly used worldwide.
During RF ablation, alternating electrical current (~500 kHz) produces resistive heating around the interstitial electrode. Skin surface electrodes (ground pads) are used to complete the electrical circuit. RF ablation has been in use for nearly 20 years, with good results for local tumor control, extended survival and low complication rates1,2. Recent studies suggest RF ablation may be a first-line treatment option for small hepatocellular carcinoma and renal-cell carcinoma3-5. However, RF heating is hampered by local blood flow and high electrical impedance tissues (eg, lung, bone, desiccated or charred tissue)6,7. Microwaves may alleviate some of these problems by producing faster, volumetric heating8-10. To create larger or conformal ablations, multiple microwave antennas can be used simultaneously while RF electrodes require sequential operation, which limits their efficiency. Early experiences with microwave systems suggest efficacy and safety similar to, or better than RF devices11-13.
Alternatively, cryoablation freezes the target tissues to lethal levels (-20 to -40 &deg;C). Percutaneous cryoablation has been shown to be effective against RCC and many metastatic tumors, particularly colorectal cancer, in the liver14-16. Cryoablation may also be associated with less post-procedure pain and faster recovery for some indications17. Cryoablation is often contraindicated for primary liver cancer due to underlying coagulopathy and associated bleeding risks frequently seen in cirrhotic patients. In addition, sudden release of tumor cellular contents when the frozen tissue thaws can lead to a potentially serious condition known as cryoshock 16.
Thermal tumor ablation can be performed at open surgery, laparoscopy or using a percutaneous approach. When performed percutaneously, the ablation procedure relies on imaging for diagnosis, planning, applicator guidance, treatment monitoring and follow-up. Ultrasound is the most popular modality for guidance and treatment monitoring worldwide, but computed tomography (CT) and magnetic resonance imaging (MRI) are commonly used as well. Contrast-enhanced CT or MRI are typically employed for diagnosis and follow-up imaging.

A thermal tumor ablation procedure is described. The entire procedure is detailed, including pretreatment planning and imaging studies, anesthesia, adjuvant techniques to facilitate a percutaneous approach, imaging guidance of the ablation device to the tumor, thermal treatment, post-treatment care and follow-up.

복부 종양의 치료를위한 열 절제

Percutaneous thermal ablation is an emerging treatment option for many tumors of the abdomen not amenable to conventional treatments. During a thermal ...

연구

의학

Evaluation of the Feasibility, Safety, and Accuracy of an Intraoperative High-intensity Focused Ultrasound Device for Treating Liver Metastases

Today, the only potentially curative option in patients with colorectal liver metastases is surgery. However, liver resection is feasible in less than 20% of patients. Surgery has been widely used in association with radiofrequency, cryotherapy, or microwaves to expand the number of treatments performed with a curative intent. Nevertheless, several limitations have been documented when using these techniques (i.e., a traumatic puncture of the parenchyma, a limited size of lesions, and an inability to monitor the treatment in real-time).High-intensity focused ultrasound (HIFU) technology can achieve precise ablations of biological tissues without incisions or radiation. Current HIFU devices are based on an extracorporeal approach with limited access to the liver. We have developed a HIFU device designed for intraoperative use. The use of a toroidal transducer enables an ablation rate (10 cm3&#183;min-1) higher than any other treatment and is independent of perfusion.
The feasibility, safety, and accuracy of intraoperative HIFU ablation were evaluated during an ablate-and-resect prospective study. This clinical phase I and IIa study was performed in patients undergoing hepatectomy for liver metastases. The HIFU treatment was performed on healthy tissue scheduled for resection.Liver metastases measuring less than 20 mm will be targeted during phase IIb (currently ongoing). This set-up allows the real-time evaluation of HIFU ablation while protecting participating patients from any adverse effects related to this new technique.
Fifteen patients were included in phase I&#8211;IIa and 30 HIFU ablations were safely created within 40 s and with a precision of 1&#8211;2 mm. The average dimensions of the HIFU ablations were 27.5 x 21.0 mm2, corresponding to a volume of approximately 7.5 cm3. The aim of the ongoing phase IIb is to ablate metastases of less than 20 mm in diameter with a 5 mm margin.

Here, we present an ablate-and-resect prospective study to evaluate the feasibility, safety, and accuracy of intraoperative high-intensity focused ultrasound ablation in patients undergoing hepatectomy for liver metastases.

간 전이 치료를 위한 초음파 장치 타당성, 안전, 그리고 자가 고 강도의 정확도의 평가 초점을 맞춘

Today, the only potentially curative option in patients with colorectal liver metastases is surgery. However, liver resection is feasible in less than 20% ...

암 연구학

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.

마우스 난모세포에서 세포질 미세소관 조직 센터의 다광자 레이저 제거

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

발생학

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.

최종 발사 리튬 Triborate 크리스탈 레이저를 통해 전립선의 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 ...

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.

980nm 다이오드 레이저를 사용한 양성 전립선 비대증 치료를 위한 전립선 적출

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).

각막 내피 세포 손실의 비 침습적, 레이저 보조 실험 모델의 개발

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.

전립선암의 초점 레이저 절제: 사무실 절차

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.

난소 자궁내막증에 대한 복강경 낭포절제술 중 난소 보호구역을 최적화하는 외과 기술

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.

난소 자궁 내막종의 이산화탄소 섬유 레이저 기화를 이용한 불임 스파링 절차

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

용종 제거를 위한 Micro-Scissors and Forceps를 사용한 자궁경 기술

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.

저자 스포트라이트: 완전한 자궁내막 용종 제거 및 향상된 자궁내막 수용성을 위한 생식 자궁경 접근법

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 Micro-Scissors and Forceps를 사용한 자궁내막 용종의 개선된 자궁경 절제술

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