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Aprovação ética foi obtida do Hospital de ética Comissão de Xangai nona do povo e o consentimento informado de cada paciente foram obtidos em nosso estudo.
1. pacientes e materiais cirúrgicos
Notas: Os pacientes diagnosticados com HBP e precisa de tratamento cirúrgico em conformidade com as orientações da Associação Europeia de Urologia (EAU) pode ser incluído10. Este procedimento cirúrgico requer experiência e uma longa curva de aprendizado. A experiência do cirurgião é um dos fatores mais importantes para realizar esta técnica, especificamente para a próstata, com um volume superior a 100 g. O efeito da explosão micro do laser de hólmio é apropriado para enucleação.
<ol><li>Preparação pré-cirúrgica<ol>
<li>Avalie pacientes com HPB que requerem tratamento cirúrgico, em conformidade com as diretrizes EAU10.</li>
		<li>Excluir aqueles com as seguintes condições: infecção urinária grave, doença pulmonar ou cardíaco grave, comprometimento da função renal grave distúrbio hemorrágico, controle de pressão de sangue pobre, disfunção neurogênica da bexiga, câncer de bexiga, próstata anterior cirurgia, câncer de próstata, estenose uretral e outras contra-indicações cirúrgicas mencionadas em relatórios anteriores11.</li>
		<li>Realizar avaliações pré-operatória e conduzir determinado tratamento perioperatório de acordo com os resultados.</li>
		<li>Administrar anestesia geral ou lombar para o paciente e colocar o paciente em posição de litotomia.</li>
	</ol>
</li>
	<li>Avaliação pré-cirúrgica Notas: Para a avaliação pré-operatória, realizar as análises de seguidores, incluindo a verificação regular cirurgia: análise dinâmica de fluxo urinário, análise de ultrassom prostática, análise do nível de antígeno prostático específico (PSA) e a análise urethroscopy.<ol>
<li>HoLEP executar usando uma fibra de laser de acionamento final µm 550 e um laser de hólmio 100 W Versa Pulse, com configurações de energia de 80-100 Wat 1.6-2 J/s e 40-50 Hz. realizar transuretral morcellation com um nephroscope de F 26 usando um morcellator mecânico. Use cerca de 1 L de solução salina (0,9%) como o ﬂuid de irrigação.</li>
	</ol>
</li>
</ol>2. Enucleação procedimentos
Notas: Use esterilização plasma para esterilizar os instrumentos e colocar os instrumentos em embalagens assépticas até usado. Administrar anestesia geral ou lombar para os pacientes e colocar o paciente em posição de litotomia durante a cirurgia.
<ol><li>Observação da próstata e da uretra<ol>
<li>Inserir o cistoscópio de fluxo contínuo, garantindo a dano tecidual mínima e observando a próstata, a uretra e a bexiga com cuidado.</li>
		<li>Localize os orifícios ureterais com o uso de um obturador visual para uma avaliação geral, incluindo o volume lóbulo mediano e a quantidade de tecido intravesical.</li>
		<li>Identifica o verumontanum que é um dos mais importantes marcos para enucleação. Inserir as peças de mão com uma fibra de laser ligada à máquina do laser com o poder da máquina do laser a 80-100 W em J 1.6-2 por segundo e 40-50 Hz.</li>
	</ol>
</li>
	<li>Túnel da incisão em torno da posição de 06:00 da próstata com os pacientes na posição de litotomia.<ol>
<li>Usando um laser de hólmio, faça uma incisão horizontal curta em torno da posição de 06:00 em frente o verumontanum (como mostrado na figura 1A) para localizar a cápsula cirúrgica da próstata.</li>
		<li>Expor a cápsula cirúrgica da próstata do verumontanum para o colo da bexiga. Na camada da cápsula cirúrgica, crie um túnel a partir do ápice em direção a parte de trás do colo da bexiga, como mostrado na figura 1A e 1D.</li>
		<li>Quando a operação está próximo do colo da bexiga, certifique-se de que a mucosa e o músculo são protegidos para facilitar o controle urinário eficiente.</li>
	</ol>
</li>
	<li>Remoção de lóbulo lateral Notas: A cápsula é caracterizada por um tecido branco liso com suficiente dos vasos sanguíneos na superfície. Sangramento de vasos também pode ser selada usando o laser com distância um pouco maior do que o utilizado no processo sem núcleo (distância maior é apropriada para hemostasia, enquanto a menor distância é apropriada para o corte). Durante o procedimento, retorno ao ápice prostático sem hesitar para assegurar que a cápsula cirúrgica exata está localizada, que é útil para evitar perder-se no processo, quando o operador não pode encontrar a visão clara.<ol>
<li>Em primeiro lugar, enucleate a esquerda lóbulo lateral desde as 06:00 as 12:00 posição a nível da cápsula cirúrgica e então enucleate o outro lóbulo lateral da mesma forma.</li>
		<li>Durante o procedimento, usar blur separação por meio de uma bainha de escopo combinada com corte a laser.</li>
		<li>Pendure o aumento da próstata na posição do colo da bexiga, sem corte de 12:00.</li>
		<li>Cortar o tecido do colo da bexiga e empurrá-lo para a bexiga ao final do procedimento de enucleação.</li>
		<li>Verifique novamente a cápsula da próstata para não garantir que nenhum sangramento ativo ocorre. Remover as glândulas muito alargada e parar os pontos de sangramento graves (ilustrado na figura 1A-1F).</li>
	</ol>
</li>
</ol>3. Morcellation
Notas: Existem duas engrenagens no morcellator, que pode ser deslocada de acordo com a pressão de pé aplicada. A primeira usa uma leve pressão para absorver água e tecido, enquanto a segunda engrenagem é usado para morcellation. Para evitar complicações e melhorar a eficiência do processo, desenvolvemos procedimentos e habilidades tradicionais morcellation. A abordagem para implementar neste caso é discutida em detalhes no nosso anterior estudo12. O tecido retirado da bexiga é mostrado na Figura 2.
<ol><li>Procedimento de Morcellation<ol>
<li>Equipe o morcellator e o tubo de correspondência de acordo com a instrução de morcellator, independentemente do tipo de morcellator usado. Remova o tecido da próstata da bexiga usando um morcellator eficientemente.</li>
		<li>Durante o procedimento, trate o tecido da bexiga com grande prudência13. Manter a água de irrigação suficiente na bexiga para manter a bexiga inchada, evitando lesão de bexiga e para manter o morcellator longe da parede da bexiga, permanecendo dentro da bexiga, para a máxima proteção a parede da bexiga.</li>
		<li>Finalmente, observe o estado geral da bexiga e certifique-se de que nenhum tecido reservado é deixado na bexiga.</li>
	</ol>
</li>
	<li>Habilidades de Morcellation<ol>
<li>Conforme relatado no nosso anterior estudo12, antes da morcellation, avaliar a textura do tecido da glândula.</li>
		<li>Cave buracos usando laser para fornecer a fricção na superfície da glândula e, assim, obter uma superfície lisa.</li>
		<li>Use a técnica inversa para morcellate os tecidos grandes e firmes, bem como glândulas fibróticas, esféricas com superfícies lisas e tecidos firmes. Durante o processo de inverter a morcellator para sua abertura a face para baixo na bexiga. Certifique-se de que a água de circulação está desobstruída e constantemente sentir a pressão da bexiga durante morcellation.</li>
	</ol>
</li>
</ol>4. tratamento pós-operatório
<ol style="margin-left: 40px;"><li>Após a cirurgia, inserir o cateter e então irrigar solução salina normal para a bexiga, até que a água de irrigação é clara ou apenas ligeiramente avermelhada.</li>
	<li>Remova o cateter até a urina torna-se claro sem hematúria.</li>
	<li>Se nenhuma retenção óbvia é observada e o paciente pode urinar sem assistência após a remoção do cateter, descarregue o paciente o hospital14,15.</li>
</ol>5. seguimento observação
<ol><li>Após a alta hospitalar, examinar os dados de acompanhamento do paciente por 1, 6 e 12 meses, que incluem o Internacional Próstata Sintoma Pontuação (IPSS), bexiga sobre-ativo marcando o sistema (OABSS), qualidade de vida (QoL) e Qmax. Se ocorrerem complicações pós-operatórias, aplica mais tratamento14.</li>
</ol>

<ol><li>Bushman, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Etiology%2C+epidemiology%2C+and+natural+history+of+benign+prostatic+hyperplasia%5BTitle%5D)+AND+%22Urol+Clin+North+Am%22%5BJournal%5D)">Etiology, epidemiology, and natural history of benign prostatic hyperplasia.</a> Urol Clin North Am. 36 (4), 403-415 (2009).</li>
<li>Millin, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Retropubic+prostatectomy%3B+a+new+extravesical+technique%3B+report+of+20+cases%5BTitle%5D)+AND+%22Lancet%22%5BJournal%5D)">Retropubic prostatectomy; a new extravesical technique; report of 20 cases.</a> Lancet. 2 (6380), 693-696 (1945).</li>
<li>Kahokehr, A. A., Gilling, P. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Which+laser+works+best+for+benign+prostatic+hyperplasia%3F%5BTitle%5D)+AND+%22Curr+Urol+Rep%22%5BJournal%5D)">Which laser works best for benign prostatic hyperplasia?</a> Curr Urol Rep. 14 (6), 614-619 (2013).</li>
<li>Gilling, P. J., Cass, C. B., Malcolm, A. R., Fraundorfer, M. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Combination+holmium+and+Nd%3AYAG+laser+ablation+of+the+prostate%3A+initial+clinical+experience%5BTitle%5D)+AND+%22J+Endourol%22%5BJournal%5D)">Combination holmium and Nd:YAG laser ablation of the prostate: initial clinical experience.</a> J Endourol. 9 (2), 151-153 (1995).</li>
<li>Fraundorfer, M. R., Gilling, P. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Holmium%3AYAG+laser+enucleation+of+the+prostate+combined+with+mechanical+morcellation%3A+preliminary+results%5BTitle%5D)+AND+%22Eur+Urol%22%5BJournal%5D)">Holmium:YAG laser enucleation of the prostate combined with mechanical morcellation: preliminary results.</a> Eur Urol. 33 (1), 69-72 (1998).</li>
<li>Chen, Y. B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((A+prospective%2C+randomized+clinical+trial+comparing+plasmakinetic+resection+of+the+prostate+with+holmium+laser+enucleation+of+the+prostate+based+on+a+2-year+followup%5BTitle%5D)+AND+%22J+Urol%22%5BJournal%5D)">A prospective, randomized clinical trial comparing plasmakinetic resection of the prostate with holmium laser enucleation of the prostate based on a 2-year followup.</a> J Urol. 189 (1), 217-222 (2013).</li>
<li>Kahokehr, A., Gilling, P. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Enucleation+techniques+for+benign+prostate+obstruction%3A+which+one+and+why%3F%5BTitle%5D)+AND+%22Curr+Opin+Urol%22%5BJournal%5D)">Enucleation techniques for benign prostate obstruction: which one and why?</a> Curr Opin Urol. 24 (1), 49-55 (2014).</li>
<li>Kuntz, R. M., Lehrich, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Transurethral+holmium+laser+enucleation+versus+transvesical+open+enucleation+for+prostate+adenoma+greater+than+100+gm.%3A%3A+a+randomized+prospective+trial+of+120+patients%5BTitle%5D)+AND+%22J+Urol%22%5BJournal%5D)">Transurethral holmium laser enucleation versus transvesical open enucleation for prostate adenoma greater than 100 gm.:: a randomized prospective trial of 120 patients.</a> J Urol. 168 (4 Pt 1), 1465-1469 (2002).</li>
<li>Elzayat, E., Habib, E., Elhilali, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Holmium+laser+enucleation+of+the+prostate+in+patients+on+anticoagulant+therapy+or+with+bleeding+disorders%5BTitle%5D)+AND+%22J+Urol%22%5BJournal%5D)">Holmium laser enucleation of the prostate in patients on anticoagulant therapy or with bleeding disorders.</a> J Urol. 175 (4), 1428-1432 (2006).</li>
<li>Oelke, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((EAU+guidelines+on+the+treatment+and+follow-up+of+non-neurogenic+male+lower+urinary+tract+symptoms+including+benign+prostatic+obstruction%5BTitle%5D)+AND+%22Eur+Urol%22%5BJournal%5D)">EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction.</a> Eur Urol. 64 (1), 118-140 (2013).</li>
<li>Xu, H., et al. <a target="_blank" href="http://www.ijcem.com/files/ijcem0029922.pdf">Efficacy and safety of an improved technique of holmium laser enucleation of the prostate versus open prostatectomy in treating enlarged prostates combined with multiple bladder stones: one-year of followup.</a> Int J Clin Exp Med. 9 (12), 23612-23617 (2016).</li>
<li>Chen, Q., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((An+improved+morcellation+procedure+for+holmium+laser+enucleation+of+the+prostate%5BTitle%5D)+AND+%22J+Endourol%22%5BJournal%5D)">An improved morcellation procedure for holmium laser enucleation of the prostate.</a> J Endourol. 26 (12), 1625-1628 (2012).</li>
<li>El Tayeb, M. M., Borofsky, M. S., Paonessa, J. E., Lingeman, J. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Wolf+Piranha+Versus+Lumenis+Versacut+Prostate+Morcellation+Devices%3A+A+Prospective+Randomized+Trial%5BTitle%5D)+AND+%22J+Urol%22%5BJournal%5D)">Wolf Piranha Versus Lumenis Versacut Prostate Morcellation Devices: A Prospective Randomized Trial.</a> J Urol. , (2015).</li>
<li>Gilling, P. J., Aho, T. F., Frampton, C. M., King, C. J., Fraundorfer, M. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Holmium+laser+enucleation+of+the+prostate%3A+results+at+6+years%5BTitle%5D)+AND+%22Eur+Urol%22%5BJournal%5D)">Holmium laser enucleation of the prostate: results at 6 years.</a> Eur Urol. 53 (4), 744-749 (2008).</li>
<li>Shah, H. N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Prospective+evaluation+of+the+learning+curve+for+holmium+laser+enucleation+of+the+prostate%5BTitle%5D)+AND+%22J+Urol%22%5BJournal%5D)">Prospective evaluation of the learning curve for holmium laser enucleation of the prostate.</a> J Urol. 177 (4), 1468-1474 (2007).</li>
<li>Gratzke, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((EAU+Guidelines+on+the+Assessment+of+Non-neurogenic+Male+Lower+Urinary+Tract+Symptoms+including+Benign+Prostatic+Obstruction%5BTitle%5D)+AND+%22Eur+Urol%22%5BJournal%5D)">EAU Guidelines on the Assessment of Non-neurogenic Male Lower Urinary Tract Symptoms including Benign Prostatic Obstruction.</a> Eur Urol. 67 (6), 1099-1109 (2015).</li>
<li>Vincent, M. W., Gilling, P. J. <a target="_blank" href="https://www.ncbi.nlm.nih.gov/pubmed/25416347">HoLEP has come of age.</a> World J Urol. 33 (4), 487-493 (2015).</li>
<li>Qian, X., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Functional+outcomes+and+complications+following+B-TURP+versus+HoLEP+for+the+treatment+of+benign+prostatic+hyperplasia%3A+a+review+of+the+literature+and+Meta-analysis%5BTitle%5D)+AND+%22Aging+Male%22%5BJournal%5D)">Functional outcomes and complications following B-TURP versus HoLEP for the treatment of benign prostatic hyperplasia: a review of the literature and Meta-analysis.</a> Aging Male. 20 (3), 184-191 (2017).</li>
<li>Xu, H., Chen, Y. B., Gu, M., Chen, Q., Wang, Z. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Evaluation+of+noise+hazard+during+the+holmium+laser+enucleation+of+prostate%5BTitle%5D)+AND+%22BMC+Urol%22%5BJournal%5D)">Evaluation of noise hazard during the holmium laser enucleation of prostate.</a> BMC Urol. 17 (1), 71(2017).</li>
<li>Gilling, P. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Long-term+results+of+a+randomized+trial+comparing+holmium+laser+enucleation+of+the+prostate+and+transurethral+resection+of+the+prostate%3A+results+at+7+years%5BTitle%5D)+AND+%22BJU+Int%22%5BJournal%5D)">Long-term results of a randomized trial comparing holmium laser enucleation of the prostate and transurethral resection of the prostate: results at 7 years.</a> BJU Int. 109 (3), 408-411 (2012).</li>
</ol>

Esta pesquisa foi apoiada pela chave disciplinas grupo construção projeto de Pudong saúde Bureau de Shanghai (PWZxq2014-11), programa para excelente médica líder acadêmico e especial construção de integrado medicina tradicional chinesa e ocidental Wedicine no Hospital Geral de Shanghai (ZHYY-ZXYJHZX-1-03).

Neste protocolo, apresentamos um procedimento para o tratamento cirúrgico da HBP. HoLEP pode ser empregada na prática clínica diária. Como mencionado, o desenvolvimento da HPB cirurgia inclui três marcos. A primeira é a cirurgia aberta. Prostatectomia retropúbica e aberto prostatectomia suprapúbica extensivamente têm sido empregadas na prática clínica por um longo tempo. Apesar disso, a técnica envolve graves efeitos colaterais adversos, que são frequentemente observados durante o período perioperatório. E...

Hiperplasia prostática benigna (BPH), que é a hiperplasia da próstata, ocorre em homens idosos. Esta condição começa em aproximadamente 40 y velho e morbidade podem chegar a 50-60% para os homens na casa dos 60 e 80-90% para os homens em seus anos 70 e 801. BPH provoca obstrução progressiva, sintomas do trato urinário inferior, retenção e suas complicações e mesmo doença renal, que diminuir a qualidade de vida do homem idoso. Após a terapia médica, o tratamento cirúrgico é frequentemente usado como o tratamento mais eficiente para HPB sintomática.
Foram desenvolvidos vários tipos de cirurgia para tratar os sintomas da HBP, incluindo a primeira prostatectomia aberta introduzida em 18942 e cirurgia endoscópica transuretral (RTU), um século mais tarde. Desde o seu desenvolvimento, TURP tem sido considerado como o padrão ouro para aliviar cirurgicamente a ampliação da próstata.
O laser de hólmio opera no comprimento de onda de 2120 nm, que é similar do tecido água3, que induz a vaporização da água. Penetração de tecido atinge 0,4 mm, e coagulação também pode ser operada com ele. O processo foi introduzido pela primeira vez para HPB em 19944. Em 1998, Peter Gilling usado o dispositivo para executar Enucleação aplicação5. Como proposto por Peter Gilling et al. na década de 19904, Enucleação de laser de hólmio da próstata (HoLEP) é usada para tratar a HBP, combinando os dois tipos anteriores de cirurgia, incluindo a Enucleação aberta e a TURP4. Com o desenvolvimento do processo de hiperplasia, zona periférica prostática é cercaram pela zona de transição (TZ) para formar uma cápsula cirúrgica chamada. HoLEP permite a remoção da parte da próstata, o TZ, que separa a cápsula da próstata hiperplásica. Assim, HoLEP, como a cirurgia anatômica, pode enucleate a zona da próstata alargada da separação formada entre TZ e cápsula. HoLEP comparado com o método cirúrgico tradicional, pode ser mais seguro, mais eficiente e completa com resultados duráveis. Comparado com TURP, hólmio reduzido a duração, tempo de irrigação e tempo de cateter do procedimento e internação hospitalar encurtado. 6 , 7 , 8 a técnica também pode ser realizada com segurança em pacientes que estão em terapia anticoagulante ou com sangramento transtornos9. Apesar de existirem diferentes tipos de procedimentos para HoLEP, o principal procedimento é o mesmo como mencionado a seguir. Também apresentamos nossas próprias experiências e a inovação para este método para torná-lo mais fácil de aceitar e encurtar a curva de aprendizado. O procedimento é particularmente apropriado para grandes próstatas e aqueles combinados com pedras na bexiga, dado que o laser de hólmio também pode ser usado para litotripsia8. Este artigo apresenta esta técnica e o procedimento detalhado.

<table><tbody><tr><td>holmium laser</td><td>Lumenis, USA</td><td></td><td>PowerSuite 100W</td></tr><tr><td>mechanical morcellator</td><td>Lumenis, USA</td><td></td><td>VersaCut</td></tr><tr><td>27Fr continuous flow resectoscope</td><td>Storz, Tuttlingen, Germany</td><td></td><td></td></tr></tbody></table>

surgical treatment for benign prostatic hyperplasia: holmium laser enucleation of the prostate (holep).

Hiperplasia prostática benigna (BPH) comumente ocorre entre os homens idosos. A doença provoca sintomas do trato urinário inferior, reduzindo assim a qualidade de vida. BPH inclui 2 tratamentos principais: medicação e cirurgia. Tratamento cirúrgico geralmente é a intervenção mais eficaz e final. Enucleação de laser de hólmio da próstata (HoLEP), um dos procedimentos cirúrgicos mais eficientes para HPB, é conduzida por transurethrally. Durante a cirurgia, a parte mais importante e mais difícil é localizar a cápsula cirúrgica da próstata, que é consistente com a ideia de cirurgia anatômica. Diferentes habilidades podem ser necessários no tratamento de diferentes partes da próstata. HoLEP tende a ser eficiente e seguro, com boas propriedades hemostáticas, e capaz de tratar o cálculo de bexiga, que podem ser as complicações da HPB. A técnica é particularmente adequada para a próstata de volumes e tamanhos variados. Com efeito, HoLEP também apresenta alguns inconvenientes, como uma longa curva de aprendizado e equipamentos caros. Independentemente disso, esse método pode ser o "novo padrão" e o excelente método para o tratamento cirúrgico da HBP.

Dados retrospectivos, recolhidos entre 2015 e 2016, foram obtidos do banco de dados clínico de nosso departamento. Um total de 100 pacientes tratados para BPH foram incluídos no estudo. Os resultados peri-operatórios foram incluídos: tempo de operação (OT), diminuição da hemoglobina após a cirurgia, variação at+ , duração de estadia do hospital, duração de irrigação de bexiga e dados de seguimento. Características básicas do pacientes foram também coletadas ...

Watch this Scientific Journal Video about Surgical Treatment for Benign Prostatic Hyperplasia: Holmium Laser Enucleation of the Prostate HoLEP. at JoVE.com

Surgical Treatment for Benign Prostatic Hyperplasia: Holmium Laser Enucleation of the Prostate HoLEP.

Aqui nós apresentamos um protocolo seguro e eficiente, Enucleação de laser de hólmio da próstata, para tratar a hiperplasia benigna da próstata.

Tratamento cirúrgico para a hiperplasia prostática benigna: Holmium Laser Enucleação da próstata (HoLEP).

Benign prostatic hyperplasia (BPH) commonly occurs among elderly males. The condition causes symptoms in the lower urinary tract, thereby reducing the ...

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Surgical Treatment for Benign Prostatic Hyperplasia: Holmium Laser Enucleation of the Prostate (HoLEP).

16.9K visualizações.  Shanghai Jiaotong University School of Medicine. Aqui nós apresentamos um protocolo seguro e eficiente, Enucleação de laser de hólmio da próstata, para tratar a hiperplasia benigna da próstata.

Vídeo: Surgical Treatment for Benign Prostatic Hyperplasia: Holmium Laser Enucleation of the Prostate HoLEP.

Improved Protocol For Laser Microdissection Of Human Pancreatic Islets From Surgical Specimens

Laser microdissection (LMD) is a technique that allows the recovery of selected cells and tissues from minute amounts of parenchyma 1,2. The dissected cells can be used for a variety of investigations, such as transcriptomic or proteomic studies, DNA assessment or chromosomal analysis 2,3. An especially challenging application of LMD is transcriptome analysis, which, due to the lability of RNA 4, can be particularly prominent when cells are dissected from tissues that are rich of RNases, such as the pancreas. A microdissection protocol that enables fast identification and collection of target cells is essential in this setting in order to shorten the tissue handling time and, consequently, to ensure RNA preservation. 
Here we describe a protocol for acquiring human pancreatic beta cells from surgical specimens to be used for transcriptomic studies 5. Small pieces of pancreas of about 0.5-1 cm3 were cut from the healthy appearing margins of resected pancreas specimens, embedded in Tissue-Tek O.C.T. Compound, immediately frozen in chilled 2-Methylbutane, and stored at -80 &deg;C until sectioning. Forty serial sections of 10 &mu;m thickness were cut on a cryostat under a -20 &deg;C setting, transferred individually to glass slides, dried inside the cryostat for 1-2 min, and stored at -80 &deg;C. 
Immediately before the laser microdissection procedure, sections were fixed in ice cold, freshly prepared 70% ethanol for 30 sec, washed by 5-6 dips in ice cold DEPC-treated water, and dehydrated by two one-minute incubations in ice cold 100% ethanol followed by xylene (which is used for tissue dehydration) for 4 min; tissue sections were then air-dried afterwards for 3-5 min. Importantly, all steps, except the incubation in xylene, were performed using ice-cold reagents - a modification over a previously described protocol 6. utilization of ice cold reagents resulted in a pronounced increase of the intrinsic autofluorescence of beta cells, and facilitated their recognition. For microdissection, four sections were dehydrated each time: two were placed into a foil-wrapped 50 ml tube, to protect the tissue from moisture and bleaching; the remaining two were immediately microdissected. This procedure was performed using a PALM MicroBeam instrument (Zeiss) employing the Auto Laser Pressure Catapulting (AutoLPC) mode. The completion of beta cell/islet dissection from four cryosections required no longer than 40-60 min. Cells were collected into one AdhesiveCap and lysed with 10 &mu;l lysis buffer. Each single RNA specimen for transcriptomic analysis was obtained by combining 10 cell microdissected samples, followed by RNA extraction using the Pico Pure RNA Isolation Kit (Arcturus). This protocol improves the intrinsic autofluorescence of human beta cells, thus facilitating their rapid and accurate recognition and collection. Further improvement of this procedure could enable the dissection of phenotypically different beta cells, with possible implications for better understanding the changes associated with type 2 diabetes.

Laser microdissection is a technique that allows the recovery of selected cells from minute amounts of parenchyma. Here we describe a protocol for acquiring human pancreatic islets from surgical specimens to be used for transcriptomic studies. Our protocol improves the intrinsic autofluorescence of human beta cells, thus facilitating their collection.

Protocolo melhorado para microdissecção a laser de ilhotas pancreáticas humanas a partir de espécimes cirúrgicos

Laser microdissection (LMD) is a technique that allows the recovery of selected cells and tissues from minute amounts of parenchyma 1,2. The dissected ...

Medicina

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.

Renal Capsule xeno e subcutânea Pellet Implantação de Avaliação de próstata Carcinogênese e hiperplasia benigna da próstata

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

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.

Captura de Laser Microdissection de Próstata Humano Epithelium para Análise de RNA

The prostate gland contains a heterogeneous milieu of stromal, epithelial, neuroendocrine and immune cell types.  Healthy prostate is comprised of ...

Murine Prostate Micro-dissection and Surgical Castration

Mouse models are used extensively to study prostate cancer and other diseases. The mouse is an excellent model with which to study the prostate and has been used as a surrogate for discoveries in human prostate development and disease. Prostate micro-dissection allows consistent study of lobe-specific prostate anatomy, histology, and cellular characteristics in the absence of contamination of other tissues. Testosterone affects prostate development and disease. Androgen deprivation therapy is a common treatment for prostate cancer patients, but many prostate tumors become castration-resistant. Surgical castration of mouse models allows for the study of castration resistance and other facets of hormonal biology on the prostate. This procedure can be coupled with testosterone reintroduction, or hormonal regeneration of the prostate, a powerful method to study stem cell lineages in the prostate. Together, prostate micro-dissection and surgical castration opens up a multitude of opportunities for robust and consistent research of prostate development and disease. This manuscript describes the protocols for prostate micro-dissection and surgical castration in the laboratory mouse.

This manuscript describes the protocols for prostate micro-dissection and surgical castration in the laboratory mouse. We also depict representative results produced by these protocols. Finally, we discuss the advantages and utilization of these protocols.

Murino próstata Micro-dissecção e castração cirúrgica

Mouse models are used extensively to study prostate cancer and other diseases. The mouse is an excellent model with which to study the prostate and has ...

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.

Análise de Redes de forame oval Eletrodo Recordings na epilepsia do lobo temporal Os pacientes resistentes a drogas

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.

Transcanalicular diodo Laser-assisted Dacryocystorhinostomy para o tratamento da primária adquiriu a obstrução do ducto Nasolacrimal

Today&#39;s gold standard in the treatment of infrasaccal primary acquired nasolacrimal duct obstruction (PANDO) is external dacryocystorhinostomy (DCR), ...

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.

Photoselective Vaporesection da próstata através de um acionamento do fim de lítio Triborate cristal 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 ...

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.

Enucleação da próstata para o tratamento da hiperplasia benigna da próstata usando um laser de diodo de 980 nm

In the aging male population, the occurrence of lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) is a common problem. ...

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.

Ablação focal a laser do câncer de próstata: um procedimento de escritório

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

Vesiculoscópio seminal Cirurgia assistida por laser para tratar o bloqueio do ducto ejaculatório

Treatment of Ejaculatory Duct Obstruction by Seminal Vesiculoscopy Assisted Flow Modification

Transurethral resection of ejaculatory duct (TURED) is a primary surgical approach to treat ejaculatory duct obstruction (EDO) caused by the ejaculatory duct cyst. Intraoperative excision of the verumontanum is usually required to expose the ejaculatory ducts. However, preserving the verumontanum structure allows for a better simulation of normal physiological anatomy. Maintaining the verumontanum may increase the risk of postoperative distal ejaculatory duct scarring, leading to recurrent obstruction or reduced semen volume. Therefore, we attempted a novel technique that preserves the verumontanum, which is relatively easier and safer compared to TURED. The following were the procedural steps: 1. A 6F seminal vesiculoscope was introduced through the external urethral orifice to the vicinity of the verumontanum, locating the opening of the affected-side ejaculatory duct and introducing a guidewire into the cyst. This successful step preserved the verumontanum, maximizing the retention of the anti-reflux mechanism in the distal ejaculatory duct. 2. The holmium laser enlarged the affected-side ejaculatory duct opening to 5 mm, decreasing the likelihood of postoperative closure of the ejaculatory duct opening and simplifying the procedure. 3. A window was created within the cyst to access the contralateral seminal vesicle, and then a holmium laser was used to burn and dilate the opening to 5 mm, redirecting the contralateral ejaculatory duct into the cystic cavity. This modification preserved the opening of the healthy-side ejaculatory duct and provided a new outflow passage for semen, reducing the risk of decreased semen volume postoperatively. The patients experienced no complications postoperatively, had shorter hospital stays, and showed improvement in semen volume. Hence, this surgical approach is simple yet effective.

Autor em destaque: Tratamento avançado do bloqueio do ducto seminal empregando refluviação do canal de sêmen mediada por endoscopia 

This protocol introduces the clinical application of seminal vesicle endoscopy combined with holmium laser in the treatment of ejaculatory duct obstruction caused by ejaculatory duct cyst.

Tratamento da Obstrução do Ducto Ejaculatório por Vesiculoscopia Seminal Modificação do Fluxo Assistido

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

Tratamento cirúrgico para a hiperplasia prostática benigna: Holmium Laser Enucleação da próstata (HoLEP).

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