Os autores gostariam de agradecer o apoio do Programa Nacional de Pesquisa e Desenvolvimento da China (Grant 2017YFC840102).

Todos os métodos descritos aqui foram aprovados pelo comitê de ética do Hospital de Pequim. As indicações para cirurgia estão de acordo com as diretrizes da Associação Europeia de Urologia para LUTS masculinos não neurogênicos. As contraindicações incluem suspeita de câncer de próstata ou disfunção do detrusor.
1. Instrumentos de operação
<ol><li>Garanta a disponibilidade de equipamentos de laser de diodo (980 nm) com potência incluindo modo contínuo (80-100 W).</li>
	<li>Empregue uma fibra de laser e solução salina a 0,9% para irrigação intraoperatória da bexiga.</li>
	<li>Use um ressectoscópio a laser 26 F para obter uma boa visualização e aumentar a eficiência.</li>
</ol>2. Preparação para a operação
<ol><li>Realize a preparação da pele no dia da operação.</li>
	<li>Fornecer um antibiótico intravenoso no pré-operatório a todos os pacientes10. NOTA: A cefuroxima sódica (1,5 g em 100 mL de cloreto de sódio a 0,9%) é fornecida 30 minutos antes da operação.</li>
	<li>Antes da anestesia, faça o paciente deitar na mesa de operação. NOTA: A anestesia geral é eficaz e apropriada para esta operação. Os anestesistas devem determinar o modo de anestesia dependendo do estado geral do paciente.</li>
	<li>Cubra o paciente de forma estéril na posição de litotomia dorsal.</li>
</ol>3. Etapas do procedimento
<ol><li>Observação<ol><li>Observe diretamente a uretra, verumontano, colo vesical, orifícios ureterais, mucosa vesical e hiperplasia trabecular por ressectoscópio (15-30°).</li>
	</ol></li>
	<li>Projete a faixa de enucleação (seta do Cupido).<ol><li>Incise circularmente (profundidade da glândula, largura de cerca de 3-4 mm) a mucosa do colo da bexiga com um laser (Figura 1).</li>
		<li>Incise circularmente (profundidade da glândula, largura de cerca de 3-4 mm) a mucosa da uretra prostática na extremidade proximal do verumontano com um laser (Figura 2). NOTA: Confirme a marca anatômica antes da incisão para evitar lesões da mucosa do colo da bexiga e da uretra do esfíncter. Use uma potência de laser de 80-100 W durante a operação, exceto para hemostasia.</li>
		<li>Conecte os círculos concêntricos do colo da bexiga e o ápice da próstata na uretra posterior na posição de 12 horas.</li>
		<li>Incisar o lobo esquerdo e o lobo direito com o laser (Figura 3). NOTA: Uma vez que a posição de 12 horas da uretra posterior é pré-incisada, mantenha a mucosa distal. Os círculos concêntricos formados no colo da bexiga e no ápice da próstata são chamados de flechas de Cupido.</li>
	</ol></li>
	<li>Fazendo um canal<ol><li>Encontre a cápsula cirúrgica nas posições de 5 e 7 horas do ápice da próstata.</li>
		<li>Encontre a cápsula cirúrgica nas posições da cápsula cirúrgica de 5 e 7 horas.</li>
		<li>Conecte as posições da cápsula cirúrgica de 5 e 7 horas com um laser (Figura 4).</li>
		<li>Na posição de 6 horas do ápice da próstata, separe o lobo mediano da cápsula cirúrgica do ápice da próstata até o colo da bexiga com um laser (Figura 5). NOTA: Se o volume da próstata for de >80 mL, os lobos mediano e lateral serão completamente separados nas posições de 5 e 7 horas do ápice da próstata.</li>
	</ol></li>
	<li>Enucleação dos lobos esquerdo e direito<ol><li>No sentido anti-horário, enuclear o lobo direito às 6 e 12 horas do ápice da próstata até o colo da bexiga com um ressectoscópio (Figura 6).</li>
		<li>No sentido horário, enuclear o lobo esquerdo às 6 e 12 horas do ápice da próstata até o colo da bexiga (Figura 7).</li>
		<li>Empurre todas as glândulas para dentro da bexiga após a enucleação. NOTA: Se o volume da próstata for >80 mL, enuclear os lobos mediano e lateral na sequência adequada; Em seguida, empurre para dentro da bexiga.</li>
	</ol></li>
	<li>Hemostasia<ol><li>Use uma potência de laser mais baixa (50 W) para parar o sangramento ao redor do local da cirurgia. Mantenha uma distância adequada (ou seja, 1-3 mm).</li>
	</ol></li>
	<li>Morcelar o tecido da próstata.<ol><li>Morcelar o tecido prostático enucleado em pequenos pedaços (o menor possível) com um morcelador e, em seguida, remover o tecido da bexiga (Figura 8).</li>
	</ol></li>
	<li>Cateterismo<ol><li>Remova o morcelador da uretra.</li>
		<li>Coloque suavemente um cateter Foley 22 F através do orifício uretral na cavidade da bexiga com 30 mL de água no balão após lubrificar suficientemente a uretra com gel de lidocaína.</li>
	</ol></li>
	<li>Cuidados pós-operatórios10<ol><li>Deixe o paciente deitar na cama por aproximadamente 3 h no pós-operatório na unidade de atendimento até que ele acorde completamente da anestesia. Certifique-se de que os monitores do paciente e o oxigênio médico estejam disponíveis durante esse período.</li>
		<li>Assim que o paciente acordar completamente, devolva-o à enfermaria. Deixe o paciente começar a beber um pouco de água e comer um pouco de comida. Registre qualquer débito de urina e preste atenção à cor da urina.</li>
	</ol></li>
</ol>

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S., Hsieh, C. H., Lee, Y. S., Chang, S. 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M., Pimentel, M. A., Gilling, P. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+Review+of+Laser+Treatment+for+Symptomatic+BPH+(Benign+Prostatic+Hyperplasia).">A Review of Laser Treatment for Symptomatic BPH (Benign Prostatic Hyperplasia).</a> Current Urology Reports. 17 (6), 1-8 (2016).</li><li>Cho, M. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Predictor+of+de+novo+urinary+incontinence+following+holmium+laser+enucleation+of+the+prostate.">Predictor of de novo urinary incontinence following holmium laser enucleation of the prostate.</a> Neurourology, Urodynamics. 30 (7), 1343-1349 (2011).</li><li>Herrmann, T. 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Os autores não têm nada a divulgar.

Atualmente, o laser de diodo de 980 mm está começando a ser usado para o tratamento da HBP5. Poucos relatos descreveram estudos clínicos relacionados. Em comparação com o efeito da RTUP no tratamento da HBP, muitos estudos mostraram que o DiLEP causa menos perda sanguínea, atinge melhor função urinária e tem menor tempo de retenção do cateter 9,13,14,15.
<...

Em comparação com a ressecção transuretral tradicional da próstata (RTU), as cirurgias a laser tornaram-se gradualmente mais populares devido à sua melhor tolerância do paciente, menores quantidades de perda sanguínea intraoperatória, eficácia e menor recuperação pós-operatória 4,5.
Nos últimos anos, as técnicas de crescimento mais rápido envolveram o uso de lasers de vários comprimentos de onda. Atualmente, muitos tipos de lasers com características diferentes podem ser usados para completar a enucleação da próstata. Desde que o laser de diodo foi aprovado pelo FDA dos EUA para hiperplasia prostática em 2007, seu uso tem aumentado gradativamente no tratamento da HPB devido à sua excelente capacidade de corte e efeito de hemostasia6. O comprimento de onda do laser determina o grau de absorção pela água e hemoglobina. Um laser de diodo com comprimento de onda de 980 nm fornece a maior taxa de absorção combinada de água e hemoglobina. A capacidade de penetração do tecido é de 0,5 mm, e pode produzir efeitos de coagulação em tecidos mais profundos, o que faz com que tenha uma capacidade de ablação e hemostasia tecidual muito boa 7,8.
Muitos centros de pesquisa começaram a usar o DiLEP para o tratamento da hiperplasia prostática benigna. Na prática, o DiLEP tradicional tem uma curva de aprendizado mais longa e não apresenta vantagens óbvias relacionadas à proteção do esfíncter urinário9. Com base nas razões acima, o DiLEP tradicional foi modificado em nosso centro para melhorar o valor do tratamento com laser de diodo em pacientes com HBP.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>HU Diode Laser</td>
			<td>Beijing L.H.H.Medical Science Development Co., Ltd</td>
			<td>HU-150</td>
			<td>Wavelength: 980nm 
			Maximum Power: 150W 
			Operation Mode: Continuous and pulsed</td>
		</tr>
		<tr>
			<td>Optical Fiber</td>
			<td>Beijing L.H.H.Medical Science Development Co., Ltd</td>
			<td>YYGX600</td>
			<td>Fiber core diameter: 
			600 &#956;m 
			Fiber length: 2m</td>
		</tr>
		<tr>
			<td>Morcellator System</td>
			<td>Beijing L.H.H.Medical Science Development Co., Ltd</td>
			<td>PXQ-01</td>
			<td>Rotate Speed: 100-3000rpm 
			MAX. Vacuum Pressure: -80KPa 
			Rated Output Torque: 12mNm 
			Blade Size: &#934;5.0*390mm; &#934;3.5*390mm 
			Blade Work Mode: Corotation alternates reversal</td>
		</tr>
	</tbody>
</table>

enucleation of the prostate for the treatment of benign prostatic hyperplasia using a 980 nm diode laser

Na população masculina idosa, a ocorrência de sintomas do trato urinário inferior (LUTS) causados por hiperplasia prostática benigna (HPB) é um problema comum. Aqui, apresentamos uma nova técnica chamada enucleação com laser de diodo de 980 nm (DiLEP) para tratar a HBP1. Os lasers de diodo podem absorver água e hemoglobina ao mesmo tempo, por isso são bons para corte e hemostasia2. O laser de diodo foi aprovado pelo FDA em 2007 e tem sido usado no tratamento da HPB devido ao seu efeito eficaz de corte e hemostasia3. O DiLEP apresenta várias vantagens em relação a outras técnicas, como TURP, HoLEP e PVP. Durante o procedimento, definimos o limite de uma próstata de alto volume e a separamos em três lóbulos com um laser de diodo, queimando dois anéis e um sulco (como uma flecha de Cupido). Em comparação com outros procedimentos, o mDiLEP tem menos complicações intraoperatórias, uma curva de aprendizado mais curta e alcança mais ressecção tecidual.

Um total de 40 pacientes com HBP submetidos a DiLEP foram incluídos em um de nossos estudos. Um teste t de amostra independente foi usado como método estatístico. Todos os pacientes concluíram a operação com sucesso. Quase todos os pacientes tiveram o cateter removido em até 5 dias de pós-operatório (Tabela 1). Todos os pacientes retornaram ao hospital para exames de acompanhamento no1º,3º e 12º meses de pós-operatório. As fe...

Watch this Scientific Journal Video about Enucleation of the Prostate for the Treatment of Benign Prostatic Hyperplasia Using a 980 nm Diode Laser at JoVE.com

Enucleation of the Prostate for the Treatment of Benign Prostatic Hyperplasia Using a 980 nm Diode Laser

Aqui, apresentamos um protocolo para enucleação modificada de laser de diodo de 980 nm para tratar hiperplasia prostática benigna de grande volume.

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. ...

enucleation-prostate-for-treatment-benign-prostatic-hyperplasia-using

Research

JoVE Journal

Medicine

2.0K visualizações.  Beijing Hospital. Aqui, apresentamos um protocolo para enucleação modificada de laser de diodo de 980 nm para tratar hiperplasia prostática benigna de grande volume.

Vídeo: Enucleation of the Prostate for the Treatment of Benign Prostatic Hyperplasia Using a 980 nm Diode Laser

Renal Capsule Xenografting and Subcutaneous Pellet Implantation for the Evaluation of Prostate Carcinogenesis and Benign Prostatic Hyperplasia

New therapies for two common prostate diseases, prostate cancer (PrCa) and benign prostatic hyperplasia (BPH), depend critically on experiments evaluating their hormonal regulation. Sex steroid hormones (notably androgens and estrogens) are important in PrCa and BPH; we probe their respective roles in inducing prostate growth and carcinogenesis in mice with experiments using compressed hormone pellets. Hormone and/or drug pellets are easily manufactured with a pellet press, and surgically implanted into the subcutaneous tissue of the male mouse host. We also describe a protocol for the evaluation of hormonal carcinogenesis by combining subcutaneous hormone pellet implantation with xenografting of prostate cell recombinants under the renal capsule of immunocompromised mice. Moreover, subcutaneous hormone pellet implantation, in combination with renal capsule xenografting of BPH tissue, is useful to better understand hormonal regulation of benign prostate growth, and to test new therapies targeting sex steroid hormone pathways.

We describe the manufacture of compressed hormone pellets, as well as subcutaneous surgical implantation into mice. This strategy can be combined with the growth of cell and tissue xenografts under the renal capsule of athymic nude mice to evaluate hormonal carcinogenesis and regulation of benign prostate growth.

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 ...

Medicina

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 ...

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), ...

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

Benign prostatic hyperplasia (BPH) commonly occurs among elderly males. The condition causes symptoms in the lower urinary tract, thereby reducing the quality of life. BPH includes 2 major treatments: medication and surgery. Surgical treatment is often the most effective and final intervention. Holmium laser enucleation of the prostate (HoLEP), one of the most efficient surgical procedures for BPH, is conducted transurethrally. During surgery, the most important and most difficult part is to locate the surgical capsule of the prostate, which is consistent to the idea of anatomic surgery. Different skills may be needed in treating different parts of the prostate. HoLEP tends to be efficient and safe with good hemostatic properties, and able to treat bladder calculus, which may be the complications of BPH. The technique is particularly suitable for prostate of varying volumes and sizes. Indeed, HoLEP also presents certain disadvantages, such as a long learning curve and costly equipment. Regardless, this method may be the "new standard" and the excellent method for the surgical treatment of BPH.

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

Here we present a safe and efficient protocol, holmium laser enucleation of the prostate, to treat benign prostatic hyperplasia.

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 ...

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 ...

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

In mares, endometrial cysts are associated with endometriosis and can cause maternal recognition failure or compromise and delay pregnancy diagnoses. Historical treatments were invasive and had adverse effects on the endometrium. Hysteroscopically guided laser therapy is easy and effective for endometrial cysts resection, with no deleterious effects for the endometrium.
A 110 cm long and 1.0 cm wide endoscope is sterilely introduced in the uterus through the open cervix of an estrous mare after vulvar cleaning. The uterus is slowly infused with less than 1 L of physiologic solution and the laser fiber is inserted in the biopsy canal of the endoscope. Cysts are then cauterized with the 980 nm diode laser with a contact fiber set at 20&#8210;2 5W in continuous mode. Each cyst is punctured&#160;until complete voiding of the cyst and shrinking of the cyst wall around the fiber. Uterine lavages with sterile saline solution are performed directly after the surgery and for one or two days as non-inflammatory fluid can be observed.
This procedure is easy and quickly performed, with no obvious deleterious effects. Cysts resection makes ultrasound pregnancy diagnosis easier and, in some cases, could restore proper embryo migration in the uterine horns between day 6.5 and 17. However, this treatment does not improve the underlying histological lesions related to endometriosis. These considerations should be clearly expressed to the breeder before this procedure.

The aim of this report is to describe the photoablation of endometrial cysts in the mare using an endoscopic laser device, and to discuss the interest and limitations of this new approach to deal with low fertility issues.

Fotoablação Guiada de Endoscopia de Cistos Endometrial usando um Laser de 980 nm com uma fibra de contato em Mares

In mares, endometrial cysts are associated with endometriosis and can cause maternal recognition failure or compromise and delay pregnancy diagnoses. ...

Focal Laser Ablation of Prostate Cancer: An Office Procedure

In this article, we describe and illustrate an outpatient procedure for focal laser ablation (FLA) of prostate cancer (PCa). The procedure is conceptually similar to a fusion biopsy and is performed under local anesthesia in a clinic setting; treatment time is usually less than one hour. Laser insertion is guided by ultrasound; lesion targeting is via magnetic resonance imaging-ultrasound (MRI/US) fusion, as in targeted prostate biopsy. Real-time ablation monitoring is achieved utilizing a thermal probe adjacent to the laser fiber. The video demonstrates procedure planning, patient preparation, various steps during the procedure, and treatment monitoring. Safety, feasibility, and efficacy of this approach have been established during a previous trial. Outpatient FLA under local anesthesia is an option for management of intermediate risk prostate cancer.

This article presents and describes an outpatient treatment for prostate cancer using focal laser ablation. Laser catheter placement is guided by MRI-ultrasound fusion imaging in a fashion similar to prostate needle biopsy. Treatment is monitored in real-time with a thermal probe, placed adjacent to the laser fiber.

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 ...

Adjunctive Diode Laser Therapy and Probiotic Lactobacillus Therapy in the Treatment of Periodontitis and Peri-Implant Disease

Periodontal and peri-implant diseases are plaque-induced infections with a high prevalence, seriously impairing people&#39;s quality of life. The diode laser has long been recommended as adjunctive therapy in treating periodontitis. However, the optimal combination of usage mode (inside or outside periodontal pocket) and application regimen (single or multiple sessions of appointment) has not been described in detail. Meanwhile, probiotic Lactobacillus is regarded as a potential adjuvant in the management of the peri-implant disease. Nonetheless, a detailed protocol for an effective probiotic application is lacking. This article aims to summarize two clinical protocols. For periodontitis, the optimal collaboration of laser usage mode and application regimen was identified. Regarding peri-implant mucositis, a combined therapy containing professional topical use and home administration of probiotic Lactobacillus was established. This updated laser protocol clarifies the relationship between the treatment mode (inside or outside the periodontal pocket) and the number of laser appointments, further refining the existing diode laser therapy. For inside pocket irradiation, a single session of laser treatment is suggested whereas, for outside pocket irradiation, multiple sessions of laser treatment provide better effects. The improved probiotic Lactobacillus therapy resulted in the disappearance of swelling of the peri-implant mucosa, a reduced bleeding on probing (BOP), and an obvious reduction and good control of plaque and pigmentation; however, probing pocket depth (PPD) had limited improvement. The current protocol should be regarded as preliminary and could be further enhanced.

Adjunctive Diode Laser Therapy and Probiotic Lactobacillus Therapy in the Treatment of Periodontitis and Peri-Implant Disease

This article describes two protocols: 1) adjunctive diode laser therapy for treating periodontitis and 2) probiotic Lactobacillus therapy for treating peri-implant disease, with emphasis on the laser usage mode (inside or outside pocket), laser application regimen (single or multiple sessions), and a probiotic protocol of professional and home administration.

Terapia a Laser com Diodo Adjuvante e Terapia Probiótica de Lactobacilos no Tratamento de Periodontite e Doença Peri-Implante

Periodontal and peri-implant diseases are plaque-induced infections with a high prevalence, seriously impairing people&#39;s quality of life. The diode ...

Laparoscopic Duodenum-Preserving Pancreatic Head Resection via Inferior Infracolic Approach: A Surgical Approach for Benign Lesions

Minimally invasive pancreatic resections are gaining popularity despite being technically demanding. However, in contrast to laparoscopic pancreatoduodenectomy (LPD), laparoscopic duodenum-preserving pancreatic head resection (LDPPHR) has not yet obtained wide acceptance. This could be attributed to the technical challenges involved in preserving the blood supply of the duodenum and bile duct.
This study describes and demonstrates all the steps of LDPPHR. A 48-year-old woman was diagnosed with a 3.0 cm x 2.5 cm pancreatic head cystic mass, which was detected unexpectedly. The surgery was performed using the 3D laparoscopy via an inferior infracolic approach. The operation lasted approximately 310 min with 100 mL of blood loss. Postoperatively, the patient experienced no complications and was discharged 5 days later. Pathology revealed intraductal papillary mucinous neoplasms.
LDPPHR via an inferior infracolic approach is feasible and safe when performed by experienced surgeons in selected patients with thin mesenteric fat layers. The described technique for LDPPHR via inferior infracolic approach should be well standardized and performed at high-volume centers with experienced surgeons in both open and laparoscopic pancreatology.

This article provides a whole technical process of laparoscopic duodenum-preserving pancreatic head resection via an inferior infracolic approach. This is a surgical approach for benign tumors without intraoperative fluorescence image guidance.