Os autores gostariam de agradecer ao Sr. Pascal Lejeune por seu apoio técnico durante todos os procedimentos.

O protocolo apresentado é utilizado para éguas apresentadas no hospital equino e segue as diretrizes institucionais de cuidados com os animais.
NOTA: Realizar fotoablação de cistos endometrial antes do anestrus: os calores observados no final de julho ou agosto parecem, portanto, mais confiáveis. Não realize este procedimento tarde demais na estação de reprodução, pois pode limitar o número de estruses disponíveis para tratar uma endometrite potencial.
1. Durante as estrus anteriores
<ol><li>Realize um exame completo de solidez de reprodução da égua, incluindo uma biópsia endometrial1 (não descrita aqui) para garantir que a égua possa potencialmente engravidar após o procedimento.</li>
	<li>Em caso de má biópsia endometrial de acordo com a classificação1de Kenney, dê a transferência de embrião ou a injeção intra citoplasmática de espermatozoides (ICSI) preferência sobre a fotoabalização dos cistos endometrial.</li>
</ol>2. Durante o diestrus anterior
<ol><li>Uma vez que o reto esteja vazio, conte, meça e mapeie cistos endometrial da égua no útero usando ultrassonografia trans-retal guiada pela palpação retal com uma sonda retatal linear de 7,5 ou 5 MHz e pinças na tela(Figura 3) em um estoque de contenção.</li>
	<li>Administrar 250 μg de cloprostenol intra-muscularmente para induzir estrus dentro de 2 ou 3 dias após o dia 6\u20127 pós-ovulação.</li>
	<li>Diariamente, realizam ultrassonografia de rotina comum e palpação do colo do útero para observar sinais de estrus, incluindo edema endometrial significativo, folículo antral de 35 mm e colo uterino suavizado e aberto.</li>
</ol>3. Preparação quando a égua está no calor
<ol><li>Restringir o acesso à sala de operação para pessoas que usam óculos de proteção ocular.</li>
	<li>Após o esvaziamento do reto, enrole a cauda e limpe a vulva asepticamente usando iodo-povidone.</li>
	<li>Para garantir fácil manipulação e conforto da égua, administre a detomidina (10 μg/kg) e o butorphanol (0,1 mg/kg) por via intravenosa na veia jugular com uma agulha de 21 G.</li>
	<li>Por vagina, instale o cateter de coleta de embriões através do colo uterino e insuflar o balão com 40 mL de ar.</li>
	<li>Infundir o útero com 1,5 L de solução salina estéril (0,9% NaCl) para inflar o útero.</li>
	<li>Esvazie o balão e remova o cateter.</li>
	<li>Passe o endoscópio asepticamente através do colo uterino dentro de uma manga estéril.</li>
</ol>4. Técnica
<ol><li>Conecte a fibra de quartzo de 600 μm a um laser de diodo operando a 980 nm. Defina a potência em 20\u201225 W em modo contínuo.</li>
	<li>Passe a fibra de quartzo flexível através do canal de biópsia de um vídeo-endoscópio de 10 mm de diâmetro até que 3\u20124 cm de fibra livre possam ser identificados na tela. Um mínimo de 10 mm a partir da extremidade da fibra deve ser visível.</li>
	<li>Ative o laser para perfurar o cisto idealmente em seu ápice: um pedal dedicado está disponível no dispositivo para manter as mãos livres. Em alguns casos, múltiplas perfurações em vários locais são necessárias para alcançar a anulação completa do cisto. O fluido cístico é passivamente drenado para dentro do útero.</li>
	<li>Depois que o revestimento do cisto entrou em colapso ao redor da fibra, implante o laser até que a membrana encole.</li>
	<li>Realize a ultrassonografia transretal do útero quantas vezes for necessário durante o procedimento para confirmar que cistos endometrial desapareceram.</li>
</ol>5. Tratamentos pós-operatórios
<ol><li>Administrou o tratamento geral com antibióticos: 22.000 UI/kg penicilina-procaina suspensão, intra-muscular, duas vezes por dia, durante 3 dias.</li>
	<li>Logo após a intervenção, realize lavage uterino conforme descrito acima (ver passos 3.4-3.6).<ol>
<li>Colete o líquido infundido no útero antes do procedimento endoscópico através de um cateter algemado estéril.</li>
		<li>Lave o útero com sucessivas instilações de 1 L solução isotônica estéril (0,9% NaCl) até que um líquido claro seja coletado.</li>
		<li>Ao final do procedimento, administre 20 UI de ocitocina por via intravenosa.</li>
		<li>Realize a ultrassonografia transretal do útero da égua no dia seguinte: o líquido livre intraluminal é frequentemente observado (ver passo 2.1).</li>
	</ol>
</li>
	<li>Desde que o fluido intra-luminal livre seja observado pela ultrassonografia transretal e até o fim do calor, realize lavages uterinos diariamente com o procedimento descrito acima (etapas 3.4-3.6). Às vezes, o líquido manchado de soro, límpido e amarelo é coletado por vários dias. NOTA: Dar repetidas injeções intra-musculares de ocitocina (20 UI) a cada 4h ou menos quando a égua está em estrus pode evitar o acúmulo de fluidos e reduzir o risco de contaminação bacteriana no útero.</li>
	<li>Realizar ultrassonografia uterina trans-retal durante os seguintes diestrus para confirmar o desaparecimento de cistos endometrial e a ausência de fluido livre intraluminal. NOTA: Se for observado fluido intraluminal livre, recomenda-se a injeção de prostaglandina para induzir um novo estrus, diagnosticar uma eventual endometrite subsequente e tratá-la.</li>
</ol>

<ol>
	<li>Kenney, R. M., Ganjam, V. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Selected+pathological+changes+of+the+mare+uterus+and+ovary.">Selected pathological changes of the mare uterus and ovary.</a> Journal of Reproduction and Fertility. (23), 335-339 (1975).</li><li>Bracher, V., Mathias, S., Allen, W. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Videoendoscopic+evaluation+of+the+mare's+uterus:+II.+Findings+in+subfertile+mares.">Videoendoscopic evaluation of the mare's uterus: II. Findings in subfertile mares.</a> Equine Veterinary Journal. 24 (4), 279-284 (1992).</li><li>Kaspar, B., Kahn, W., Laging, C., Leidl, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endometrial+cysts+in+the+mare.+1.+Post-mortem+studies:+occurrence+and+morphology.">Endometrial cysts in the mare. 1. Post-mortem studies: occurrence and morphology.</a> Tier&#228;rztliche Praxis. 15 (2), 161-166 (1987).</li><li>Leidl, W., Kaspar, B., Kahn, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endometrial+cysts+in+the+mare.+2.+Clinical+studies:+occurrence+and+significance.">Endometrial cysts in the mare. 2. Clinical studies: occurrence and significance.</a> Tier&#228;rztliche Praxis. 15 (3), 281-289 (1987).</li><li>Mather, E. C., Refsal, K. R., Gustafsson, B. K., Seguin, B. E., Whitmore, H. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+use+of+fibre-optic+techniques+in+clinical+diagnosis+and+visual+assessment+of+experimental+intrauterine+therapy+in+mares.">The use of fibre-optic techniques in clinical diagnosis and visual assessment of experimental intrauterine therapy in mares.</a> Journal of Reproduction and Fertility. (27), 293-297 (1979).</li><li>Stanton, M. E., Mc Kinnon, A. O., Squires, E. L., Vaala, W. E., Varner, D. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Equine Reproduction Vol. 2. , 2665-2668 (2011).</li><li>Bracher, V., Mathias, S., Allen, W. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Influence+of+chronic+degenerative+endometritis+(endometrosis)+on+placental+development+in+the+mare.">Influence of chronic degenerative endometritis (endometrosis) on placental development in the mare.</a> Equine Veterinary Journal. 28 (3), 180-188 (1996).</li><li>Tannus, R. J., Thun, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Influence+of+endometrial+cysts+on+conception+rate+of+mares.">Influence of endometrial cysts on conception rate of mares.</a> Zentralbl Veterinarmed A. 42 (4), 275-283 (1995).</li><li>Pipers, F. S., Zent, W., Holder, R., Asbury, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ultrasonography+as+an+adjunct+to+pregnancy+assessments+in+the+mare.">Ultrasonography as an adjunct to pregnancy assessments in the mare.</a> Journal of the American Veterinary Medical Association. 184 (3), 328-334 (1984).</li><li>LeBlanc, M., Mc Kinnon, A. O., Mc Kinnon, A. O., Squires, E. L., Vaala, W. E., Varner, D. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Equine Reproduction Vol. 2. , 2620-2642 (2011).</li><li>van Ittersum, A. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+electrosurgical+treatment+of+endometrial+cysts+in+the+mare.">The electrosurgical treatment of endometrial cysts in the mare.</a> Tijdschr Diergeneeskd. 124 (21), 630-633 (1999).</li><li>Rambags, B. P., Stout, T. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transcervical+endoscope-guided+emptying+of+a+transmural+uterine+cyst+in+a+mare.">Transcervical endoscope-guided emptying of a transmural uterine cyst in a mare.</a> Vet Record. 156 (21), 679-682 (2005).</li><li>Blikslager, A. T., Tate, L. P., Weinstock, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effects+of+neodymium:yttrium+aluminum+garnet+laser+irradiation+on+endometrium+and+on+endometrial+cysts+in+six+mares.">Effects of neodymium:yttrium aluminum garnet laser irradiation on endometrium and on endometrial cysts in six mares.</a> Veterinary Surgery. 22 (5), 351-356 (1993).</li><li>Bartmann, C. P., Stief, B., Schoon, H. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Thermal+injury+and+wound+healing+of+the+endometrium+subsequent+to+minimally+invasive+transendoscopic+use+of+Nd:YAG-laser-and+electrosurgery+in+horses.">Thermal injury and wound healing of the endometrium subsequent to minimally invasive transendoscopic use of Nd:YAG-laser-and electrosurgery in horses.</a> Dtsch Tierarztl Wochenschr. 110 (7), 271-280 (2003).</li><li>Conley, A. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Review+of+the+reproductive+endocrinology+of+the+pregnant+and+parturient+mare.">Review of the reproductive endocrinology of the pregnant and parturient mare.</a> Theriogenology. 86 (1), 355-365 (2016).</li><li>Guzeloglu, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Expression+of+enzymes+and+receptors+of+leukotriene+pathway+genes+in+equine+endometrium+during+the+estrous+cycle+and+early+pregnancy.">Expression of enzymes and receptors of leukotriene pathway genes in equine endometrium during the estrous cycle and early pregnancy.</a> Theriogenology. 80 (2), 145-152 (2013).</li><li>Senger, P. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Pathways to pregnancy and parturition, 3rd edn. , (2015).</li></ol>

Todos os autores são totalmente empregados pela Clínica Equina da Universidade liège e não têm conflitos de interesse com qualquer empresa negociando um dos produtos mencionados acima.

A histeroscopia e a fotoablação a laser dos cistos endometrial é um procedimento fácil para reduzir grandes cistos intra-luminais na égua, como sugerido anteriormente14. Tecnicamente, este método é melhorado quando realizado em uma égua em estrus. Inflar o útero com solução salina estéril melhorou a visibilidade quando comparado ao enchimento do ar e à aspiração contínua durante a realização do procedimento.  Pequenos cistos intra parietais (<10 mm) são mais difíceis de alcan?...

Cistos endometrial em éguas foram histopatológicos descritos nos anos 70 por Kenney1. No final dos anos 80, o uso de histeroscopia e ultrassonografia levou à sua descrição clínica e ajudou a entender suas consequências sobre a fertilidade2,3,4,5.
Nos estágios iniciais, os cistos endometrial têm sido associados a uma degeneração do endométrio agora chamado de endometrose1,3,4,6,7,8 e atualmente é aceito que pequenos cistos (<1 cm) estão relacionados à fibrose endometrial das glândulas quando cistos maiores estão relacionados à dilatação linfática6 . Esses cistos grandes são os mais propensos a perturbar a migração de embriões equinos entre o dia 6,5 e o dia 17, diminuindo assim a fertilidade ao prejudicar o reconhecimento materno1,3,4,6,8. Cistos endometrial também podem interferir no diagnóstico precoce da gravidez, especialmente se forem redondos e tiverem um tamanho semelhante ao de uma vesícula embrionária3,4,6,9 (ver Figura 1). Assim, podem potencialmente aumentar o intervalo entre duas inseminações, atrasando a ultrassonografia do primeiro embrião e a avaliação da gestação de gêmeos (ver Figura 2). Cistos endometrial também podem interferir mecanicamente com a coleta de fluidos durante a lavagem uterina realizada para tratar endometrite ou coletar o embrião. Consequentemente, os cistos endometrial têm efeitos sobre a fertilidade observada da égua, com potenciais consequências econômicas nas fazendas de reprodução.
Além das tentativas de tratar a endometrosesubjacente 10,foram propostos tratamentos focais endoscopicamente guiados de cistos. A cauterização eletrocirúrgica foi descrita, mas a exposição ao calor pode ferir o endométrio ao redor do cisto11. A aspiração do cisto só é eficiente se a estrutura de segregação não estiver mais ativa no momento da punção12. Irradiação a laser com um laser de diodo de 980 nm com fibra de contato parece mostrar cicatrizes endometrial subsequentes menores6,13. O aprimoramento de dispositivos e procedimentos a laser6 agora nos permite propor essa técnica segura e eficiente na prática clínica equina. No entanto, os proprietários de éguas devem ser informados sobre os limites desta opção. A fotoablação dos cistos aumentará o reconhecimento de embriões em algumas éguas, avançará no diagnóstico da gravidez em alguns casos e poderá limitar o efeito mecânico negativo dos cistos endometrial sobre o lavage uterino realizado para tratar endometrite ou coletar embriões. No entanto, nunca tratará a endometriose ou endometriose subjacente concomitante.
Este relatório tem como objetivo descrever um procedimento eficiente para realizar a ablação de cisto a laser de diodo guiado por histeroscopia em éguas. A preparação e os procedimentos serão praticamente descritos para uma aplicação clínica.

<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

Nas éguas, os cistos endometrial estão associados à endometriose e podem causar falha de reconhecimento materno ou comprometer e retardar o diagnóstico da gravidez. Os tratamentos históricos foram invasivos e tiveram efeitos adversos no endométrio. A laserterapia histeroscópica guiada é fácil e eficaz para a ressecção de cistos endometrial, sem efeitos deletérios para o endométrio.
Um endoscópio de 110 cm de comprimento e 1,0 cm de largura é introduzido estérilmente no útero através do colo uterino aberto de uma égua estrâmica após a limpeza vulvar. O útero é lentamente infundido com menos de 1 L de solução fisiológica e a fibra laser é inserida no canal de biópsia do endoscópio. Os cistos são então cauterizados com o laser de diodo de 980 nm com um conjunto de fibra de contato a 20\u20122 5W no modo contínuo. Cada cisto é perfurado até a anulação completa do cisto e o encolhimento da parede do cisto ao redor da fibra. Lavages uterinas com solução salina estéril são realizadas logo após a cirurgia e por um ou dois dias como fluido não inflamatório pode ser observado.
Este procedimento é fácil e rapidamente realizado, sem efeitos deletérios óbvios. A ressecção de cistos facilita o diagnóstico de gravidez por ultrassom e, em alguns casos, pode restaurar a migração adequada de embriões nos chifres uterinos entre os dias 6,5 e 17. No entanto, este tratamento não melhora as lesões histológicas subjacentes relacionadas à endometriose. Essas considerações devem ser expressas claramente ao criador antes deste procedimento.

Foram realizadas cirurgias em éguas com cistos com diâmetros acima de 15 mm. No entanto, se outros cistos menores também estivessem presentes, a fotoablação dos outros cistos foi tentada. Geralmente, esses grandes cistos estavam na bifurcação ou na base dos chifres. No entanto, alguns deles estavam presentes no corpo do útero e foram igualmente tratados.
Em nossa experiência, cistos intraluminais são muito fáceis de localização com o endoscópio. Além disso, a realização desse ...

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

O objetivo deste relatório é descrever a fotoablação de cistos endometrial na égua usando um dispositivo laser endoscópico, e discutir os interesses e limitações dessa nova abordagem para lidar com problemas de baixa fertilidade.

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. ...

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

Research

JoVE Journal

Medicine

4.3K visualizações.  Liège University. O objetivo deste relatório é descrever a fotoablação de cistos endometrial na égua usando um dispositivo laser endoscópico, e discutir os interesses e limitações dessa nova abordagem para lidar com problemas de baixa fertilidade.

Vídeo: 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.

Ablação térmica para o tratamento de tumores abdominais

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

Medicina

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.

Avaliação da viabilidade, segurança e precisão de uma alta intensidade intra-operatória focado dispositivo de ultra-som para o tratamento de metástases hepáticas

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

Pesquisa do câncer

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.

Ablação a Laser Multifóton de Centros Organizadores de Microtúbulos Citoplasmáticos em Oócitos de Camundongos

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

Biologia do Desenvolvimento

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. ...

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).

Desenvolvimento de um modelo experimental não invasivo, assistido a laser de perda de células endoteliais córneas

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.

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 ...

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.

Técnicas cirúrgicas para otimizar a reserva ovariana durante a Cistectomia Laparoscópica para Endometrioma Ovariano

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.

Procedimento de poupança de fertilidade usando vaporização a laser de fibra de dióxido de carbono do endometrioma ovariano

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

Técnica histeroscópica com microtesoura e fórceps para remoção de pólipos

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.

Autor em destaque: uma abordagem de histeroscopia reprodutiva para remoção completa de pólipos endometriais e receptividade endometrial aprimorada

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.

Ressecção histeroscópica aprimorada de pólipos endometriais usando microtesouras e pinças 6-FR

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