Name: endoscopy guided photoablation of endometrial cysts using a 980 nm laser with a contact fiber in mares
Uploaded: 2020-07-16T14:30:00.000+00:00
Duration: 7 min 7 s
Description: Watch this Scientific Journal Video about Endoscopy Guided Photoablation of Endometrial Cysts using a 980 nm Laser with a Contact Fiber in Mares at JoVE.com

Yazarlar, tüm prosedürler sırasındaki teknik desteği için Bay Pascal Lejeune'ye teşekkür eder.

Sunulan protokol, at hastanesinde sunulan kısraklar için kullanılır ve kurumsal hayvan bakım yönergelerine uyar.
NOT: Anestrüs öncesi endometriyal kist fotoablasyonunu gerçekleştirin: Temmuz sonu veya Ağustos ayında gözlenen ısılar bu nedenle en güvenilir görünüyor. Potansiyel bir endometriti tedavi etmek için mevcut östrus sayısını sınırlandırabileceğinden, bu prosedürü üreme mevsiminde çok geç yapmayın.
1. Önceki östrus sırasında
<ol><li>Kısrağın işlemden sonra potansiyel olarak hamile kalmasını sağlamak için endometriyal biyopsi1 (burada açıklanmamıştır) dahil olmak üzere kısrağın tam bir üreme sağlamlığı incelemesi gerçekleştirin.</li>
	<li>Kenney'in sınıflandırmasına göre kötü endometriyal biyopsi evrelemesi durumunda1, embriyo transferine veya intra sitoplazmik sperm enjeksiyonu (ICSI) programına endometriyal kist fotoabalasyon yerine tercih verin.</li>
</ol>2. Önceki diestrus sırasında
<ol><li>Rektum boşaldıktan sonra, bir çekişme stoğunda ekranda 7,5 veya 5 MHz doğrusal rektal prob ve kaliperler ile rektal palpasyon tarafındanyönlendirilen trans-rektal ultrasonografi kullanarak rahimdeki kısrağın endometriyal kistlerini sayın, ölçün ve haritalayın.</li>
	<li>Yumurtlama sonrası 6\u20127 gününden sonraki 2 veya 3 gün içinde östrus indük etmek için 250 μg kloprostenol intra-kaslı olarak uygulayın.</li>
	<li>Günlük olarak, önemli endometriyal ödem, 35 mm antral folikül ve yumuşatılmış ve açılmış serviks dahil olmak üzere östrus belirtilerini gözlemlemek için yaygın rutin ultrasonografi ve serviks palpasyonu gerçekleştirin.</li>
</ol>3. Kısrak sıcaktayken hazırlık
<ol><li>Göz koruma gözlüğü takan kişilere operasyon odasına erişimi kısıtlayın.</li>
	<li>Rektumun boşalması üzerine kuyruğu sarın ve vulvayı iyot-povidon kullanarak aseptik olarak temizleyin.</li>
	<li>Kısrağın kolay manipülasyonunu ve konforunu sağlamak için, 21 G iğne ile şahdamarına (10 μg/kg) ve butorfaninol (0,1 mg/kg) intravenöz olarak sürün.</li>
	<li>Vajina başına, embriyo toplama kateterini serviksten geçirin ve balonu 40 mL hava ile insufflate edin.</li>
	<li>Uterusun şişirmek için uterusa 1,5 L steril salin çözeltisi (%0,9 NaCl) aşılaması.</li>
	<li>Balonu söndür ve kateteri çıkarın.</li>
	<li>Endoskopu steril bir manşon içinde serviksten aseptik olarak geçirin.</li>
</ol>4. Teknik
<ol><li>600 μm kuvars fiberi 980 nm'de çalışan bir diyot lazere bağlayın. Sürekli modda gücü 20\u201225 W olarak ayarlayın.</li>
	<li>Esnek kuvars lifini 10 mm çapında bir video-endoskopun biyopsi kanalından geçirin, ta ki ekranda 3\u20124 cm serbest lif tespit edilene kadar. Lifin ucundan en az 10 mm görünür olmalıdır.</li>
	<li>Kisti ideal olarak tepe noktasında delmek için lazeri etkinleştirin: cihazda elleri serbest tutmak için özel bir pedal mevcuttur. Bazı durumlarda, kistin tamamen geçersiz kılınmasını sağlamak için çeşitli yerlerde birden fazla delinme gereklidir. Kistik sıvı pasif olarak uterusa boşaltılır.</li>
	<li>Kist astarı lifin etrafına çöktükten sonra, membran küçülene kadar lazeri dağıtın.</li>
	<li>Endometriyal kistlerin kaybolduğunu doğrulamak için işlem sırasında uterusun transrektal ultrasonografisini gerektiği kadar gerçekleştirin.</li>
</ol>5. Ameliyat sonrası tedaviler
<ol><li>Genel antibiyotik tedavisi uygulayin: 22.000 UI / kg penisilin-prokain süspansiyonu, kas içi, günde iki kez, 3 gün boyunca.</li>
	<li>Müdahaleden hemen sonra, yukarıda açıklandığı gibi rahim lavajı gerçekleştirin (bkz. adımlar 3.4-3.6).<ol>
<li>Endoskopik işlemden önce uterusa aşılanmış sıvıyı steril bir manşetli kateterden toplayın.</li>
		<li>Uterusun ardından 1 L steril izotonik çözelti (%0,9 NaCl) aşıları ile berrak bir sıvı toplanana kadar yıkayın.</li>
		<li>İşlemin sonunda, intravenöz olarak 20 IU oksitosin uygulayın.</li>
		<li>Ertesi gün kısrak uterusunun transrektal ultrasonografisini gerçekleştirin: intralüminal serbest sıvı sıklıkla gözlenir (bkz. adım 2.1).</li>
	</ol>
</li>
	<li>Transrektal ultrasonografi ile serbest ışık içi sıvı gözlendiği sürece ve ısının sonuna kadar yukarıda açıklanan işlemle günlük rahim lavajları gerçekleştirin (adım 3.4-3.6). Bazen birkaç gün boyunca serum benzeri, limpid ve sarı lekeli sıvı toplanır. NOT: Kısrak östrustayken her 4 saat veya daha az bir oksitosin (20 IU) tekrarlayan kas içi enjeksiyonları vermek sıvı birikmesini önleyebilir ve rahimde bakteriyel kontaminasyon riskini azaltabilir.</li>
	<li>Endometriyal kistlerin kayboluşunu ve intralüminal serbest sıvının yokluğunu doğrulamak için aşağıdaki diestrus sırasında trans-rektal rahim ultrasonografisi yapın. NOT: Serbest intralüminal sıvı gözlenirse, yeni bir östrus indüklenmesi, sonraki endometriti teşhis etmek ve tedavi etmek için prostaglandin enjeksiyonu önerilir.</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. 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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>

Tüm yazarlar liège Üniversitesi Equine Clinic tarafından tamamen istihdam edilmektedir ve yukarıda belirtilen ürünlerden birini ticaretini yapmak için herhangi bir şirketle çıkar çatışması yoktur.

Endometriyal kistlerin histeroskopisi ve lazer fotoablasyonu, daha önce öneren gibi kısraktaki büyük ışık içi kistleri azaltmak için kolay bir prosedürdür14. Teknik olarak, bu yöntem östrustaki bir kısrakta gerçekleştirildiğinde geliştirilmiştir. Rahmi steril salin çözeltisi ile şişirmek, işlemi gerçekleştirirken hava doldurma ve sürekli aspirasyon ile karşılaştırıldığında görünürlüğü artırdı.  Küçük parietal kistlere (<10 mm) ulaşmak ve tedavi etme...

Kısraklardaki endometriyal kistler yetmişli yıllarda Kenney1tarafından histopatolojik olarak tanımlanmıştır. Seksenli yılların sonlarında, histeroskopi ve ultrasonografi kullanımı klinik tanımlarına yol açtı ve doğurganlık üzerindeki sonuçlarını anlamaya yardımcı oldu2,3,4,5.
Erken evrelerde, endometriyal kistler şimdi endometroz 1 , 3 ,4,6,7,8 olarak adlandırılan endometriyumun dejenerasyonu ile ilişkilendirilmiştir ve şu anda daha büyük kistler lenfatik dilatasyonla ilişkili olduğunda küçük (<1 cm) kistlerin endometriyal bez fibrozis ile ilişkili olduğu kabul edilmektedir6 . Bu büyük kistler, 6,5 ve 17. gün arasında at embriyosu göçünü bozma olasılığı en yüksek olanlardır, böylece anne tanıma 1 ,3,4,6,8'ibozarak doğurganlığı azaltırlar. Endometriyal kistler, özellikle yuvarlaksa ve embriyonik vezikül 3 ,4,6,9'a benzer bir boyuta sahipse erken gebelik teşhisine de müdahale edebilir (bkz. Şekil 1). Böylece, ilk embriyo ultrasonografisini ve ikiz gebelik değerlendirmesini geciktirerek iki döllenme arasındaki aralığı potansiyel olarak artırabilirler (bkz. Şekil 2). Endometriyal kistler, endometriti tedavi etmek veya embriyoyu toplamak için gerçekleştirilen rahim lavajı sırasında sıvı toplanmasına mekanik olarak müdahale edebilir. Sonuç olarak, endometriyal kistlerin gözlenen kısrağın doğurganlığı üzerinde etkileri vardır ve üreme çiftliklerinde potansiyel ekonomik sonuçlar doğurur.
Alttaki endometrozis10'utedavi etme girişimlerinin yanı sıra kistlerin endoskopik güdümlü odak tedavileri önerilmiştir. Elektrocerrahi koterizasyon tanımlanmıştır, ancak ısıya maruz kalma kist çevresindeki endometriuma zarar verebilir11. Kistin aspirasyonu sadece salgılama yapısı delinme sırasında daha aktif değilse etkilidir12. Temas lifli 980 nm diyot lazer ile lazer ışınlama daha küçük sonraki endometriyal izleri göstermek gibi görünüyor6,13. Lazer cihazlarının ve prosedürlerinin iyileştirilmesi6 artık at klinik uygulamalarında bu güvenli ve verimli tekniği önermemizi sağlar. Ancak, kısrak sahipleri bu seçeneğin sınırları hakkında bilgilendirilmelidir. Kistlerin fotoablasyonu bazı kısraklarda embriyo tanımayı artıracak, bazı durumlarda gebelik tanısını ilerletecek ve endometriyal kistlerin endometriti tedavi etmek veya embriyo toplamak için yapılan rahim lavajı üzerindeki olumsuz mekanik etkisini sınırlayabilir. Bununla birlikte, eşlik eden alttaki endometriozis veya endometriti asla tedavi etmeyecektir.
Bu rapor, kısraklarda histeroskopi güdümlü diyot lazer kist ablasyonunu gerçekleştirmek için etkili bir prosedürü tanımlamayı amaçlamaktadır. Klinik bir uygulama için hazırlık ve prosedürler pratik olarak tanımlanacaktır.

<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

Kısraklarda, endometriyal kistler endometriozis ile ilişkilidir ve anne tanıma başarısızlığına veya riskten ve gebelik teşhislerini geciktirebilir. Tarihsel tedaviler invazivdi ve endometriyum üzerinde olumsuz etkileri vardı. Histoskopik güdümlü lazer tedavisi, endometrium için zararlı etkileri olmayan endometriyal kistlerin rezeksiyonu için kolay ve etkilidir.
110 cm uzunluğunda ve 1,0 cm genişliğinde bir endoskop, vulvar temizliğinden sonra östrous bir kısrağın açık serviksi yoluyla uterusa steril olarak sokulur. Rahim yavaşça 1 L'den az fizyolojik çözelti ile aşılanır ve lazer lifi endoskopun biyopsi kanalına yerleştirilir. Kistler daha sonra 980 nm diyot lazer ile 20\u20122 5W'da sürekli modda bir temas fiber seti ile dağlanır. Her kist, kistin tamamen geçersiz kılınıp lif etrafındaki kist duvarının küçülmesine kadar delinür. Steril salin çözeltisi ile rahim lavajları ameliyattan hemen sonra ve enflamatuar olmayan sıvı gözlenebildiği için bir veya iki gün boyunca gerçekleştirilir.
Bu prosedür, belirgin zararlı etkileri olmadan kolay ve hızlı bir şekilde gerçekleştirilir. Kist rezeksiyonu ultrason gebelik tanısını kolaylaştırır ve bazı durumlarda 6.5 ile 17. Ancak bu tedavi endometriozis ile ilgili altta kalan histolojik lezyonları iyileştirmez. Bu hususlar, bu işlemden önce yetiştiriciye açıkça ifade edilmelidir.

Çapları 15 mm'nin üzerinde kist olan kısraklara ameliyatlar yapıldı. Bununla birlikte, diğer küçük kistler de mevcutsa, diğer kistlerin fotoablasyonu denendi. Genellikle, bu büyük kistler çatallanmada veya boynuzların temelindeydi. Bununla birlikte, bazıları uterusun vücudunda mevcuttu ve eşit olarak tedavi edildi.
Deneyimlerimize göre, intralüminal kistlerin endoskop ile lokalize etmesi çok kolaydır. Ayrıca, bu prosedürün tuzlu su çözeltisinde yapılması uterusun ...

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

Bu raporun amacı, endoskopik bir lazer cihazı kullanarak kısraktaki endometriyal kistlerin fotoablasyonunu tanımlamak ve düşük doğurganlık sorunlarıyla başa çıkmak için bu yeni yaklaşımın ilgisini ve sınırlamalarını tartışmaktır.

Mares'te Temas Lifli 980 nm Lazer Kullanarak Endometriyal Kistlerin Endoskopi Güdümlü Fotoablasyonu

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 Görüntüleme.  Liège University. Bu raporun amacı, endoskopik bir lazer cihazı kullanarak kısraktaki endometriyal kistlerin fotoablasyonunu tanımlamak ve düşük doğurganlık sorunlarıyla başa çıkmak için bu yeni yaklaşımın ilgisini ve sınırlamalarını tartışmaktır.

Video: 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.

Karın Tümörler Tedavi için Termal Ablasyon

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

Tıp

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.

Fizibilite, Emanet ve intraoperatif bir yoğun doğruluğunu karaciğer metastaz tedavisi için ultrason cihazı odaklı

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

Kanser Araştırmaları

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.

Fare Oositlerinde Sitoplazmik Mikrotübül Düzenleme Merkezlerinin Multi-Foton Lazer Ablasyonu

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

Gelişim Biyolojisi

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 bir sonu-ateş lityum Triborate kristal lazer ile prostat

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.

980 nm Diyot Lazer Kullanılarak İyi Huylu Prostat Hiperplazisinin Tedavisi için Prostatın Enükleasyonu

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).

Kornea Endotel Hücre Kaybının Noninvaziv, Lazer Destekli Deneysel Modelinin Geliştirilmesi

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.

Prostat Kanserinin Odak Lazer Ablasyonu: Bir Ofis Prosedürü

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.

Yumurtalık Endometriomu için Laparoskopik Sistektomi Sırasında Yumurtalık Rezervlerini Optimize Etmek için Cerrahi Teknikler

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.

Yumurtalık Endometriomunun Karbondioksit Fiber Lazer Buharlaştırılması Kullanılarak Doğurganlık Koruyucu Prosedür

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

Polip Çıkarılması İçin Mikro Makas ve Forseps ile Histeroskopik Teknik

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.

Yazar Spotlight: Tam Endometriyal Polip Çıkarılması ve Gelişmiş Endometriyal Alıcılık için Üreme Histeroskopisi Yaklaşımı

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.

Endometrial Poliplerin 6-FR Mikro Makas ve Forseps Kullanılarak İyileştirilmiş Histeroskopik Rezeksiyonu

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