Name: enucleation of the prostate for the treatment of benign prostatic hyperplasia using a 980 nm diode laser
Uploaded: 2020-05-05T13:00:00
Description: 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

Die Autoren bedanken sich für die Unterstützung durch das National Key Research and Development Program of China (Grant 2017YFC840102).

Alle hier beschriebenen Methoden wurden von der Ethikkommission des Pekinger Krankenhauses genehmigt. Die Indikationen für eine Operation richten sich nach den Leitlinien der European Association of Urology für nicht-neurogene männliche LUTS. Kontraindikationen sind der Verdacht auf Prostatakrebs oder eine Detrusorfunktionsstörung.
1. Instrumente für den Betrieb
<ol><li>Stellen Sie die Verfügbarkeit von Diodenlasern (980 nm) mit einer Leistung einschließlich Dauerbetrieb (80-100 W) si...

<ol>
	<li>Maliszewski, T. M., Sikorski, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=574+Diode+laser+980+nm+for+the+treatment+of+BPH:+Long-term+comparison+of+the+enucleation+vs.+vaporization.">574 Diode laser 980 nm for the treatment of BPH: Long-term comparison of the enucleation vs. vaporization.</a> European Eurology. 14 (2), 137-151 (2015).</li><li>Lerner, L. B., Rajender, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laser+prostate+enucleation+techniques.">Laser prostate enucleation techniques.</a> Canadian Journal of Urology. 22 (Suppl 1), 53-59 (2015).</li><li>Das, A. K., 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=A+retrospective+comparison+of+diode+to+holmium+for+laser+enucleation+of+the+prostate.">A retrospective comparison of diode to holmium for laser enucleation of the prostate.</a> Canadian Journal of Urology. 26 (4), 9836-9842 (2019).</li><li>Hruby, S., 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=Eraser+Laser+Enucleation+of+the+Prostate:+Technique+and+Results.">Eraser Laser Enucleation of the Prostate: Technique and Results.</a> European Urology. 63 (2), 341-346 (2013).</li><li>Lerner, L. B., Archana, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laser+prostate+enucleation+techniques.">Laser prostate enucleation techniques.</a> Canadian Journal of Urology. 22 (5 Suppl 1), 53 (2015).</li><li>Leonardi, R., Caltabiano, R., Lanzafame, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Histological+evaluation+of+prostatic+tissue+following+transurethral+laser+resection+(TULaR)+using+the+980+nm+diode+laser.">Histological evaluation of prostatic tissue following transurethral laser resection (TULaR) using the 980 nm diode laser.</a> Archivio Italiano di Urologia e Andrologia. 82 (82), 1-4 (2010).</li><li>Kahokehr, 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=Enucleation+techniques+for+benign+prostate+obstruction:+Which+one+and+why?.">Enucleation techniques for benign prostate obstruction: Which one and why?.</a> Current Opinion in Urology. 24 (1), 49-55 (2013).</li><li>Chung, D. E., Te, A. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=New+techniques+for+laser+prostatectomy:+an+update.">New techniques for laser prostatectomy: an update.</a> Therapeutic Advances in Urology. 1 (2), 85-97 (2014).</li><li>Wu, G., 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=A+comparative+study+of+diode+laser+and+plasmakinetic+in+transurethral+enucleation+of+the+prostate+for+treating+large+volume+benign+prostatic+hyperplasia:+a+randomized+clinical+trial+with+12-month+follow-up.">A comparative study of diode laser and plasmakinetic in transurethral enucleation of the prostate for treating large volume benign prostatic hyperplasia: a randomized clinical trial with 12-month follow-up.</a> Lasers in Medical Science. 31 (4), 599-604 (2016).</li><li>Wang, X., 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=Photoselective+Vaporesection+of+the+Prostate+via+an+End-firing+Lithium+Triborate+Crystal+Laser.">Photoselective Vaporesection of the Prostate via an End-firing Lithium Triborate Crystal Laser.</a> Journal of Visualized Experiments. (135), e57336 (2018).</li><li>Shigemura, K., Tanaka, K., Yamamichi, F., Chiba, K., Fujisawa, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+Predictive+Factors+for+Postoperative+Incontinence+of+Holmium+Laser+Enucleation+of+the+Prostate+by+the+Surgeons'+Experience+During+Learning+Curve.">Comparison of Predictive Factors for Postoperative Incontinence of Holmium Laser Enucleation of the Prostate by the Surgeons' Experience During Learning Curve.</a> International Neurourology Journal. 20 (1), 59-68 (2016).</li><li>Stroman, L., Ellis, D., Toomey, R., Mazaris, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=An+18-month+Audit+of+TURP+Complications+using+the+Clavien-Dindo+Classification+System.">An 18-month Audit of TURP Complications using the Clavien-Dindo Classification System.</a> Journal of Urology. 1 (3), 3 (2013).</li><li>Li, B., Xu, A., Zou, Y., Liu, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+Randomized+Trial+Comparing+Diode+Laser+Enucleation+of+the+Prostate+with+Plasmakinetic+Enucleation+and+Resection+of+the+Prostate+for+the+Treatment+of+Benign+Prostatic+Hyperplasia.">A Randomized Trial Comparing Diode Laser Enucleation of the Prostate with Plasmakinetic Enucleation and Resection of the Prostate for the Treatment of Benign Prostatic Hyperplasia.</a> Journal of Endourology. 27 (10), 1254-1260 (2013).</li><li>Lerner, L. B., Rajender, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laser+prostate+enucleation+techniques.">Laser prostate enucleation techniques.</a> Canadian Journal of Urology. 22 (5 Suppl 1), 53 (2015).</li><li>Wu, G., 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=A+comparative+study+of+diode+laser+and+plasmakinetic+in+transurethral+enucleation+of+the+prostate+for+treating+large+volume+benign+prostatic+hyperplasia:+a+randomized+clinical+trial+with+12-month+follow-up.">A comparative study of diode laser and plasmakinetic in transurethral enucleation of the prostate for treating large volume benign prostatic hyperplasia: a randomized clinical trial with 12-month follow-up.</a> Lasers in Medical Science. 31 (4), 599-604 (2016).</li><li>Xu, 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=A+randomized+trial+comparing+diode+laser+enucleation+of+the+prostate+with+plasmakinetic+enucleation+and+resection+of+the+prostate+for+the+treatment+of+benign+prostatic+hyperplasia.">A randomized trial comparing diode laser enucleation of the prostate with plasmakinetic enucleation and resection of the prostate for the treatment of benign prostatic hyperplasia.</a> Journal of Endourology. 27 (10), 1254-1260 (2013).</li><li>Yang, S. S., Hsieh, C. H., Lee, Y. S., Chang, S. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diode+laser+(980+nm)+enucleation+of+the+prostate:+a+promising+alternative+to+transurethral+resection+of+the+prostate.">Diode laser (980 nm) enucleation of the prostate: a promising alternative to transurethral resection of the prostate.</a> Lasers in Medical Science. 28 (2), 353-360 (2013).</li><li>Liu, L., Cheng, F., Li, H., Yu, W., Rao, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+Clinical+Effect+Between+Transurethral+1+470+nm+Diode+Laser+Enucleation+of+the+Prostate+and+Transurethral+Bipolar+Plasmakinetic+Resection+of+Prostate.">Comparison of Clinical Effect Between Transurethral 1 470 nm Diode Laser Enucleation of the Prostate and Transurethral Bipolar Plasmakinetic Resection of Prostate.</a> Medical Journal of Wuhan University. 39 (5), 809-812 (2018).</li><li>Nair, S. 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. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Long-term+outcome+after+endoscopic+enucleation+of+the+prostate:+From+monopolar+enucleation+to+HoLEP+and+from+HoLEP+to+EEP.">Long-term outcome after endoscopic enucleation of the prostate: From monopolar enucleation to HoLEP and from HoLEP to EEP.</a> Der Urologe. Ausg. A. 55 (11), 1446 (2016).</li></ol>

Derzeit wird der 980-mm-Diodenlaser für die Behandlung von BPH5 eingesetzt. In wenigen Berichten wurden verwandte klinische Studien beschrieben. Im Vergleich zur Wirkung von TURP bei der Behandlung von BPH haben viele Studien gezeigt, dass DiLEP weniger Blutverlust verursacht, eine bessere Funktion beim Wasserlassen erreicht und kürzere Katheterverweilzeiten aufweist 9,13,14,15.<sup class="xr...

Im Vergleich zur traditionellen transurethralen Resektion der Prostata (TURP) haben Laseroperationen aufgrund ihrer besseren Patientenverträglichkeit, des geringeren intraoperativen Blutverlusts, der Wirksamkeit und der kürzeren postoperativen Genesung allmählich an Popularität gewonnen 4,5.
In den letzten Jahren waren die am schnellsten wachsenden Techniken der Einsatz von Lasern verschiedener Wellenlängen. Gegenwärtig können viele Arten von Lasern mit unterschiedlichen Eigenschaften verwendet werden, um die Prostata-Enukleation abzuschließen. Seit der Zulassung des Diodenlasers durch die US-amerikanische FDA zur Behandlung der Prostatahyperplasie im Jahr 2007 hat sein Einsatz bei der Behandlung von BPH aufgrund seiner hervorragenden Schneidfähigkeit und des Blutstillungseffekts schrittweise zugenommen6. Die Wellenlänge des Lasers bestimmt den Grad der Absorption durch Wasser und Hämoglobin. Ein Diodenlaser mit einer Wellenlänge von 980 nm sorgt für die höchste kombinierte Absorptionsrate von Wasser und Hämoglobin. Die Penetrationsfähigkeit des Gewebes beträgt 0,5 mm und kann in tieferem Gewebe Gerinnungseffekte hervorrufen, was ihm eine sehr gute Gewebeablations- und Blutstillungsfähigkeit verleiht 7,8.
Viele Forschungszentren haben begonnen, DiLEP zur Behandlung der gutartigen Prostatahyperplasie einzusetzen. In der Praxis hat die traditionelle DiLEP eine längere Lernkurve und bietet keine offensichtlichen Vorteile in Bezug auf den Harnschließmuskelschutz9. Aus den oben genannten Gründen wurde die traditionelle DiLEP in unserem Zentrum modifiziert, um den Wert der Diodenlaserbehandlung bei Patienten mit BPH zu verbessern.

<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

In der alternden männlichen Bevölkerung ist das Auftreten von Symptomen der unteren Harnwege (LUTS), die durch eine gutartige Prostatahyperplasie (BPH) verursacht werden, ein häufiges Problem. Hier stellen wir eine neue Technik namens 980-nm-Diodenlaser-Enukleation (DiLEP) zur Behandlung von BPH1 vor. Diodenlaser können sowohl Wasser als auch Hämoglobin gleichzeitig absorbieren, so dass sie gut zum Schneiden und zur Blutstillunggeeignet sind 2. Der Diodenlaser wurde 2007 von der FDA zugelassen und wird aufgrund seiner effektiven Schneid- und Blutstillungswirkung bei der Behandlung von BPH eingesetzt3. DiLEP bietet mehrere Vorteile gegenüber anderen Techniken wie TURP, HoLEP und PVP. Während des Eingriffs definieren wir die Grenze einer Prostata mit hohem Volumen und teilen sie mit einem Diodenlaser in drei Lappen, indem wir zwei Ringe und eine Rille (wie ein Amorpfeil) brennen. Im Vergleich zu anderen Verfahren weist mDiLEP weniger intraoperative Komplikationen auf, eine kürzere Lernkurve und führt zu mehr Geweberesektionen.

Insgesamt wurden 40 Patienten mit BPH, die sich einer DiLEP unterzogen hatten, in eine unserer Studien eingeschlossen. Als statistische Methode wurde ein unabhängiger Stichproben-t-Test verwendet. Alle Patienten schlossen die Operation erfolgreich ab. Bei fast allen Patienten wurde der Katheter innerhalb von 5 Tagen nach der Operation entfernt (Tabelle 1). Alle Patienten kehrten im 1., 3. und 12. Monat postoperativ zur Nachuntersuchung in...

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

Hier stellen wir ein Protokoll für die modifizierte 980-nm-Diodenlaser-Enukleation zur Behandlung großvolumiger gutartiger Prostatahyperplasie vor.

Enukleation der Prostata zur Behandlung der gutartigen Prostatahyperplasie mit einem 980 nm Diodenlaser

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

Lower urinary tract symptom caused by benign prosthetic hypoplasia is a common condition in older males. Our new technology, 980 diode laser enucleation, can be used to treat this condition. Diode lasers can simultaneously absorb both water and hemoglobin.Compared to other procedures, diode has fewer intra-operative complications, a shorter learning curve, and achieves a greater t-cell reception. Before beginning the procedure, confirm the availability of 980-nanometer diode laser with an 80 to 100-watt continuous power source. 30 minutes before the procedure, administer an intravenous antibiotic to the patient and have the patient lie on the operating table.When the patient is in position, use the resectoscope to observe the urethra, verumontanum, bladder neck, urethral orifices, bladder mucosa, and trabecular hyperplasia. Use the laser to make a three to four-millimeter wide circular incision in the bladder neck mucosa, and a three to four-millimeter circular incision in the proximal end of the verumontanum of the prostatic urethra mucosa. Then connect the concentric circles of the bladder neck and the apex of the prostate in the posterior urethra at 12 o'clock, and incise the left and right lobes of the bladder.Then to create the channel, locate the surgical capsule at the five and seven o'clock positions of the apex of the prostate, and the surgical capsule at the five and seven o'clock surgical capsule positions. Then connect the five and seven o'clock surgical capsule positions with the laser. At the six o'clock position of the prostate's apex, separate the median lobe from the surgical capsule from the prostate's apex to the bladder neck.For lobe enucleation, use the resectoscope to enucleate the right lobe at 6 and 12 o'clock from the apex of the prostate to the bladder neck in a counterclockwise direction. Enucleate the left lobe at 6 and 12 o'clock from the apex of the prostate to the bladder neck in a clockwise direction. Then push all of the glands into the bladder.To stop bleeding around the site, place a 50-watt laser one to three millimeters from the sites of bleeding to achieve hemostasis within the surgical area. To morcellate the enucleated prostatic tissue, use a morcellator to break the tissue into as small pieces as possible, and remove the tissue from the bladder. When all of the enucleated tissue has been removed, remove the morcellator from the urethra and gently insert a 22-French Foley catheter lubricated with lidocaine gel through the urethral orifice into the bladder cavity.Then inflate the balloon with 30 milliliters of water. In this clinical study, all 40 of the patients with benign prostatic hypoplasia who underwent diode laser enucleation successfully completed the operation, and almost all of the patients had the catheter removed within five days of the procedure. All of the patients returned to the hospital for follow-up examinations in the first, third, and 12th months postoperatively.The International Prostate Symptom Score and quality of life tools were used to screen for, rapidly diagnose, track the symptoms off, and suggest the management of the symptoms of benign prostatic hyperplasia. Compared to baseline values, the International Prostate Symptom Score and quality of life both significantly decreased at one, three, and 12 months postoperatively. The mean Qmax increased nearly threefold, and the mean post-void residual decreased nearly fourfold.Compared to the preoperative values, the prostate volume also decreased dramatically. According to the modified Clavien-Dindo Classification system, no patient had complications intraoperatively, and only four cases reported grade one postoperative complications. It's critical that the channel is created in the correct location and the manner to reduce the chance of injury to the sphincter and neck of bladder.Also, other lasers may be used. Their performance will not be as accurate as that achieved using diode light. Diode light provides a new tool for the treatment of the benign prosthetic hyperplasia and encourages the urologists to consider the physical characteristics of different lasers to improve the outcome of the procedure.

Research

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Nierenkapsel Xenografting und subkutane Implantation Pellet für die Beurteilung von Prostata-Karzinogenese und benigne Prostatahyperplasie

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Approximately 30% of epilepsy patients are refractory to antiepileptic drugs. In these cases, surgery is the only alternative to eliminate/control ...

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

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The use of animal models is essential for a better understanding of MH, one major cause for arterial stenosis.In this article, we demonstrate a murine ...

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

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

Chirurgische Behandlung der benignen Prostatahyperplasie: Holmium Laser Enukleation der Prostata (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

Photoselektiven Vaporesection der Prostata mittels einer Ende-Firing Lithium Triborate Kristall 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 ...

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Pancreatic parenchyma sparing surgery for insulinomas avoids the risk of endocrine and exocrine insufficiency, and potential high-risk anastomoses ...

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When investigating the body&#39;s mechanisms for regulating cerebral blood flow, a relative measurement of microcirculatory blood flow can be obtained ...

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