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

著者らは、National Key Research and Development Program of China(Grant 2017YFC840102)の支援に感謝します。

ここに記載されているすべての方法は、北京病院の倫理委員会によって承認されています。手術の適応は、非神経原性男性のLUTSに関する欧州泌尿器科学会のガイドラインに従っています。禁忌には、前立腺がんまたは排尿筋機能障害の疑いが含まれます。
1.操作用機器
<ol><li>連続モード(80-100 W)を含む電力を備えたダイオードレーザー(980 nm)機器の可用性を確保します。...

<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>

現在、980mmのダイオードレーザーはBPH5の治療に使用され始めています。関連する臨床研究について記述した報告はほとんどありません。BPHの治療におけるTURPの効果と比較して、多くの研究は、DiLEPが失血を減らし、より良い排尿機能を達成し、カテーテル保持時間が短いことを示しています9,13,14,15。...

従来の経尿道的前立腺切除術 (TURP) と比較して、レーザー手術は、患者の耐性が高く、術中の失血量が少なく、有効性が低く、術後の回復が短いため、徐々に人気が高まっています 4,5。
近年、最も急速に成長している技術は、さまざまな波長のレーザーの使用を含んでいます。現在、前立腺摘出術を完了するために、さまざまな特性を持つ多くの種類のレーザーを使用できます。ダイオードレーザーは、2007年に前立腺肥大症に対して米国FDAによって承認されて以来、その優れた切断能力と止血効果6のために、BPHの治療でその使用が徐々に増加しています。レーザーの波長は、水とヘモグロビンによる吸収の程度を決定します。波長980nmのダイオードレーザーは、水とヘモグロビンの組み合わせ吸収率が最も高いです。組織浸透能力は0.5mmで、より深い組織で凝固効果を生み出すことができるため、非常に優れた組織アブレーションおよび止血能力7,8が得られます。
多くの研究センターでは、良性前立腺肥大症の治療にDiLEPを使用し始めています。実際には、従来のDiLEPは学習曲線が長く、尿括約筋の保護に関連する明らかな利点はありません9。以上の理由から、当センターでは従来のDiLEPを改良し、BPH患者におけるダイオードレーザー治療の価値を向上させました。

<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

高齢化する男性人口では、良性前立腺肥大症(BPH)によって引き起こされる下部尿路症状(LUTS)の発生が一般的な問題です。ここでは、BPH1を治療するための980 nmダイオードレーザー核摘出術(DiLEP)という新しい技術を紹介します。ダイオードレーザーは、水とヘモグロビンの両方を同時に吸収できるため、切断や止血に適しています2。ダイオードレーザーは2007年にFDAによって承認され、その効果的な切断および止血効果3のためにBPHの治療に使用されてきました。DiLEPには、TURP、HoLEP、PVPなどの他の手法に比べていくつかの利点があります。手順では、大量の前立腺の境界を定義し、ダイオードレーザーで2つのリングと1つの溝(キューピッドの矢のように)を燃焼させることにより、前立腺を3つの葉に分離します。mDiLEPは、他の手技と比較して、術中の合併症が少なく、学習曲線が短く、より多くの組織切除を実現します。

DiLEPを受けたBPH患者の合計40人が、私たちの研究の1つに含まれていました。統計的手法として、独立したサンプルのt検定を使用しました。すべての患者が無事に手術を完了しました。ほぼ全ての患者様が術後5日以内にカテーテルを抜去されました(表1)。すべての患者は、術後 1か月目、3か月目、および 12か月目に フォローアップ...

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

ここでは、大量の良性前立腺肥大症を治療するための修正された980nmダイオードレーザー除核術のプロトコルを紹介します。

980 nm ダイオード レーザーを使用した良性前立腺肥大症の治療のための前立腺の摘出術

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

JoVE Journal

Medicine

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

前立腺発がんおよび良性前立腺過形成の評価のための腎皮膜異種移植および皮下ペレット移植

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

医学

Laser-capture Microdissection of Human Prostatic Epithelium for RNA Analysis

RNA分析のためのヒト前立腺上皮のレーザーキャプチャーマイクロダイセクション

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

Network Analysis of Foramen Ovale Electrode Recordings in Drug-resistant Temporal Lobe Epilepsy Patients

薬剤耐性側頭葉てんかん患者における孔開存電極レコーディングのネットワーク解析

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

Transcanalicular Diode Laser-assisted Dacryocystorhinostomy for the Treatment of Primary Acquired Nasolacrimal Duct Obstruction

プライマリの治療のための Transcanalicular ダイオード レーザ リノストーミー取得鼻涙管閉塞

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

Balloon-based Injury to Induce Myointimal Hyperplasia in the Mouse Abdominal Aorta

マウスの腹部大動脈 Myointimal 過形成を誘導するために気球を利用した傷害

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.

前立腺肥大症の外科治療: ホルミウム レーザー核出術 (HoLEP) 前立腺の。

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

最後発火リチウム三ほう酸結晶レーザーを介して前立腺の Photoselective Vaporesection

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 ...

Robotic Enucleation of an Intra-Pancreatic Insulinoma in the Pancreatic Head

膵臓頭部における膵内インスリン腫のロボット的発風

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

Evaluation of Cerebral Blood Flow Autoregulation in the Rat Using Laser Doppler Flowmetry

レーザードップラー流量測定を用いたラットにおける脳血流自動調節の評価

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

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

マレスの接触繊維を用いた980 nmレーザーを用いた子宮内膜嚢胞の導き光化による内視鏡検査

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

980 nm ダイオード レーザーを使用した良性前立腺肥大症の治療のための前立腺の摘出術

980 nm ダイオードレーザーを使用した良性前立腺肥大症の治療のための前立腺の摘出術