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

Forfatterne vil gjerne anerkjenne støtten fra National Key Research and Development Program of China (Grant 2017YFC840102).

Alle metodene som er beskrevet her er godkjent av etikkkomiteen ved Beijing sykehus. Indikasjoner for kirurgi er i henhold til European Association of Urologys retningslinjer for ikke-nevrogene mannlige LUTS. Kontraindikasjoner inkluderer mistanke om prostatakreft eller detrusordysfunksjon.
1. Instrumenter for drift
<ol><li>Sørg for tilgjengeligheten av diodelaserutstyr (980 nm) med en effekt inkludert kontinuerlig modus (80-100 W).</li>
	<li>Bruk en laserfiber og 0,9 % saltløsning for int...

<ol>
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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>

For tiden begynner 980 mm diodelaseren å bli brukt til behandling av BPH5. Få rapporter har beskrevet relaterte kliniske studier. Sammenlignet med effekten av TURP i behandlingen av BPH, har mange studier vist at DiLEP forårsaker mindre blodtap, oppnår bedre vannlatingsfunksjon og har kortere kateterretensjonstider 9,13,14,15.
Her deler vi...

Sammenlignet med tradisjonell transuretral reseksjon av prostata (TURP), har laseroperasjoner gradvis blitt mer populære på grunn av deres bedre pasienttoleranse, lavere mengder intraoperativt blodtap, effekt og kortere postoperativ restitusjon 4,5.
De siste årene har de raskest voksende teknikkene involvert bruk av lasere med forskjellige bølgelengder. For tiden kan mange typer lasere med forskjellige egenskaper brukes til å fullføre prostataenukleasjon. Siden diodelaseren ble godkjent av US FDA for prostatahyperplasi i 2007, har bruken gradvis økt i behandlingen av BPH på grunn av dens enestående skjæreevne og hemostaseeffekt6. Laserbølgelengden bestemmer graden av absorpsjon av vann og hemoglobin. En diodelaser med en bølgelengde på 980 nm gir den høyeste kombinerte absorpsjonshastigheten av vann og hemoglobin. Vevspenetrasjonsevnen er 0,5 mm, og den kan gi koagulasjonseffekter i dypere vev, noe som gjør at den har en veldig god vevsablasjons- og hemostaseevne 7,8.
Mange forskningssentre har begynt å bruke DiLEP til behandling av godartet prostatahyperplasi. I praksis har tradisjonell DiLEP en lengre læringskurve og gir ingen åpenbare fordeler knyttet til urinsfinkterbeskyttelse9. Basert på de ovennevnte årsakene ble tradisjonell DiLEP modifisert i vårt senter for å forbedre verdien av diodelaserbehandling hos pasienter med BPH.

<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

I den aldrende mannlige befolkningen er forekomsten av nedre urinveissymptomer (LUTS) forårsaket av godartet prostatahyperplasi (BPH) et vanlig problem. Her introduserer vi en ny teknikk kalt 980 nm diodelaserenukleasjon (DiLEP) for å behandle BPH1. Diodelasere kan absorbere både vann og hemoglobin samtidig, så de er gode for skjæring og hemostase2. Diodelaseren ble godkjent av FDA i 2007, og har blitt brukt i behandlingen av BPH på grunn av dens effektive skjære- og hemostaseeffekt3. DiLEP presenterer flere fordeler i forhold til andre teknikker, som TURP, HoLEP og PVP. Under prosedyren definerer vi grensen til en prostata med høyt volum og deler den i tre lober med en diodelaser ved å brenne to ringer og ett spor (som en amorpil). Sammenlignet med andre prosedyrer har mDiLEP færre intraoperative komplikasjoner, en kortere læringskurve og oppnår mer vevsreseksjon.

Totalt 40 pasienter med BPH som gjennomgikk DiLEP ble inkludert i en av våre studier. Et uavhengig utvalg av t-test ble brukt som statistisk metode. Alle pasientene fullførte operasjonen. Nesten alle pasientene fikk fjernet kateteret innen 5 dager etter operasjonen (tab 1). Alle pasientene kom tilbake til sykehuset for oppfølgingsundersøkelser i 1., 3.,og 12.måned postoperativt. Verktøyene International Prostate Symptom Score (IPSS)<...

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

Her presenterer vi en protokoll for modifisert 980 nm diodelaserenukleasjon for å behandle godartet prostatahyperplasi med stort volum.

Enukleering av prostata for behandling av godartet prostatahyperplasi ved bruk av en 980 nm diodelaser

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.

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Benign prostatic hyperplasia (BPH) commonly occurs among elderly males. The condition causes symptoms in the lower urinary tract, thereby reducing the ...

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Photoselective Vaporesection av prostata via en End-skyting Lithium Triborate krystall 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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