Name: technical modification of the terminal ureter during total transperitoneal laparoscopic nephroureterectomy for upper urinary tract urothelial carcinoma
Uploaded: 2019-11-22T14:00:00
Description: Watch this Scientific Journal Video about Technical Modification of the Terminal Ureter During Total Transperitoneal Laparoscopic Nephroureterectomy for Upper Urinary Tract Urothelial Carcinoma at JoV

Denna studie sponsrades av CAMS innovation Fund för medicinska vetenskaper, nr 2018-I2M-1-002.

Alla metoder som beskrivs här har godkänts av etikkommittén vid Beijings sjukhus. Indikationer och kontraindikationer för kirurgi är enligt den Europeiska föreningen för urologi riktlinjer för övre urinvägarna urotelial cell carcinoma.
1. instrument för drift
<ol><li>Se till att det laparoskopiska avbildnings systemet, bilder av pneumoperitoneum, och ultraljud skalpell.</li>
</ol>2. förberedelse för drift
<ol><li>Förbered patienten med en tarm rensning...

<ol>
	<li>Roupret, M., 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=European+guidelines+for+the+diagnosis+and+management+of+upper+urinary+tract+urothelial+cell+carcinomas:+2011+update.">European guidelines for the diagnosis and management of upper urinary tract urothelial cell carcinomas: 2011 update.</a> European Urology. 59 (4), 584-594 (2011).</li><li>Ristau, B. T., Tomaszewski, J. J., Ost, M. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Upper+Tract+Urothelial+Carcinoma:+Current+Treatment+and+Outcomes.">Upper Tract Urothelial Carcinoma: Current Treatment and Outcomes.</a> Urology. 79 (4), 749-756 (2012).</li><li>Ni, 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=Laparoscopic+Versus+Open+Nephroureterectomy+for+the+Treatment+of+Upper+Urinary+Tract+Urothelial+Carcinoma:+A+Systematic+Review+and+Cumulative+Analysis+of+Comparative+Studies.">Laparoscopic Versus Open Nephroureterectomy for the Treatment of Upper Urinary Tract Urothelial Carcinoma: A Systematic Review and Cumulative Analysis of Comparative Studies.</a> European Urology. 61 (6), 1142-1153 (2012).</li><li>Ghazi, A., Shefler, A., Gruell, M., Zimmermann, R., Janetschek, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+Novel+Approach+for+a+Complete+Laparoscopic+Nephroureterectomy+with+Bladder+Cuff+Excision.">A Novel Approach for a Complete Laparoscopic Nephroureterectomy with Bladder Cuff Excision.</a> Journal of Endourology. 24 (3), 415 (2010).</li><li>Hiroshi, 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=Comparison+of+Laparoscopic,+Hand-Assisted,+and+Open+Surgical+Nephroureterectomy.">Comparison of Laparoscopic, Hand-Assisted, and Open Surgical Nephroureterectomy.</a> Journal of the Society of Laparoendoscopic Surgeons. 18 (2), 288-293 (2014).</li><li>Ni, 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=Laparoscopic+Versus+Open+Nephroureterectomy+for+the+Treatment+of+Upper+Urinary+Tract+Urothelial+Carcinoma:+A+Systematic+Review+and+Cumulative+Analysis+of+Comparative+Studies.">Laparoscopic Versus Open Nephroureterectomy for the Treatment of Upper Urinary Tract Urothelial Carcinoma: A Systematic Review and Cumulative Analysis of Comparative Studies.</a> European Urology. 61 (6), 1142-1153 (2012).</li><li>Seisen, T., 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+Systematic+Review+and+Meta-analysis+of+Clinicopathologic+Factors+Linked+to+Intravesical+Recurrence+After+Radical+Nephroureterectomy+to+Treat+Upper+Tract+Urothelial+Carcinoma.">A Systematic Review and Meta-analysis of Clinicopathologic Factors Linked to Intravesical Recurrence After Radical Nephroureterectomy to Treat Upper Tract Urothelial Carcinoma.</a> Journal of Urology. 67 (6), 1122-1133 (2015).</li><li>Michael, M. <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+oncologic+outcome+after+laparoscopic+radical+nephroureterectomy+for+upper+tract+transitional+cell+carcinoma.">Long-term oncologic outcome after laparoscopic radical nephroureterectomy for upper tract transitional cell carcinoma.</a> European Urology. 6 (51), (2007).</li><li>Terakawa, T. T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Retroperitoneoscopic+nephroureterectomy+for+upper+urinary+tract+cancer:+a+comparative+study+with+conventional+open+retroperitoneal+nephroureterectomy.">Retroperitoneoscopic nephroureterectomy for upper urinary tract cancer: a comparative study with conventional open retroperitoneal nephroureterectomy.</a> Journal of Endourology. 22 (8), 1693-1699 (2008).</li><li>Gkougkousis, E. G., Mellon, J. K., Griffiths, T. R. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Management+of+the+Distal+Ureter+during+Nephroureterectomy+for+Upper+Urinary+Tract+Transitional+Cell+Carcinoma:+A+Review.">Management of the Distal Ureter during Nephroureterectomy for Upper Urinary Tract Transitional Cell Carcinoma: A Review.</a> Urologia Internationalis. 85 (3), 249-256 (2010).</li><li>Li, C. 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=Significant+Predictive+Factors+for+Prognosis+of+Primary+Upper+Urinary+Tract+Cancer+after+Radical+Nephroureterectomy+in+Taiwanese+Patients.">Significant Predictive Factors for Prognosis of Primary Upper Urinary Tract Cancer after Radical Nephroureterectomy in Taiwanese Patients.</a> European Urology. 54 (5), 1127-1135 (2008).</li><li>Cormio, L., 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=Simultaneous+radical+nephroureterectomy+and+transurethral+distal+ureter+balloon+occlusion+and+detachment.">Simultaneous radical nephroureterectomy and transurethral distal ureter balloon occlusion and detachment.</a> World Journal of Surgical Oncology. 12 (1), 345 (2014).</li><li>Waldert, M., Remzi, M., Klingler, H. C., Mueller, L., Marberger, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+oncological+results+of+laparoscopic+nephroureterectomy+for+upper+urinary+tract+transitional+cell+cancer+are+equal+to+those+of+open+nephroureterectomy.">The oncological results of laparoscopic nephroureterectomy for upper urinary tract transitional cell cancer are equal to those of open nephroureterectomy.</a> Bju International. 103 (1), 66-70 (2010).</li><li>Liu, P., 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+Novel+and+Simple+Modification+for+Management+of+Distal+Ureter+During+Laparoscopic+Nephroureterectomy+Without+Patient+Repositioning:+A+Bulldog+Clamp+Technique+and+Description+of+Modified+Port+Placement.">A Novel and Simple Modification for Management of Distal Ureter During Laparoscopic Nephroureterectomy Without Patient Repositioning: A Bulldog Clamp Technique and Description of Modified Port Placement.</a> Journal of Endourology. 30 (2), 195-200 (2016).</li><li>Xylinas, E., 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=Impact+of+distal+ureter+management+on+oncologic+outcomes+following+radical+nephroureterectomy+for+upper+tract+urothelial+carcinoma.">Impact of distal ureter management on oncologic outcomes following radical nephroureterectomy for upper tract urothelial carcinoma.</a> European Urology. 65 (1), 210-217 (2014).</li></ol>

En traditionell öppen renal urinledaren resektion och manschetten-liknande resektion mestadels involvera övre och undre snitt, som kräver att byta positioner och desinficering de kirurgiska handdukar två gånger. Drifttiden är lång, och mängden trauma är stor. Laparoskopisk renal urinledaren och blåsa ärm resektion har gradvis antagits av urologer sedan minimalt invasiva kirurgi tekniker har använts i stor utsträckning i urologi8. Metoderna för laparoskopisk nephroureterectomy och rad...

Radikal nephroureterectomy är ett standardförfarande för behandling av övre urotelcancer (UTUC)1. Traditionell öppen kirurgi kräver två stora snitt i nedre delen av buken, som är förknippad med en stor mängd trauma och många komplikationer2. Med den snabba utvecklingen av minimalt invasiva tekniker i urologi, laparoskopisk kirurgi har successivt tillämpats i många forskningsstudier. Laparoskopisk kirurgi är identisk med öppen kirurgi vid behandling av tumörer, så de traditionella kirurgiska metoder har successivt ersatts av laparoskopisk kirurgi3.
I laparoskopisk kirurgi, behandling av terminalen urinledaren har varit ett fokusområde och en känd svårighet av operationen. För närvarande, olika alternativ finns för att behandla uretär slutet i laparoskopisk nephroureterectomy. Emellertid, minskningar av svårigheten att operationen och mängden trauma har inte varit möjligt4,5.
Efter år av prospektering, har vårt centrum förbättrats och antagit en ny metod för behandling av terminalen Ureter: precutting den mediala navel vecken inte bara ökar drifts utrymmet utan också minskar svårigheten att operationen och minimerar extra trauma för patienten.

<table>
	<tbody>
		<tr>
			<td>Laparoscopic imaging system</td>
			<td>STORZ</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Pneumoperitoneum</td>
			<td>STORZ</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Ultrasonic scalpel</td>
			<td>Johnson</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Vascular closure clip</td>
			<td>Hem-o-Lock</td>
			<td></td>
			<td></td>
		</tr>
	</tbody>
</table>

technical modification of the terminal ureter during total transperitoneal laparoscopic nephroureterectomy for upper urinary tract urothelial carcinoma

Övre tarmkanalen urotelial carcinoma (UTUC) står för 5% – 10% av alla uroteliala tumörer. Radikal nephroureterectomy är standardbehandling förfarande. För närvarande finns det olika alternativ fortfarande för behandling av uretär slutet under laparoskopisk uretär urinblåsan ärm resektion. Vårt Center har antagit en ny metod för behandling av uretär slutet. Denna nya metod kan öka Operations utrymmet och minska svårigheten att operationen jämfört med nuvarande metoder.

Totalt genomgick 87 patienter kirurgi utan svårigheter, och det fanns inga öppna operationer. Genomsnittsåldern för patienterna var 67,25 ± 9,90 år. Inom denna grupp fanns det 47 fall av njur bäcken cancer, 10 fall av bäcken cancer med uretär cancer, och 30 fall av uretär cancer (10 fall av övre uretär cancer, 9 fall av mellersta uretär cancer, och 11 fall av lägre uretär cancer). Totalt 49 cancer var på vänster sida och 38 cancer var på höger sida. Den genomsnittliga tumör diametern var 3,24 ± 1,47 ...

Watch this Scientific Journal Video about Technical Modification of the Terminal Ureter During Total Transperitoneal Laparoscopic Nephroureterectomy for Upper Urinary Tract Urothelial Carcinoma at JoV

Technical Modification of the Terminal Ureter During Total Transperitoneal Laparoscopic Nephroureterectomy for Upper Urinary Tract Urothelial Carcinoma

Här presenterar vi ett protokoll för att öka det kirurgiska synfält och minska svårigheten att total transperitoneal laparoskopisk nephroureterectomy kirurgi genom precutting navelsträngen ligament innan du behandlar terminalen Ureter.

Teknisk modifiering av terminalen Ureter under total Transperitoneal laparoskopisk Nephroureterectomy för övre urinvägarna Urotelial cancer

Upper tract urothelial carcinoma (UTUC) accounts for 5%&ndash;10% of all urothelial tumors. Radical nephroureterectomy is the standard treatment ...

Vårt center har antagit en ny teknik för att behandla den distala urinledaren. Jämfört med den tidigare, vår nya teknik öka operationsutrymmet och minska svårigheten att förfarandet. Koppla navelpulsådern gör att synfältet öppnas, öka tillgången till det kirurgiska utrymmet och bidra till att minska risken för skador på de omgivande vävnaderna.Dessutom kan denna teknik minska den totala drift och anestesi tid, minska risken för tumörimplantation, och även svårigheten att förfarandet. Den bästa tillämpningen av denna färdighet är för dig att se, men vi kan också använda denna färdighet för att göra andra laparoskopisk kirurgi för att öka arbetsutrymmet. Innan du börjar förfarandet, administrera en intravenös antibiotikum.Efter administrering av generell anestesi, placera patientens friska sida i en 60-graders liggande liggande i midjan så att patienten befi ck en V-formad position på operationsbordet. Placera den andra trocar nära den laterala kanten av rectus abdominis längs umbilical nivån av den drabbade sidan. I tredje trocar, under den drabbade delen av mittlinjen av nyckelbenet.Med patienten i den vänstra laterala position, använd trocar att upprätta pneumoperitoneum och upprätthålla pneumoperitoneum trycket vid 14 millimeter kvicksilver vid mittlinjen av nyckelbenet, och mittpunkten av inguinal ligament, och under xiphoid processen. För att behandla njuren i övre och mellersta urinrör, dissekera bukhinnan på den drabbade sidan för att helt släppa tjocktarmen. Använd en vaskulär stängningsklämma för att frigöra och klämma in urinledaren vid den distala änden av tumören och rubba vävnaden uppåt längs urinledaren tills njurlymfknutor hilum nås.Sekventiellt behandla njurartären och njurvenen att helt befria njuren. Frigör sedan urinledaren till den externa vaskulära nivån. För att behandla terminalen urinledaren, använd en ultraljudskalpell för att öppna den främre bukhinnan av urinledaren.Efter att ha korsat iliacakärlen, identifiera den umbilical mediala höftbenskammen vid vilken umbilical artären är belägen. Skär sedan den mediala iliacammen så att artären kan nå utsida av blåsan. Det är avgörande att skära den mediala höftbenskammen före terminalen urinledaren behandling.Kläm fast och skär den distala änden av kärlstrukturen enligt standardprotokoll. Befria blåsan tills den punkt där urinledaren kommer in i urinblåsan. Skär hela lagret av urinblåsan väggen på den övre sidan av uretal korsningen och suturera hela lagret av urinblåsan med 3-0 absorberbar tråd för att ge dragkraft och att möjliggöra visualisering av den normala urinblåsan slemhinna.Använd sedan en skalpell för att ta bort segmentet urinblåsan vägg och en del av urinblåsan slemhinnan innan helt suturering blåsväggen med resorberbara linjer. När preparatet har lokaliserats, förläng snittet för kanyl A och ta bort preparatet. Ladda sedan det kirurgiska preparatet i preparatpåsen och lager av varje snitt.Vid slutet av förfarandet låta patienten att lägga i sängen i postoperativ vård enhet för cirka en timme med övervakning. När patienten är helt vaken, returnera patienten till avdelningen. I denna representativa analys av 87 patienter som genomgick operationen som visats, var den genomsnittliga patientens ålder 67,25 plus eller minus 9,9 år, med 47 fall av njurlymfknutor bäckenhålorna cancer, 10 fall av bäckenhålorna cancer med ureteral cancer, 10 fall av övre ureteral cancer, 9 fall av mellersta ureteral cancer och 11 fall av lägre ureteral cancer.49 cancerformer var på vänster sida av patienten, och 38 var på höger sida. Den genomsnittliga tumör diameter var 3,24 plus eller minus 1,47 centimeter, och den genomsnittliga drifttiden var 162,5 plus eller minus 45,64 minuter. Volymen av intraoperativ blodförlust var 113,33 plus eller minus 59,74 millileter, och inga patienter krävs perioperativ blodtransfusion.I genomsnitt var dräneringsrören på plats i 4,56 plus eller minus 1,12 dagar, och katetrarna var på plats för 5,63 plus eller minus 2,17 dagar. De postoperativa patologiska stadierna varierade från T-1, N-0, N-0 till T-4, N-0, N-0. Inga komplikationer uppstod under operationerna, även om två patienter hade komplikationer efter operationen.Uppföljningstiden var en till 44 månader med mediantiden för uppföljning på 13 månader. Åtta patienter hade postoperativa tumör återkommande, som alla var urinblåsan återkommande. Excision av umbilical medial iliaca krönet kan avsevärt öka det kirurgiska synfältet och förbättra framgången för förfarandet.Kanske skära den mediala iliaca krönet kan vara en utförs här med sax. Men det har inte rapporterats ofta i litteraturen att presentera.

technical-modification-terminal-ureter-during-total-transperitoneal

Research

JoVE Journal

Medicine

Probe-based Confocal Laser Endomicroscopy of the Urinary Tract: The Technique

Probe-based confocal laser endomicroscopy (CLE) is an emerging optical imaging technology that enables real-time in vivo microscopy of mucosal surfaces during standard endoscopy. With applications currently in the respiratory1 and gastrointestinal tracts,2-6 CLE has also been explored in the urinary tract for bladder cancer diagnosis.7-10 Cellular morphology and tissue microarchitecture can be resolved with micron scale resolution in real time, in addition to dynamic imaging of the normal and pathological vasculature.7
The probe-based CLE system (Cellvizio, Mauna Kea Technologies, France) consists of a reusable fiberoptic imaging probe coupled to a 488 nm laser scanning unit. The imaging probe is inserted in the working channels of standard flexible and rigid endoscopes. An endoscope-based CLE system (Optiscan, Australia), in which the confocal endomicroscopy functionality is integrated onto the endoscope, is also used in the gastrointestinal tract. Given the larger scope diameter, however, application in the urinary tract is currently limited to ex vivo use.11 Confocal image acquisition is done through direct contact of the imaging probe with the target tissue and recorded as video sequences. As in the gastrointestinal tract, endomicroscopy of the urinary tract requires an exogenenous contrast agent&mdash;most commonly fluorescein, which can be administered intravenously or intravesically. Intravesical administration is a well-established method to introduce pharmacological agents locally with minimal systemic toxicity that is unique to the urinary tract. Fluorescein rapidly stains the extracellular matrix and has an established safety profile.12 Imaging probes of various diameters enable compatibility with different caliber endoscopes. To date, 1.4 and 2.6 mm probes have been evaluated with flexible and rigid cystoscopy.10 Recent availability of a &lt; 1 mm imaging probe13 opens up the possibility of CLE in the upper urinary tract during ureteroscopy. Fluorescence cystoscopy (i.e. photodynamic diagnosis) and narrow band imaging are additional endoscope-based optical imaging modalities14 that can be combined with CLE to achieve multimodal imaging of the urinary tract. In the future, CLE may be coupled with molecular contrast agents such as fluorescently labeled peptides15 and antibodies for endoscopic imaging of disease processes with molecular specificity.

Probe-based confocal laser endomicroscopy enables real-time microscopy of the human urinary tract during cystoscopy, providing dynamic, intravital imaging of pathological states such as bladder cancer with cellular resolution. Endomicroscopy may augment the diagnostic accuracy of standard white light endoscopy and provide intraoperative image guidance to improve surgical resection.

Sondbaserad Confocal Laser Endomicroscopy av urinvägarna: Tekniken

Probe-based  confocal laser endomicroscopy (CLE) is an emerging optical imaging technology  that enables real-time in vivo microscopy of mucosal surfaces ...

Technical Aspects of the Mouse Aortocaval Fistula

Technical aspects of creating an arteriovenous fistula in the mouse are discussed. Under general anesthesia, an abdominal incision is made, and the aorta and inferior vena cava (IVC) are exposed. The proximal infrarenal aorta and the distal aorta are dissected for clamp placement and needle puncture, respectively. Special attention is paid to avoid dissection between the aorta and the IVC. After clamping the aorta, a 25 G needle is used to puncture both walls of the aorta into the IVC. The surrounding connective tissue is used for hemostatic compression. Successful creation of the AVF will show pulsatile arterial blood flow in the IVC. Further confirmation of successful AVF can be achieved by post-operative Doppler ultrasound.

The goal is to produce an arteriovenous fistula that is simple and reproducible. This method does not use sutures or glue adhesive. Therefore the samples can be used with the least amount of foreign materials for analysis.

Tekniska aspekterna av mus Aortocaval Fistula

Technical aspects of creating an arteriovenous fistula in the mouse are discussed. Under general anesthesia, an abdominal incision is made, and the aorta ...

Dual-phase Cone-beam Computed Tomography to See, Reach, and Treat Hepatocellular Carcinoma during Drug-eluting Beads Transarterial Chemo-embolization

The advent of cone-beam computed tomography (CBCT) in the angiography suite has been revolutionary in interventional radiology. CBCT offers 3 dimensional&#160;(3D) diagnostic imaging in the interventional suite and can enhance minimally-invasive therapy beyond the limitations of 2D angiography alone. The role of CBCT has been recognized in transarterial chemo-embolization (TACE) treatment of hepatocellular carcinoma (HCC). The recent introduction of a CBCT technique: dual-phase CBCT (DP-CBCT) improves intra-arterial HCC treatment with drug-eluting beads (DEB-TACE). DP-CBCT can be used to localize liver tumors with the diagnostic accuracy of multi-phasic multidetector computed tomography (M-MDCT) and contrast enhanced magnetic resonance imaging (CE-MRI) (See the tumor), to guide intra-arterially guidewire and microcatheter to the desired location for selective therapy (Reach the tumor), and to evaluate treatment success during the procedure (Treat the tumor). The purpose of this manuscript is to illustrate how DP-CBCT is used in DEB-TACE to see, reach, and treat HCC.

Dual-phase cone-beam computed tomography (DP-CBCT) is a useful intraprocedural imaging technique for transarterial chemo-embolization treatment with drug-eluting beads of hepatocellular carcinoma. DP-CBCT has been used to perform three major steps in oncologic interventional radiology: tumor localization (see), navigation and intraprocedural catheter guidance (reach), and intraprocedural evaluation of treatment success (treat).

The advent of cone-beam computed tomography (CBCT) in the angiography suite has been revolutionary in interventional radiology. CBCT offers 3 ...

Bladder Smooth Muscle Strip Contractility as a Method to Evaluate Lower Urinary Tract Pharmacology

We describe an in vitro method to measure bladder smooth muscle contractility, and its use for investigating physiological and pharmacological properties of the smooth muscle as well as changes induced by pathology. This method provides critical information for understanding bladder function while overcoming major methodological difficulties encountered in in vivo experiments, such as surgical and pharmacological manipulations that affect stability and survival of the preparations, the use of human tissue, and/or the use of expensive chemicals. It also provides a way to investigate the properties of each bladder component (i.e. smooth muscle, mucosa, nerves) in healthy and pathological conditions.
The urinary bladder is removed from an anesthetized animal, placed in Krebs solution and cut into strips. Strips are placed into a chamber filled with warm Krebs solution. One end is attached to an isometric tension transducer to measure contraction force, the other end is attached to a fixed rod. Tissue is stimulated by directly adding compounds to the bath or by electric field stimulation electrodes that activate nerves, similar to triggering bladder contractions in vivo. We demonstrate the use of this method to evaluate spontaneous smooth muscle contractility during development and after an experimental spinal cord injury, the nature of neurotransmission (transmitters and receptors involved), factors involved in modulation of smooth muscle activity, the role of individual bladder components, and species and organ differences in response to pharmacological agents. Additionally, it could be used for investigating intracellular pathways involved in contraction and/or relaxation of the smooth muscle, drug structure-activity relationships and evaluation of transmitter release.
The in vitro smooth muscle contractility method has been used extensively for over 50 years, and has provided data that significantly contributed to our understanding of bladder function as well as to pharmaceutical development of compounds currently used clinically for bladder management.

This manuscript presents a simple, yet powerful, in vitro method for evaluating smooth muscle contractility in response to pharmacological agents or nerve stimulation. Main applications are drug screening and understanding tissue physiology, pharmacology,&#160;and pathology.

Bladder Smooth Muscle Strip Kontraktilitet som en metod för att utvärdera Lower Urinary Tract farmakologi

We describe an in vitro method to measure bladder smooth muscle contractility, and its use for investigating physiological and pharmacological properties ...

Ultrasonography of the Adult Male Urinary Tract for Urinary Functional Testing

The incidence of clinical benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) is increasing due to the aging population, resulting in a significant economic and quality of life burden. Transgenic and other mouse models have been developed to recreate various aspects of this multifactorial disease; however, methods to accurately quantitate urinary dysfunction and the effectiveness of new therapeutic options are lacking. Here, we describe a method that can be used to measure bladder volume and detrusor wall thickness, urinary velocity, void volume and void duration, and urethral diameter. This would allow for the evaluation of disease progression and treatment efficacy over time. Mice were anesthetized with isoflurane, and the bladder was visualized by ultrasound. For non-contrast imaging, a 3D image was taken of the bladder to calculate volume and evaluate shape; the bladder wall thickness was measured from this image. For contrast-enhanced imaging, a catheter was placed through the dome of the bladder using a 27-gauge needle connected to a syringe by PE50 tubing. A bolus of 0.5 mL of contrast was infused into the bladder until a urination event occurred. Urethral diameter was determined at the point of the Doppler velocity sample window during the first voiding event. Velocity was measured for each subsequent event yielding a flow rate. In conclusion, high frequency ultrasound proved to be an effective method for assessing bladder and urethral measurements during urinary function in mice. This technique may be useful in the assessment of novel therapies for BPH/LUTS in an experimental setting.

We describe the use of high frequency ultrasound with contrast imaging as a method to measure bladder volume, bladder wall thickness, urine velocity, void volume, void duration, and urethral diameter. This strategy can be used to assess voiding dysfunction and treatment efficacy in various mouse models of lower urinary tract dysfunction (LUTD).

Ultraljud av den vuxna manliga urinvägarna för urin funktionella tester

The incidence of clinical benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) is increasing due to the aging population, resulting ...

Technical Detail for Robot Assisted Pancreaticoduodenectomy

Since its first report in 2003, robotic pancreaticoduodenectomy (RPD) has gained popularity among pancreatic surgeons. Inherent advantages of the robotic platform, including three-dimensional vision, wristed instruments, and improved ergonomics, allow the surgeon to recapitulate the principles of open pancreatoduodenectomy allowing safe oncologic dissection, hemostasis, and meticulous reconstruction. Over the course of the past decade, significant strides have been achieved in outlining the safety, feasibility, and learning curve of the robotic Whipple. When performed by high volume pancreatic surgeons experienced in RPD, recent comparative effectiveness studies show potential advantages compared to the open technique, including reductions in hospital stay and morbidity. National data also show reductions in conversion rates compared to its laparoscopic counterpart. Although long-term oncologic data are still needed, short-term oncologic surrogates of margin resection and lymph node harvest suggest no compromise in oncologic outcomes. As pancreatic surgeons increasingly integrate robotics into their practice, proficiency-based training and credentialing will be necessary for the safe application and dissemination of RPD. Here, we provide the detailed steps of a robotic pancreaticoduodenectomy performed at the University of Pittsburgh Medical Center.&#160;

The following manuscript details a stepwise approach to the robot-assisted pancreaticoduodenectomy performed at the University of Pittsburgh Medical Center.

Teknisk detalj för robot assisterad pancreaticoduodenectomy

Since its first report in 2003, robotic pancreaticoduodenectomy (RPD) has gained popularity among pancreatic surgeons. Inherent advantages of the robotic ...

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.

Kirurgiska tekniker för att optimera äggstocksreserven under laparoskopisk cystektomi för äggstockscancer

Surgical management of ovarian endometrioma in patients desiring fertility is complicated by the need to balance maximal resection of disease with efforts ...

Laparoscopic Pancreatoduodenectomy for Pancreatic Cancer Using In-Situ No-Touch Isolation Technique

Laparoscopic pancreatoduodenectomy (LPD) is a standard radical operation for pancreatic head malignant tumors by now. Due to the complex laparoscopic resection and reconstruction techniques, it is difficult to perform LPD for patients with locally advanced pancreatic head cancer after neoadjuvant therapy. Our team initiates LPD using the in-situ No-Touch isolation technique. The innovation and optimization of this modified No-Touch isolation technique emphasize exploring the distal section of superior mesenteric vein&#160;(SMV) and the left side of the superior mesenteric artery (SMA) prior to evaluating the resectability by subcolonic mesenteric approach, which is an ideal exploring approach. After that, we use the median-anterior, and left-posterior of SMA approaches to cut off the blood flow of the pancreatic head to make the tumor isolated intact, then move and dissect the tumor. It is a process fitting the surgical principle of tumor-free. This article aims to demonstrate the feasibility and safety of performing LPD using the in-situ No-Touch isolation technique, which might elevate the R0 resection rate. It is an oncological ideal operation process.

Laparoscopic Pancreatoduodenectomy for Pancreatic Cancer Using In-Situ No-Touch Isolation Technique

No-Touch isolation procedures might prevent the dissemination of cancer cells from the primary tumor. However, these techniques are not widely accepted in laparoscopic pancreatoduodenectomy (LPD) by now. We herein present in-situ No-Touch isolation LPD with partial resection and reconstruction of the superior mesenteric vein (SMV) for pancreatic cancer after neoadjuvant therapy.

Laparoskopisk pankreatoduodenektomi för bukspottskörtelcancer med hjälp av in-situ beröringsfri isoleringsteknik

Laparoscopic pancreatoduodenectomy (LPD) is a standard radical operation for pancreatic head malignant tumors by now. Due to the complex laparoscopic ...

Laparoscopic Oocyte Retrieval and Cryopreservation during Vaginoplasty for Treatment of Mayer-Rokitansky-Kuster-Hauser Syndrome

In Mayer-Rokitansky-Kuster-Hauser Syndrome (MRKHS) patients who are scheduled for laparoscopic vaginoplasty and have a desire for biological motherhood, we propose that a concomitant laparoscopic oocyte retrieval for cryopreservation is performed. Oocyte retrieval is pursued at the beginning of the laparoscopy. Right and left 5 mm trocars are positioned, through which a 17 G ovum aspiration needle is used for puncture of the right and left ovaries, respectively. To facilitate exposure of the follicles, the ovaries are mobilized and held with laparoscopic forceps.
When aspirating multiple follicles near each other, the needle tip is retained in the ovary to reduce the number of times that the ovarian cortex is transfixed and due to the inherent risk of bleeding. Subsequent steps are unchanged compared to the Davydov laparoscopic modified technique for vaginoplasty. Prior to surgery, controlled ovarian stimulation is performed with a gonadotropin hormone-releasing hormone (Gn-RH) antagonist protocol, and the concomitant procedure of oocyte retrieval and vaginoplasty is scheduled 36 h after the final follicular maturation trigger. Follicular fluid is collected in the same 10 mL sterile tubes used during transvaginal oocyte retrieval and transferred in a warming block (37 &#176;C) to the assisted reproduction laboratory, where mature (metaphase II) oocytes are vitrified.
In this case, a series of 23 women with MRKH, oocytes were successfully retrieved and cryopreserved in all patients; vaginoplasty was subsequently conducted without modifications, and the inpatient and outpatient postoperative care (day of urinary catheter removal, day of hospital discharge, dilator use, and comfort at follow-up) remained unaffected. One postoperative complication occurred in one patient (fever developing on day 5 post surgery and intraperitoneal fluid detection on transabdominal ultrasound) and resolved after conservative treatment. Rather than performing surgical vaginoplasty and delaying oocyte retrieval in MRKH patients, this approach combines both procedures in a single laparoscopy, thereby minimizing surgical invasiveness and anesthesiologic risks.

A dedicated team can offer Mayer-Rokitansky-Kuster-Hauser patients the option to perform controlled ovarian stimulation and oocyte cryopreservation at the time of laparoscopic vaginoplasty.

Laparoskopisk äggcellshämtning och kryokonservering under vaginoplastik för behandling av Mayer-Rokitansky-Kuster-Hauser syndrom

In Mayer-Rokitansky-Kuster-Hauser Syndrome (MRKHS) patients who are scheduled for laparoscopic vaginoplasty and have a desire for biological motherhood, ...

Laparoscopic Non-Mesh Cerclage Pectopexy for Pelvic Organ Prolapse

Pelvic organ prolapse (POP) is widespread among the female population and significantly impairs the patient's quality of life. It is important to restore apical support for treating POP. Sacrocolpopexy and pectopexy are indicated for apical prolapse. Using a synthetic mesh in these techniques increases success by enhancing apical support. However, the implantation of synthetic mesh is associated with mesh-related complications. In addition, the exorbitant cost of synthetic mesh and lack of universal access limit the popularity of these procedures. The current study develops a unique technique known as laparoscopic non-mesh cerclage pectopexy (LNMCP), in which permanent cervical cerclage sutures are embedded in the round ligament until the iliopectineal ligament. The iliopectineal ligament was sutured, resulting in a firm cervical suspension. The procedure was successfully performed in 16 cases in the hospital. The surgical duration was 67.8 min &plusmn; 15.5 min, and the blood loss was 73.1 mL &plusmn; 51.1 mL. No procedural complications were seen. LNMCP is associated with an objective success rate of 100% and a subjective success rate of 93.8%. LNMCP for patients with apical prolapse obviates the need for a mesh, thereby avoiding complications associated with mesh erosion and reducing medical costs. In addition, it is easy to perform even in resource-poor areas without access to synthetic mesh.

The present pilot study describes the development of laparoscopic non-mesh cerclage pectopexy to treat pelvic organ prolapse. The procedure can be used to prevent any complications associated with the use of mesh.

Laparoskopisk icke-mesh cerclage pectopexy för bäckenorganprolaps

Pelvic organ prolapse (POP) is widespread among the female population and significantly impairs the patient's quality of life. It is important to restore ...