作者感谢中国国家重点研发计划（Grant 2017YFC840102）的支持。

此处描述的所有方法均已获得北京医院伦理委员会的批准。手术适应症根据欧洲泌尿外科协会 （European Association of Urology） 针对非神经源性男性 LUTS 的指南。禁忌证包括疑似前列腺癌或逼尿肌功能障碍。
1. 操作仪器
<ol><li>确保具有功率（包括连续模式 （980-80 W） 的半导体激光器 （100 nm） 设备的可用性。</li>
	<li>使用激光光纤和 0.9% 盐水溶液进行术中膀胱冲洗。</li>
	<li>使用 26 F 激光电切镜获得良好的可视化并提高效率。</li>
</ol>2. 操作准备
<ol><li>手术当天进行皮肤准备。</li>
	<li>术前为所有患者提供静脉注射抗生素10. 注意:手术前 30 分钟提供头孢呋辛钠（1.5 g 在 100 mL 0.9% 氯化钠中）。</li>
	<li>麻醉前，让患者躺在手术台上。 注意:全身麻醉是有效且适合于此手术的。麻醉师应根据患者的一般情况确定麻醉模式。</li>
	<li>以无菌方式将患者覆盖在背侧截石位置。</li>
</ol>3. 操作步骤
<ol><li>观察<ol><li>通过电切镜 （15-30°） 直接观察尿道、verumontanum、膀胱颈、输尿管口、膀胱粘膜和小梁增生。</li>
	</ol></li>
	<li>设计剜除范围（丘比特箭头）。<ol><li>用激光圆切开（到腺体的深度，宽度约 3-4 毫米）膀胱颈粘膜（图1）。</li>
		<li>用激光圆形切开（到腺体的深度，宽度约 3-4 毫米）止回端的前列腺尿道粘膜（图2）。 注意:切开前确认解剖标记，以避免损伤膀胱颈粘膜和尿道括约肌。手术期间使用 80-100 W 的激光功率，止血除外。</li>
		<li>将膀胱颈的同心圆和尿道后部的前列腺顶点在 12 点钟位置连接起来。</li>
		<li>用激光切开左叶和右叶（图 3）。 注意:预先切开后尿道的 12 点钟位置后，保留远端粘膜。在膀胱颈部和前列腺顶点形成的同心圆称为丘比特箭头。</li>
	</ol></li>
	<li>创建频道<ol><li>在前列腺心尖的 5 点钟和 7 点钟位置找到手术囊。</li>
		<li>在 5 点钟和 7 点钟位置的手术囊位置找到手术囊。</li>
		<li>用激光连接 5 点钟和 7 点钟位置的手术囊位置（图 4）。</li>
		<li>在前列腺心尖的 6 点钟位置，用激光将正中叶与手术囊从前列腺心尖分离到膀胱颈（图5）。 注意:如果前列腺体积为 >80 mL，则正中叶和外叶将在前列腺心尖的 5 点钟和 7 点钟位置完全分离。</li>
	</ol></li>
	<li>左肺叶和右肺叶摘除术<ol><li>沿逆时针方向，用电切镜将 6 点钟和 12 点钟位置的右叶从前列腺顶点切入膀胱颈（图6）。</li>
		<li>顺时针方向，从前列腺顶点到膀胱颈的 6 点钟和 12 点钟处摘除左叶（图7）。</li>
		<li>眼球摘除术后将所有腺体推入膀胱。 注意:如果前列腺体积为 >80 mL，请按适当的顺序摘除正中叶和外叶;然后，推入膀胱。</li>
	</ol></li>
	<li>止血<ol><li>使用较低的激光功率 （50 W） 止血手术部位周围。保持适当的距离（即 1-3 毫米）。</li>
	</ol></li>
	<li>粉碎前列腺组织。<ol><li>用分碎器将去核的前列腺组织分碎成小块（尽可能小），然后从膀胱中取出组织（图8）。</li>
	</ol></li>
	<li>插管<ol><li>从尿道中取出分碎器。</li>
		<li>用利多卡因凝胶充分润滑尿道后，将 22 F Foley 导管通过尿道口轻轻放入膀胱腔中，球囊中加入 30 mL 水。</li>
	</ol></li>
	<li>术后护理10<ol><li>让患者术后在护理病房的床上躺下约 3 小时，直到他们从麻醉中完全醒来。确保在此期间有病人监护仪和医用氧气可用。</li>
		<li>患者完全醒来后，将患者送回病房。让患者开始喝一些水和吃一些食物。记录任何尿量并注意尿液的颜色。</li>
	</ol></li>
</ol>

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作者没有什么可披露的。

目前，980 毫米半导体激光器开始用于治疗 BPH5。很少有报告描述相关的临床研究。与 TURP 治疗 BPH 的效果相比，许多研究表明，DiLEP 引起的失血量更少，排尿功能更好，导管保留时间更短 9,13,14,15。
在这里，我们分享了我们使用 mDiLEP 的经验。在我们的研究中，与传统的 DiLEP 9,16,17 相比，我们在眼球摘除前用激光圆形切开了膀胱颈粘膜和外端近端的前列腺尿道粘膜。然后，我们在 12 点钟位置连接了膀胱颈的同心圆和前列腺的顶点。这被称为丘比特之箭。尽管该程序似乎增加了手术时间，但相对于其他研究中描述的结果，它并没有增加总手术时间。它还带来了许多好处:首先，尿道括约肌受到保护，免受伤害，因为我们在18 瓣近端圆形切开了前列腺尿道粘膜。前列腺顶端保存的尿道粘膜可以起到肛垫的作用，让尿道括约肌更好地工作，提高尿漏的预防效果。由于上述原因，本研究中没有患者报告压力性尿失禁。其次，外科医生可以通过用激光圆切开膀胱颈粘膜，在划定的手术区域内进行手术，这可以保护输尿管口免受损伤。这两个步骤在传统操作中不执行。一些研究 11,19,20 报道了尿道括约肌和输尿管口损伤的发生率相对较高，尤其是对于没有经验的外科医生，这些并发症的发生对医生和患者来说都是沉重的负担。第三，操作者可以通过切开膀胱颈粘膜和位于 verumontanum 近端的前列腺尿道粘膜来确定手术范围。这有助于外科医生找到前列腺手术囊，减少前列腺囊穿孔的发生，并促进正中叶和外叶的摘除术21。根据我们的经验，这种涉及丘比特之箭的操作更容易掌握，并有助于这项新技术的推广。
与 BPH 治疗中使用的现有程序相比，DiLEP 显示出令人满意的短期临床结果。此外，这种有前途的技术具有明显的优势，因为它可以防止尿失禁。然而，需要更多的研究来证明这种技术的长期疗效。只有这样，这项技术才能发展成为未来前列腺摘除术方案的蓝图。

与传统的经尿道前列腺切除术 （TURP） 相比，激光手术因其更好的患者耐受性、较低的术中失血量、疗效和更短的术后恢复时间而逐渐变得更加流行 4,5。
近年来，发展最快的技术涉及使用各种波长的激光器。目前，许多类型具有不同特性的激光器可用于完成前列腺眼球摘除术。自2007年二极管激光器被美国FDA批准用于治疗前列腺增生以来，由于其出色的切割能力和止血效果，其在BPH治疗中的应用逐渐增加6。激光波长决定了水和血红蛋白的吸收程度。波长为 980 nm 的二极管激光器提供最高的水和血红蛋白综合吸收率。组织穿透能力为 0.5 mm，可在更深的组织内产生凝血作用，使其具有非常好的组织消融止血能力 7,8。
许多研究中心已开始使用 DiLEP 治疗良性前列腺增生。在实践中，传统的 DiLEP 学习曲线较长，在尿道括约肌保护方面没有明显优势9。基于以上原因，我中心对传统的 DiLEP 进行了改造，以提高二极管激光治疗 BPH 患者的价值。

<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

在老龄化男性人群中，良性前列腺增生 （BPH） 引起的下尿路症状 （LUTS） 的发生是一个常见问题。在这里，我们介绍了一种称为 980 nm 二极管激光剜除术 （DiLEP） 的新技术来治疗 BPH1。二极管激光器可以同时吸收水和血红蛋白，因此它们有利于切割和止血2。二极管激光器于 2007 年获得 FDA 批准，并因其有效的切割和止血作用而被用于治疗 BPH3。与其他技术（如 TURP、HoLEP 和 PVP）相比，DiLEP 具有多项优势。在手术过程中，我们定义高体积前列腺的边界，并通过燃烧两个环和一个凹槽（如丘比特箭）用二极管激光器将其分成三个叶。与其他手术相比，mDiLEP 的术中并发症更少，学习曲线更短，并且实现了更多的组织切除。

我们的一项研究共纳入了 40 例接受 DiLEP 的 BPH 患者。采用独立样本 t 检验作为统计方法。所有患者均成功完成手术。几乎所有患者在术后 5 天内拔除导管（表 1）。所有患者均在术后第1 、 3 和 12 个月返回医院进行随访检查。使用国际前列腺症状评分 （IPSS）11 和生活质量 （QoL）1 工具筛查、快速诊断、跟踪症状并指导 BPH 的管理。这些也可用于评估 BPH 治疗的疗效。与基线值相比，术后 1 、 3 和 12 个月国际前列腺症状评分 （IPSS） 分别显著下降至 38.15% 、 31.92% 和 18.70% （均 p < 0.001），QoL 显著下降至 57.89% 、 43.94% 和 20.78% （均 p <分别为 0.001）。对于客观参数，与基线相比，平均 Qmax 增加了近 3 倍，随访期间的平均排尿后残余量减少了近 4 倍。与术前值相比，术后前列腺体积急剧下降 （p < 0.001）（表2）。
本研究期间报告的围手术期和术后并发症见 表 3。根据改良的 Clavien Dindo 分类系统12，一种广泛使用且权威的手术并发症分级工具，术中患者无并发症，只有 4 例报告术后 1 级并发症12。
<img alt="Figure 1" class="xfigimg" src="/files/ftp_upload/60532/60532fig1.jpg"> 图 1:用激光圆形切开膀胱颈粘膜。<a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/60532/60532fig1large.jpg" target="_blank">请单击此处查看此图的较大版本。</a>
<img alt="Figure 2" class="xfigimg" src="/files/ftp_upload/60532/60532fig2.jpg"> 图 2:用激光圆形切开 verumontanum 近端的前列腺尿道粘膜。<a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/60532/60532fig2large.jpg" target="_blank">请单击此处查看此图的较大版本。</a>
<img alt="Figure 3" class="xfigimg" src="/files/ftp_upload/60532/60532fig3.jpg"> 图 3:在 12 点钟位置的前列腺顶点切开左叶和右叶。<a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/60532/60532fig3large.jpg" target="_blank">请单击此处查看此图的较大版本。</a>
<img alt="Figure 4" class="xfigimg" src="/files/ftp_upload/60532/60532fig4.jpg"> 图 4:用激光圆形切开膀胱颈粘膜。<a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/60532/60532fig4large.jpg" target="_blank">请单击此处查看此图的较大版本。</a>
<img alt="Figure 5" class="xfigimg" src="/files/ftp_upload/60532/60532fig5.jpg"> 图 5:在前列腺心尖的 5 点钟和 7 点钟位置找到手术囊，并用激光连接 5 点钟和 7 点钟位置的手术囊。<a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/60532/60532fig5large.jpg" target="_blank">请单击此处查看此图的较大版本。</a>
<img alt="Figure 6" class="xfigimg" src="/files/ftp_upload/60532/60532fig6.jpg"> 图 6:逆时针方向，从前列腺顶点到膀胱颈的 6 点钟和 12 点钟位置摘除右叶。<a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/60532/60532fig6large.jpg" target="_blank">请单击此处查看此图的较大版本。</a>
<img alt="Figure 7" class="xfigimg" src="/files/ftp_upload/60532/60532fig7.jpg"> 图 7:顺时针方向，从前列腺顶点到膀胱颈的 6 点钟和 12 点钟位置摘除左叶。<a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/60532/60532fig7large.jpg" target="_blank">请单击此处查看此图的较大版本。</a>
<img alt="Figure 8" class="xfigimg" src="/files/ftp_upload/60532/60532fig8.jpg"> 图 8:使用分碎器将去核的前列腺组织切成小块，然后从膀胱中取出组织。<a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/60532/60532fig8.jpg" target="_blank">请单击此处查看此图的较大版本。</a>
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always"><tbody><tr><td>参数</td>
			<td>数据</td>
		</tr><tr><td>年龄 （y）</td>
			<td>73.35±7.84</td>
		</tr><tr><td>前列腺体积 （ml）</td>
			<td>106.40±19.01</td>
		</tr><tr><td>手术时间（分钟）</td>
			<td>71.18±16.55</td>
		</tr><tr><td>灌注液量 （L）</td>
			<td>80 年 2 月 28 日±13 月 28 日</td>
		</tr><tr><td>术后冲洗时间 （h）</td>
			<td>13.47±1.83</td>
		</tr><tr><td>血红蛋白降低 （g/L）</td>
			<td>2.62±1.24</td>
		</tr><tr><td>导管持续时间 （d）</td>
			<td>4.25±0.08</td>
		</tr><tr><td>住院时间 （d）</td>
			<td>4.60±0.77 元</td>
		</tr><tr><td>随访时间（m）</td>
			<td>12.45±1.75 元</td>
		</tr><tr><td colspan="2">数据显示为 SD ±平均值;BPH: 良性前列腺增生;二极管激光前列腺剜除术;SD:标准差</td>
		</tr></tbody></table>表 1:40 例接受 DiLEP 的 BPH 患者的围手术期数据。
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always"><tbody><tr><td>参数</td>
			<td>术前</td>
			<td>1 分钟</td>
			<td>3 分钟</td>
			<td>12 分钟</td>
			<td>P 值</td>
		</tr><tr><td>Qmax （毫升/分钟）</td>
			<td>7.12±2.94 α，β，γ</td>
			<td>21 月 19 ± 2 月 18 日</td>
			<td>22.24±2.02</td>
			<td>19.73±1.80 元</td>
			<td><0.001</td>
		</tr><tr><td>PVR（毫升）</td>
			<td>价格 113.22±33.56 α，β，γ</td>
			<td>98 年 3 月 27 日± 3 日</td>
			<td>25 月 5 ± 4 月 21 日</td>
			<td>65 月 31 日± 6 月 65 日</td>
			<td><0.001</td>
		</tr><tr><td>IPSS 公司</td>
			<td>23.15±7.44 α，β，γ</td>
			<td>8.37±2.49</td>
			<td>7.37±1.94</td>
			<td>4.33±1.79</td>
			<td><0.001</td>
		</tr><tr><td>生活质量</td>
			<td>3,80±0,88 α，β，γ</td>
			<td>2.20±0.89</td>
			<td>1,67±0.65</td>
			<td>0.79±0.66</td>
			<td><0.001</td>
		</tr><tr><td>光伏（毫升）</td>
			<td>106.40±19.01</td>
			<td>——</td>
			<td>——</td>
			<td>22 月 8 ± 4 月 28 日</td>
			<td><0.001</td>
		</tr><tr><td colspan="6">Qmax = 最大流速;PVR = 排尿后残余;IPSS = 国际前列腺症状评分;QoL = 生活质量;PV = 前列腺体积</td>
		</tr><tr><td colspan="6">α: 术前和术后 1 个月组差异有统计学意义;β:之间的显著差异 术前和术后 3 个月组;γ:术前和术后 12 个月差异显著</td>
		</tr></tbody></table>表 2:基线和术后 1、3 和 12 个月的数据参数。
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always"><tbody><tr><td>并发症</td>
			<td>患者，n （%）</td>
			<td>年级</td>
		</tr><tr><td>术中</td>
			<td></td>
			<td></td>
		</tr><tr><td>前列腺包膜穿孔</td>
			<td>0</td>
			<td>3b</td>
		</tr><tr><td>输血</td>
			<td>0</td>
			<td>2</td>
		</tr><tr><td>TURP 综合征</td>
			<td>0</td>
			<td>4</td>
		</tr><tr><td>膀胱壁损伤</td>
			<td>0</td>
			<td>2</td>
		</tr><tr><td>输尿管口损伤</td>
			<td>0</td>
			<td>2</td>
		</tr><tr><td>尿道括约肌损伤</td>
			<td>0</td>
			<td>2</td>
		</tr><tr><td>术后</td>
			<td></td>
			<td></td>
		</tr><tr><td>膀胱抽搐</td>
			<td>2 (5%)</td>
			<td>1</td>
		</tr><tr><td>急迫性尿失禁</td>
			<td>2 (5%)</td>
			<td>1</td>
		</tr><tr><td>压力性尿失禁</td>
			<td>0</td>
			<td>2</td>
		</tr><tr><td>重新放置导管</td>
			<td>0</td>
			<td>1</td>
		</tr><tr><td colspan="3">根据修改后的 Clavien-Dindo 分类系统对并发症进行分级</td>
		</tr></tbody></table>表 3:40 例接受 DiLEP 的 BPH 患者的围手术期和术后并发症。

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

在这里，我们提出了一种改良的 980 nm 二极管激光剜除术治疗大体积良性前列腺增生的方案。

使用 980 nm 二极管激光进行前列腺摘除术治疗良性前列腺增生

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

enucleation-prostate-for-treatment-benign-prostatic-hyperplasia-using

Nanyang Technological University

Research

JoVE Journal

Medicine

2.0K 次观看.  Beijing Hospital. 在这里，我们提出了一种改良的 980 nm 二极管激光剜除术治疗大体积良性前列腺增生的方案。

视频: Enucleation of the Prostate for the Treatment of Benign Prostatic Hyperplasia Using a 980 nm Diode Laser

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

New therapies for two common prostate diseases, prostate cancer (PrCa) and benign prostatic hyperplasia (BPH), depend critically on experiments evaluating their hormonal regulation. Sex steroid hormones (notably androgens and estrogens) are important in PrCa and BPH; we probe their respective roles in inducing prostate growth and carcinogenesis in mice with experiments using compressed hormone pellets. Hormone and/or drug pellets are easily manufactured with a pellet press, and surgically implanted into the subcutaneous tissue of the male mouse host. We also describe a protocol for the evaluation of hormonal carcinogenesis by combining subcutaneous hormone pellet implantation with xenografting of prostate cell recombinants under the renal capsule of immunocompromised mice. Moreover, subcutaneous hormone pellet implantation, in combination with renal capsule xenografting of BPH tissue, is useful to better understand hormonal regulation of benign prostate growth, and to test new therapies targeting sex steroid hormone pathways.

We describe the manufacture of compressed hormone pellets, as well as subcutaneous surgical implantation into mice. This strategy can be combined with the growth of cell and tissue xenografts under the renal capsule of athymic nude mice to evaluate hormonal carcinogenesis and regulation of benign prostate growth.

肾小囊和异种移植皮下颗粒植入前列腺癌发生和良性前列腺增生症的评价

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

科研

医学

Laser-capture Microdissection of Human Prostatic Epithelium for RNA Analysis

The prostate gland contains a heterogeneous milieu of stromal, epithelial, neuroendocrine and immune cell types. Healthy prostate is comprised of fibromuscular stroma surrounding discrete epithelial-lined secretory lumens and a very small population of immune and neuroendocrine cells. In contrast, areas of prostate cancer have increased dysplastic luminal epithelium with greatly reduced or absent stromal population. Given the profound difference between stromal and epithelial cell types, it is imperative to separate the cell types for any type of downstream molecular analysis. Despite this knowledge, the bulk of gene expression studies compare benign prostate to cancer without micro-dissection, leading to stromal bias in the benign samples. Laser-capture micro-dissection (LCM) is an effective method to physically separate different cell types from a specimen section. The goal of this protocol is to show that RNA can be successfully isolated from LCM-collected human prostatic epithelium and used for downstream gene expression studies such as RT-qPCR and RNAseq.

The goal of this protocol is to use laser-capture micro-dissection as an effective method to isolate pure populations of cell types from heterogeneous prostate tissues for downstream RNA analysis.

人类前列腺上皮的激光捕获显微切割的RNA分析

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

Approximately 30% of epilepsy patients are refractory to antiepileptic drugs. In these cases, surgery is the only alternative to eliminate/control seizures. However, a significant minority of patients continues to exhibit post-operative seizures, even in those cases in which the suspected source of seizures has been correctly localized and resected. The protocol presented here combines a clinical procedure routinely employed during the pre-operative evaluation of temporal lobe epilepsy (TLE) patients with a novel technique for network analysis. The method allows for the evaluation of the temporal evolution of mesial network parameters. The bilateral insertion of foramen ovale electrodes (FOE) into the ambient cistern simultaneously records electrocortical activity at several mesial areas in the temporal lobe. Furthermore, network methodology applied to the recorded time series tracks the temporal evolution of the mesial networks both interictally and during the seizures. In this way, the presented protocol offers a unique way to visualize and quantify measures that considers the relationships between several mesial areas instead of a single area.

This protocol describes a procedure to track the evolution of mesial network measures in temporal lobe epilepsy (TLE) patients. It is based on the combination of intracranial recordings with a novel numerical technique for data analysis. Specifically, we present a protocol for network analyses of foramen ovale recordings.

在耐药性颞叶癫痫患者卵圆孔电极记录的网络分析

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

Today&#39;s gold standard in the treatment of infrasaccal primary acquired nasolacrimal duct obstruction (PANDO) is external dacryocystorhinostomy (DCR), a relatively invasive procedure that can be performed after failure of recanalizing treatments. However, with progress in the field of diode laser technology, new approaches have emerged. Laser-assisted transcanalicular DCR with subsequent bicanalicular silicon intubation is a new option showing great promise as a viable minimally invasive procedure. Under permanent endoscopic visual control from the nasal cavity, a diode laser fiber is inserted into the lacrimal sac and laser energy is applied to create a bony ostium between the lacrimal sac and the nasal cavity. Since no skin incision needs to be made, advantages of this method comprise the sparing of the skin as well as the medial palpebral structures and the physiological palpebral-canalicular pump mechanism. The duration of surgery as well as reconvalescence is generally shorter than with external DCR. Complications include silicon tube prolapse, mild swelling and, rarely, canalicular infection and thermal injury. One-year functional success rates, defined as complete resolution of symptoms and ostium patency, are high, yet still range behind those of external DCR. However, secondary external DCR after failure of laser-assisted DCR can be performed without difficulty. Thus, laser-assisted transcanalicular DCR is a valid option that should be considered as a second-step procedure after failure of recanalization procedures and before external DCR.

The goal of this protocol is to present transcanalicular laser-assisted dacryocystorhinostomy as a minimally invasive approach in the treatment of primary acquired nasolacrimal duct obstruction.

Transcanalicular 二极管激光辅助泪囊鼻腔吻合术治疗原发性鼻泪管阻塞

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

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

Benign prostatic hyperplasia (BPH) commonly occurs among elderly males. The condition causes symptoms in the lower urinary tract, thereby reducing the quality of life. BPH includes 2 major treatments: medication and surgery. Surgical treatment is often the most effective and final intervention. Holmium laser enucleation of the prostate (HoLEP), one of the most efficient surgical procedures for BPH, is conducted transurethrally. During surgery, the most important and most difficult part is to locate the surgical capsule of the prostate, which is consistent to the idea of anatomic surgery. Different skills may be needed in treating different parts of the prostate. HoLEP tends to be efficient and safe with good hemostatic properties, and able to treat bladder calculus, which may be the complications of BPH. The technique is particularly suitable for prostate of varying volumes and sizes. Indeed, HoLEP also presents certain disadvantages, such as a long learning curve and costly equipment. Regardless, this method may be the "new standard" and the excellent method for the surgical treatment of BPH.

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

Here we present a safe and efficient protocol, holmium laser enucleation of the prostate, to treat benign prostatic hyperplasia.

良性前列腺增生的外科治疗: 钬激光前列腺摘除术 (计画)。

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

The occurrence of lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) is a common problem with a high incidence in the aging male population. Although it is not a life-threatening disease, BPH causes problems that seriously impact the quality of life. Here, we introduce a new technique called photoselective vaporesection of the prostate (PVRP) in treating BPH, which can be seen as a variation of photoselective vaporization of the prostate (PVP). This procedure presents several advantages compared to the PVP technique including less laser energy loss, less intraoperative complications as well as more tissue resection rate.

Here we present a protocol to perform Photoselective Vaporesection of the Prostate (PVRP) for benign prostatic hyperplasia (BPH) treatment.

选择性绿激光锂三硼酸晶体激光 Vaporesection 前列腺的研究

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 ...

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

When investigating the body&#39;s mechanisms for regulating cerebral blood flow, a relative measurement of microcirculatory blood flow can be obtained using laser Doppler flowmetry (LDF). This paper demonstrates a closed skull preparation that allows cerebral blood flow to be assessed without penetrating the skull or installing a chamber or cerebral window. To evaluate autoregulatory mechanisms, a model of controlled blood pressure reduction via graded hemorrhage can be utilized while simultaneously employing LDF. This enables the real time tracking of the relative changes in the blood flow in response to reductions in arterial blood pressure produced by the withdrawal of circulating blood volume. This paradigm is a valuable approach to study cerebral blood flow autoregulation during reductions in arterial blood pressure and, with minor modifications in the protocol, is also valuable as an experimental model of hemorrhagic shock. In addition to evaluating autoregulatory responses, LDF can be used to monitor the cortical blood flow when investigating metabolic, myogenic, endothelial, humoral, or neural mechanisms that regulate cerebral blood flow and the impact of various experimental interventions and pathological conditions on cerebral blood flow.

This article demonstrates the use of laser Doppler flowmetry to evaluate the ability of the cerebral circulation to autoregulate its blood flow during reductions in arterial blood pressure.

使用激光多普勒流测量测量大鼠脑血流自动调节的评估

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

In mares, endometrial cysts are associated with endometriosis and can cause maternal recognition failure or compromise and delay pregnancy diagnoses. Historical treatments were invasive and had adverse effects on the endometrium. Hysteroscopically guided laser therapy is easy and effective for endometrial cysts resection, with no deleterious effects for the endometrium.
A 110 cm long and 1.0 cm wide endoscope is sterilely introduced in the uterus through the open cervix of an estrous mare after vulvar cleaning. The uterus is slowly infused with less than 1 L of physiologic solution and the laser fiber is inserted in the biopsy canal of the endoscope. Cysts are then cauterized with the 980 nm diode laser with a contact fiber set at 20&#8210;2 5W in continuous mode. Each cyst is punctured&#160;until complete voiding of the cyst and shrinking of the cyst wall around the fiber. Uterine lavages with sterile saline solution are performed directly after the surgery and for one or two days as non-inflammatory fluid can be observed.
This procedure is easy and quickly performed, with no obvious deleterious effects. Cysts resection makes ultrasound pregnancy diagnosis easier and, in some cases, could restore proper embryo migration in the uterine horns between day 6.5 and 17. However, this treatment does not improve the underlying histological lesions related to endometriosis. These considerations should be clearly expressed to the breeder before this procedure.

The aim of this report is to describe the photoablation of endometrial cysts in the mare using an endoscopic laser device, and to discuss the interest and limitations of this new approach to deal with low fertility issues.

内窥镜引导光活内膜囊肿使用 980 nm 激光与接触纤维在马雷斯

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

Focal Laser Ablation of Prostate Cancer: An Office Procedure

In this article, we describe and illustrate an outpatient procedure for focal laser ablation (FLA) of prostate cancer (PCa). The procedure is conceptually similar to a fusion biopsy and is performed under local anesthesia in a clinic setting; treatment time is usually less than one hour. Laser insertion is guided by ultrasound; lesion targeting is via magnetic resonance imaging-ultrasound (MRI/US) fusion, as in targeted prostate biopsy. Real-time ablation monitoring is achieved utilizing a thermal probe adjacent to the laser fiber. The video demonstrates procedure planning, patient preparation, various steps during the procedure, and treatment monitoring. Safety, feasibility, and efficacy of this approach have been established during a previous trial. Outpatient FLA under local anesthesia is an option for management of intermediate risk prostate cancer.

This article presents and describes an outpatient treatment for prostate cancer using focal laser ablation. Laser catheter placement is guided by MRI-ultrasound fusion imaging in a fashion similar to prostate needle biopsy. Treatment is monitored in real-time with a thermal probe, placed adjacent to the laser fiber.

前列腺癌聚焦激光消融:办公室程序

In this article, we describe and illustrate an outpatient procedure for focal laser ablation (FLA) of prostate cancer (PCa). The procedure is conceptually ...

Laparoscopy-endoscopy Cooperative Surgery for the Treatment of Gastric Gastrointestinal Stromal Tumors

In view of the shortcomings of endoscopic or laparoscopic surgeries alone in the treatment of gastric gastrointestinal stromal tumors (G-GISTs), this approach makes an innovative improvement in the treatment of G-GISTs that are less than 5 cm in size. Laparoscopy-endoscopy cooperative surgery (LECS) is used to combine endoscopic and laparoscopic surgeries, fully realizing their respective advantages and avoiding their drawbacks. The main steps are as follows. First, gastroscopy and laparoscopy are combined to confirm the location and boundary of the tumor. Tumor resection is carried out laparoscopically, guided by a gastroscope. The specimen is removed orally and the gastric wound closed laparoscopically. Then, gastroscopy and laparoscopy are combined to determine whether there is wound bleeding, if the suture is satisfactory, and if the gastric cavity is deformed.
LECS has natural advantages in the treatment of G-GISTs that are less than 5 cm in size. The accurate estimation of tumor location and boundary greatly improves the complete resection rate of tumors. The risk of tumor rupture is substantially reduced, and the long-term prognosis of patients is significantly improved. The process allows for accurate resection of the tumor, maximum preservation of normal gastric tissue and organ function, and avoids postoperative gastric deformation. The patient's postoperative rehabilitation is greatly accelerated, and oral feeding can resume on the day of the operation. The specimen is taken out through the mouth to avoid the need for an extended abdominal incision. This greatly reduces the patient's postoperative pain and scarring. The method greatly shortens the postoperative hospital stay (i.e., discharge is possible on the day after the operation), increasing the turnover of hospital beds.

Laparoscopy-endoscopy cooperative surgery is appropriate for the treatment of gastric gastrointestinal stromal tumors less than 5 cm in size. It can achieve the respective advantages of endoscopic and laparoscopic surgeries while avoiding their drawbacks.

腹腔镜-内镜合作手术治疗胃肠道间质瘤

In view of the shortcomings of endoscopic or laparoscopic surgeries alone in the treatment of gastric gastrointestinal stromal tumors (G-GISTs), this ...