Die Autoren haben keine Bestätigungen.

Alle hier beschriebene Methoden wurden durch die Ethik-Kommission der Beijing Hospital genehmigt. Indikationen für die Chirurgie sind entsprechend den Richtlinien der European Association of Urology für nonneurogenic männlichen LUTS. Kontraindikationen sind verdächtige Prostata Krebs oder detrusors Dysfunktion.
1. Instrumente für den Betrieb
<ol><li>Sicherstellung der Verfügbarkeit von einem LBO-Kristall-Laser mit einer Höchstleistung von 160 w.</li>
	<li>Eine Endfiring Laser Faser und salzhaltigen Lösung für die Bewässerung von intraoperativen Blase zu beschäftigen.</li>
	<li>Verwenden Sie eine 26F Laser Resektoskop, ein gutes Sehvermögen zu erwerben und die Resektion Effizienz zu erhöhen.</li>
</ol>2. Vorbereitung für den Betrieb
<ol><li>Bieten eine intravenöse Antibiotika präoperativ (intravenöse Verabreichung von Cefuroxim-Natrium 1,5 g mit 100 mL 0.9%sodium-chlorid-Lösung 30 min vor der Operation) für alle Patienten.</li>
	<li>Stellen Sie vor der Narkose des Patienten auf dem OP-Tisch legen. Hinweis: Vollnarkose ist wirksam und angemessen für diese Operation, Anästhesist wird schließlich bestimmen die Art der Narkose abhängig vom Allgemeinzustand des Patienten.</li>
	<li>Drapieren Sie die Patienten in einer sterilen Mode in der Dorsa Steinschnittlage Position. Führen Sie Vorbereitung der Haut.</li>
</ol>3. die Verfahrensschritte
<ol><li>
Vaporesection des Lappens Median
	<ol>
<li>Prüfen Sie die ganze Blase Hohlraum und der prostatischen Harnröhre sorgfältig durch das Resektoskop nach die Blase aufgebläht ist. Hinweis: Dieser Schritt hilft Urologen, einige wichtige anatomische singt einschließlich der bilateralen Harnleiter Öffnung und Verumontanum zu finden.</li>
		<li>Markieren Sie zunächst zwei Linien. Stellen Sie sicher, dass diese Zeilen am 05:00 und 07:00 am Blasenhals entstehen und weiter entlang der Grenzen zwischen dem Median und seitlichen Lappen, endlich beendet am proximalen Rand der Verumontanum.</li>
		<li>Set Laser power bei 80 W. Vaporize der Prostata-Gewebe über eine Faser, die durch die Laser Verdampfung in diese Richtung, bis die weißen zyklische Fasern sichtbar sind. Hinweis: Dies ist das Zeichen der prostatakapsel. Die beiden Linien werden in Zeile neben der Verumontanum zusammengeführt.</li>
		<li>Stellen Sie Laserleistung bei 80 bis 100 W. Mark mehrere Zeilen auf Fläche des mittleren Lappens per laserfaser. Dann Teilen des keilförmiger mittleren Lappens in mehrere Stücke nach diesen Linien durch Verdampfung Technik. Dann jedes Stück aus der mittleren Lappen geteilt. Schließlich entfernen Sie den gesamten mittleren Lappen.</li>
	</ol>
</li>
	<li>
Vaporesection der seitlichen Lappen
	<ol>
<li>Verdampfen des Gewebes auf 12:00 von der Spitze der Prostata, der Blasenhals durch das Zystoskop 180° drehen. Lassen Sie sich nicht die laserfaser gehen Sie zu Apex auf 12:00 nah die postoperative Harninkontinenz verursachen können. Hinweis: Diese Technik erhöht die Rate der Resektion des Gewebes rund um die Prostata Dach.</li>
		<li>Am unteren Rand der beiden seitlichen Lappen eindeutig zu identifizieren wenn Vaporesection abgeschlossen ist.</li>
		<li>Legen Sie bevor Sie die seitlichen Lappen entfernen eine weitere 2 ähnliche Grooves, die den Blasenhals um 03:00 und 09:00 am proximalen Ende der Verumontanum abgehalten.</li>
		<li>Das Gewebe der seitlichen Drüse zu entfernen. Die Laserleistung auf 80 bis 100 W und markieren Sie mehrere Linien auf der Oberfläche der linke Lappen über Laser-Faser, die den linken Lappen teilt sich in mehrere Stücke nach diesen Linien durch Verdampfung Technik. Dann jedes Stück aus der Lappen aufgeteilt und schließlich die ganze linken Lappen zu entfernen. Wiederholen Sie diesen Vorgang zum rechten Lappen entfernen.</li>
		<li>Entfernen Sie die Überbleibsel Drüsengewebe entlang der bestehenden Grenze der Kapsel.</li>
	</ol>
</li>
	<li>
Kanal-trimmen
	<ol>
<li>Denken Sie daran, schneiden Sie einige überstehende Gewebe um die Wurzelspitze der Drüse, um die Integrität der Kavität zu verbessern.</li>
		<li>Zur Vermeidung von intraoperativer Komplikationen (z.B. Kapsel Perforation oder Schließmuskel Verletzungen) verwenden Sie Verdampfung Technik anstatt Resektion zu trimmen das Gewebe in der Nähe der externen urethralen Sphinkter und die Kraft auf weniger als 80 Watt zu senken.</li>
	</ol>
</li>
	<li>
Blutstillung und Katheterisierung
	<ol>
<li>Beschäftigen Sie eine Glasspritze, die die Schnittstelle von Resektoskop Gewebe Stück durch Wasserstrom entfernen entspricht. Stellen Sie sicher, es gibt keinen Beweis für das verbleibende Gewebe in der Blase und Prostata Fossa durch Resektoskop und identifizieren Sie das intakte der Harnleiter Öffnungen.</li>
		<li>Beschäftigen Sie eine geringere Laserleistung (30 bis 50 W) um Blutungen zu stoppen, um die Operationsstelle. Halten Sie einen entsprechenden Abstand in der Regel 3 bis 5 mm zwischen Faser und Schiffe, eine befriedigende Wirkung der Blutstillung zu erwerben.</li>
		<li>Das Resektoskop aus der Harnröhre zu entfernen. Platz 22 französische Foley Katheter aus Harnröhrenmündung, Blase Kavität sanft mit 30 mL Wasser in den Ballon nach ausreichend schmieren Harnröhre von Lidocain Gel.</li>
	</ol>
</li>
	<li>
Postoperative Pflege
	<ol>
<li>Lassen Sie den Patienten legte sich auf das Bett für ca. 3 h nach der Operation in der Intensivstation, bis sie vollständig aus der Narkose aufwachen. Unterdessen stellen Sie sicher Patientenmonitore und medizinischem Sauerstoff in dieser Zeit zur Verfügung stehen.</li>
		<li>Nach dem Aufwachen komplett, zurück den Patienten auf der Station. Lassen Sie den Patienten beginnen, etwas Wasser trinken und etwas zu essen zu nehmen. Zeichnen Sie die Urinproduktion und achten Sie auf die Farbe des Urins.</li>
	</ol>
</li>
</ol>

<ol>
	<li>Capit&#225;n, C., Bl&#225;zquez, C., Martin, M. D., Hern&#225;ndez, V., de la Pe&#241;a, E., Llorente, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=GreenLight+HPS+120W+laser+vaporization+versus+transurethral+resection+of+the+prostate+for+the+treatment+of+lower+urinary+tract+symptoms+due+to+benign+prostatic+hyperplasia:+A+randomized+clinical+trial+with+2-year+follow-up.">GreenLight HPS 120W laser vaporization versus transurethral resection of the prostate for the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia: A randomized clinical trial with 2-year follow-up.</a> Eur Urol. 60 (4), 734-739 (2011).</li><li>Cornu, J. N., Ahyai, S., Bachmann, A., de la Rosette, J., Gilling, P., Gratzke, 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=A+systematic+review+and+meta-analysis+of+functional+outcomes+and+complications+following+transurethral+procedures+for+lower+urinary+tract+symptoms+resulting+from+benign+prostatic+obstruction:+An+update.">A systematic review and meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic obstruction: An update.</a> Eur Urol. 67 (6), (2014).</li><li>Kang, H. W., Jebens, D., Malek, R. S., Mitchell, G., Koullick, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laser+vaporization+of+bovine+prostate:+A+quantitative+comparison+of+potassium-titanyl-phosphate+and+lithium+triborate+lasers.">Laser vaporization of bovine prostate: A quantitative comparison of potassium-titanyl-phosphate and lithium triborate lasers.</a> J Urol. 180 (6), 2675-2680 (2008).</li><li>Herrmann, T. R., Liatsikos, E. N., Nagele, U., Traxer, O., Merseburger, A. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=EAU+Guidelines+Panel+on+Lasers,+Technologies.+EAU+guidelines+on+laser+technologies.">EAU Guidelines Panel on Lasers, Technologies. EAU guidelines on laser technologies.</a> Eur Urol. 61 (4), 783-795 (2012).</li><li>Braeckman, J., Denis, 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+BPH+then+2000+and+now+2016+-+From+BPH+to+BPO.">Management of BPH then 2000 and now 2016 - From BPH to BPO.</a> Asian J Urol. 4 (3), 138-147 (2017).</li><li>Bachmann, A., Tubaro, A., Barber, N., d'Ancona, F., Muir, G., Witzsch, U., 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+European+multicenter+randomized+noninferiority+trial+comparing+180+W+GreenLight+XPS+laser+vaporization+and+transurethral+resection+of+the+prostate+for+the+treatment+of+benign+prostatic+obstruction:+12-month+results+of+the+GOLIATH+study.">A European multicenter randomized noninferiority trial comparing 180 W GreenLight XPS laser vaporization and transurethral resection of the prostate for the treatment of benign prostatic obstruction: 12-month results of the GOLIATH study.</a> J Urol. 193 (2), 570-578 (2015).</li><li>Peyronnet, B., Pradere, B., Brichart, N., Bodin, T., Bertrand, P., Members of French Group of GreenLight Users, ., Bruy&#232;re, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Complications+associated+with+photoselective+vaporization+of+the+prostate:+Categorization+by+a+panel+of+GreenLight+users+according+to+Clavien+score+and+report+of+a+single-center+experience.">Complications associated with photoselective vaporization of the prostate: Categorization by a panel of GreenLight users according to Clavien score and report of a single-center experience.</a> Urology. 84 (3), 657-664 (2014).</li><li>Cho, S. Y., Park, S., Jeong, M. Y., Ro, Y. K., Son, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=120W+GreenLight+high+performance+system+laser+for+benign+prostate+hyperplasia:+68+patients+with+3-year+follow-up+and+analysis+of+predictors+of+response.">120W GreenLight high performance system laser for benign prostate hyperplasia: 68 patients with 3-year follow-up and analysis of predictors of response.</a> Urology. 80 (2), 396-401 (2012).</li><li>Elmansy, H. M., Elzayat, E., Elhilali, M. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Holmium+laser+ablation+versus+photoselective+vaporization+of+prostate+less+than+60+cc:+Long-term+results+of+a+randomized+trial.">Holmium laser ablation versus photoselective vaporization of prostate less than 60 cc: Long-term results of a randomized trial.</a> J Urol. 184 (5), 2023-2028 (2010).</li><li>Hong, K., Liu, Y. Q., Lu, J., Xiao, C. L., Huang, Y., Ma, L. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Efficacy+and+safety+of+120W+thulium:+Yttrium-aluminum-garnet+vapoenucleation+of+prostates+compared+with+holmium+laser+enucleation+of+prostates+for+benign+prostatic+hyperplasia.">Efficacy and safety of 120W thulium: Yttrium-aluminum-garnet vapoenucleation of prostates compared with holmium laser enucleation of prostates for benign prostatic hyperplasia.</a> Chin Med J (Engl). 128 (7), 884-889 (2015).</li><li>Hermanns, T., Sulser, T., Fatzer, M., Baumgartner, M. K., Rey, J. M., Sigrist, M. W., 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=Laser+fiber+deterioration+and+loss+of+power+output+during+photo-selective+80-W+potassiumtitanyl-phosphate+laser+vaporization+of+the+prostate.">Laser fiber deterioration and loss of power output during photo-selective 80-W potassiumtitanyl-phosphate laser vaporization of the prostate.</a> Eur Urol. 55 (3), 679-686 (2009).</li><li>Hermanns, T., Strebel, D. D., Hefermehl, L. J., Gross, O., Mortezavi, A., M&#252;ller, 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=Lithium+triborate+laser+vaporization+of+the+prostate+using+the+120+W,+high+performance+system+laser:+High+performance+all+the+way?.">Lithium triborate laser vaporization of the prostate using the 120 W, high performance system laser: High performance all the way?.</a> J Urol. 185 (6), 2241-2247 (2011).</li><li>Schwartz, J., Renard, J., Wolf, J. P., Moret, M., Iselin, C. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=High-power+potassium-titanyl-phosphate+laser+fibres+for+endovaporization+of+benign+prostatic+hyperplasia:+How+much+do+they+deteriorate+during+the+procedure?.">High-power potassium-titanyl-phosphate laser fibres for endovaporization of benign prostatic hyperplasia: How much do they deteriorate during the procedure?.</a> BJU Int. 107 (12), 1938-1942 (2011).</li><li>Son, H., Ro, Y. K., Min, S. H., Choo, M. S., Kim, J. K., Lee, C. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Modified+vaporization-resection+for+photoselective+vaporization+of+the+prostate+using+a+GreenLight+high+-performance+system+120-W+Laser:+the+Seoul+technique.">Modified vaporization-resection for photoselective vaporization of the prostate using a GreenLight high -performance system 120-W Laser: the Seoul technique.</a> Urology. 77 (2), 427-432 (2011).</li><li>Mandal, S., Sankhwar, S. N., Kathpalia, R., Singh, M. K., Kumar, M., Goel, 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=Grading+complications+after+transurethral+resection+of+prostate+using+modified+Clavien+classification+system+and+predicting+complications+using+the+Charlson+comorbidity+index.">Grading complications after transurethral resection of prostate using modified Clavien classification system and predicting complications using the Charlson comorbidity index.</a> Int Urol Nephrol. 45 (2), 347-354 (2013).</li><li>Gong, Y. G., Liu, R. M., Gao, R. <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+with+a+front-firing+lithium+triborate+laser:+Surgical+technique+and+experience+after+215+procedures.">Photoselective vaporesection of the prostate with a front-firing lithium triborate laser: Surgical technique and experience after 215 procedures.</a> Eur Urol. 67 (6), 1142-1159 (2015).</li></ol>

Diese Studie wurde vom National Key R & D Program of China (2017YFC0840100 und 2017YFC0840102) gesponsert.

Hier teilen wir unsere Erfahrungen mit PVRP. Erstens PVRP ermöglicht bessere Belichtung der Prostata-Kapsel mit richtigen Abgrenzung und reduziert das Risiko einer Kapsel Perforation. Zweitens sollte die Gewebeentnahme entlang der chirurgischen Kapsel, vor allem mit der Nut am 12:00, erfolgen die Resektion Gewebe rund um das Dach der prostatischen Harnröhre erleichtert und bietet eine befriedigende Gewebe Abtragsleistung. Drittens ist es erforderlich, den mittlere Lappen zunächst zum Erwerben eines breiteren Kanals in...

Obwohl Transurethrale Resektion der Prostata (TURP) noch als der Goldstandard in der chirurgischen Behandlung der benignen Prostatahyperplasie (BPH) angenommen wird, sind Laser-Operationen nach und nach durch die bessere geduldige Toleranz, weniger intraoperative immer beliebter geworden Blutverlust, zufrieden stellende Wirksamkeit und kürzere postoperative Genesung1,2,3. Derzeit sind die am häufigsten verwendeten Laser für die BPH-Behandlung weltweit durch Lithium-Kalium-Titanyl-Phosphat oder Lithium Triborate (LBO) Kristalle4,5erzeugt. Traditionell werden diese als Sidefiring-Laser im Vergleich zu anderen Arten von Laser, wie z. B. Holmium Laser und Thulium Laser eingestuft.
Photoselektiven Vaporisation der Prostata (PVP) Operation konnte deutlich abnehmen TURP-Syndrom durch Kochsalzlösung Bewässerung6,7, und im Vergleich zu anderen Arten von Lasern, die zuverlässige Wirksamkeit der unteren Harnwege-Syndrom (LUTS) durch PVP wurde durch eine Reihe von Studien8,9,10überprüft. Zugeordnete Seite abstrahlende Laseremission PVP hat jedoch auch einige Nachteile, wie eine Energie-Verlust von fast 20 % und eine kurze Lebensdauer der Laser Faser11,12,13. PVP erhöht darüber hinaus die Möglichkeit der verpasste Diagnose von Prostatakrebs durch komplette Gewebe verdampfen.
Die Einführung des Photoselective Vaporesection der Prostata (PVRP) mit einer Ende-schießen-Faser überwand erfolgreich die meisten Nachteile der oben genannten PVP. Erstens kann die Spitze Sende Laser zu den Geweben mit fast keinen Energieverlust intraoperativ. Zweitens Wenn Faser Ablagerungen an der Spitze sammelt, ist es einfach weiterhin die ideale Ausgangsleistung durch einfaches Entfernen der betroffenen Teile. Zu guter Letzt ermöglicht Laser Resektion der Sammlung von Proben für postoperative pathologische Untersuchung. Daher könnte unter Verwendung dieses Protokolls in der Behandlung von BPH verbessern die Abtragrate Gewebe, speichern die Operationszeit und die intraoperative Sicherheit verbessern.

<table><tbody><tr><td>FLARE surgical Laser Fiber</td><td>REALTON</td><td></td><td>The FLARE Surgical laser Fiber is a 600 micron fiber with an straight tip that transmits the laser energy directly. this product is packaged sterile for disposable use and should not be re-sterilized or reused. Dispose of properly after use.</td></tr><tr><td>AURORA Surgical Green Laser System</td><td>REALTON</td><td>pvp-160-021</td><td>The AURORA Surgical green laser system is a diode-pumped, frequency-doubled Nd:YAG solid state laser. The AURORA Surgical green laser system features a &amp;ldquo;Plug and Play&amp;rdquo; capability that self-adjusts to the facility&amp;rsquo;s individual voltage requirements, eliminating the need for electrical modifications. The laser system also includes an air-cooled internal mechanism, ensuring safe operating temperatures with no external water connections. Laser energy emission and system status selection is activated through a surgeon-controlled, color-coded footswitch or system touch screen feature located in the laser console.</td></tr></tbody></table>

photoselective vaporesection of the prostate via an end-firing lithium triborate crystal laser

Das Auftreten der unteren Harnwege Symptome (LUTS) verursacht durch benigne Prostatahyperplasie (BPH) ist ein häufiges Problem mit einer hohen Inzidenz in der männlichen Alternbevölkerung. Obwohl es keine lebensbedrohliche Krankheit, verursacht BPH Probleme, die sich ernsthaft die Lebensqualität auswirken. Hier stellen wir eine neue Technik namens photoselektiven Vaporesection der Prostata (PVRP) bei der Behandlung von BPH, die als eine Variation der photoselektiven Vaporisation der Prostata (PVP) gesehen werden kann. Dieses Verfahren bietet mehrere Vorteile im Vergleich zu den PVP-Technik einschließlich weniger Energieverlust Laser sowie weniger intraoperativen Komplikationen und mehr Gewebe Resektion bewerten.

Insgesamt 35 Patienten, die PVRP unterzogen wurden in einer unserer Studien aufgenommen. Das Durchschnittsalter der Patienten betrug 72,1 ± 7,1 Jahre (Bereich 53-85 Jahre).
Perioperative Daten sind in Tabelle 1aufgeführt. Die mittlere Laser Emissionszeit entfielen fast 50 % der mittlere Operationszeit. Der Blutverlust bei den meisten Patienten war < 200 mL. Jedoch wich der Durchschnitt durch einige Moderate Bl...

Watch this Scientific Journal Video about Photoselective Vaporesection of the Prostate via an End-firing Lithium Triborate Crystal Laser at JoVE.com

Photoselective Vaporesection of the Prostate via an End-firing Lithium Triborate Crystal Laser

Hier präsentieren wir ein Protokoll zur Photoselective Vaporesection der Prostata (PVRP) für benigne Prostatahyperplasie (BPH) Behandlung durchzuführen.

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

The occurrence of lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) is a common problem with a high incidence in the aging ...

photoselective-vaporesection-prostate-via-an-end-firing-lithium

Universidad de Cartagena UDEC

Research

JoVE Journal

Medicine

7.9K Aufrufe.  Beijing Hospital, National Center of Gerontology. Hier präsentieren wir ein Protokoll zur Photoselective Vaporesection der Prostata (PVRP) für benigne Prostatahyperplasie (BPH) Behandlung durchzuführen.

Serie: Photoselective Vaporesection of the Prostate via an End-firing Lithium Triborate Crystal Laser

Evaluation of Nanoparticle Uptake in Tumors in Real Time Using Intravital Imaging

Current technologies for tumor imaging, such as ultrasound, MRI, PET and CT, are unable to yield high-resolution images for the assessment of nanoparticle uptake in tumors at the microscopic level1,2,3, highlighting the utility of a suitable xenograft model in which to perform detailed uptake analyses. Here, we use high-resolution intravital imaging to evaluate nanoparticle uptake in human tumor xenografts in a modified, shell-less chicken embryo model. The chicken embryo model is particularly well-suited for these in vivo analyses because it supports the growth of human tumors, is relatively inexpensive and does not require anesthetization or surgery 4,5. Tumor cells form fully vascularized xenografts within 7 days when implanted into the chorioallantoic membrane (CAM) 6. The resulting tumors are visualized by non-invasive real-time, high-resolution imaging that can be maintained for up to 72 hours with little impact on either the host or tumor systems. Nanoparticles with a wide range of sizes and formulations administered distal to the tumor can be visualized and quantified as they flow through the bloodstream, extravasate from leaky tumor vasculature, and accumulate at the tumor site. We describe here the analysis of nanoparticles derived from Cowpea mosaic virus (CPMV) decorated with near-infrared fluorescent dyes and/or polyethylene glycol polymers (PEG) 7, 8, 9,10,11. Upon intravenous administration, these viral nanoparticles are rapidly internalized by endothelial cells, resulting in global labeling of the vasculature both outside and within the tumor7,12. PEGylation of the viral nanoparticles increases their plasma half-life, extends their time in the circulation, and ultimately enhances their accumulation in tumors via the enhanced permeability and retention (EPR) effect 7, 10,11. The rate and extent of accumulation of nanoparticles in a tumor is measured over time using image analysis software. This technique provides a method to both visualize and quantify nanoparticle dynamics in human tumors.

We present a novel approach to quantify nanoparticle localization in the vasculature of human xenografted tumors using dynamic, real-time intravital imaging in an avian embryo model.

Evaluation von Nanopartikel-Aufnahme in Tumoren in Echtzeit über Intravital Imaging

Current technologies for tumor imaging, such as ultrasound, MRI, PET and CT, are unable to yield high-resolution images for the assessment of nanoparticle ...

Forschung

Medizin

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.

Probe-basierte konfokale Laser Endomikroskopie der Harnwege: Die Technik

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

Endotracheal Intubation in Mice via Direct Laryngoscopy Using an Otoscope

Mice, both wildtype and transgenic, are the principal mammalian model in biomedical research currently. Intubation and mechanical ventilation are necessary for whole animal experiments that require surgery under deep anesthesia or measurements of lung function. Tracheostomy has been the standard for intubating the airway in these mice to allow mechanical ventilation. Orotracheal intubation has been reported but has not been successfully used in many studies because of the substantial technical difficulty or a requirement for highly specialized and expensive equipment. Here we report a technique of direct laryngoscopy using an otoscope fitted with a 2.0 mm speculum and using a 20 G&#160;intravenous catheter as an endotracheal tube. We have used this technique extensively and reliably to intubate and conduct accurate assessments of lung function in mice. This technique has proven safe, with essentially no animal loss in experienced hands. Moreover, this technique can be used for repeated studies of mice in chronic models.

Endotracheal Intubation in Mice via Direct Laryngoscopy Using an Otoscope

We have developed a simple, reliable, and relatively inexpensive method for endotracheal intubation in mice via direct laryngoscopy using an otoscope with a 2.0 mm speculum. This technique is atraumatic and can be used for repeated measurements in chronic experiments. We find it superior to tracheostomy or previously reported nonsurgical techniques.

Intubation bei Mäusen<em&gt; Über</em&gt; Direkte Laryngoskopie Mit einem Otoskop

Mice, both wildtype and transgenic, are the principal mammalian model in biomedical research currently. Intubation and mechanical ventilation are ...

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.

Chirurgische Behandlung der benignen Prostatahyperplasie: Holmium Laser Enukleation der Prostata (HoLEP).

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

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

In the aging male population, the occurrence of lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) is a common problem. Here, we introduce a new technique called 980 nm diode laser enucleation (DiLEP) to treat BPH1. Diode lasers can absorb both water and hemoglobin at the same time, so they are good for cutting and hemostasis2. The diode laser was approved by the FDA in 2007, and has been used in the treatment of BPH because of its effective cutting and hemostasis effect3. DiLEP presents several advantages over other techniques, such as TURP, HoLEP, and PVP. During the procedure, we define the boundary of a high-volume prostate and separate it into three lobes with a diode laser by burning two rings and one groove (like a Cupid&#39;s arrow). Compared to other procedures, mDiLEP has fewer intraoperative complications, a shorter learning curve, and achieves more tissue resection.

Here, we present a protocol for modified 980 nm diode laser enucleation to treat large volume benign prostatic hyperplasia.

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

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

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.

Endoskopiegeführte Photoablation von Endometriumzysten mit einem 980-nm-Laser mit einer Kontaktfaser in Stuten

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.

Fokale Laserablation von Prostatakrebs: Ein Büroverfahren

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

Samenvesikuloskop Laserassistierte Chirurgie zur Behandlung von Verstopfungen des Ejakulationsgangs

Treatment of Ejaculatory Duct Obstruction by Seminal Vesiculoscopy Assisted Flow Modification

Transurethral resection of ejaculatory duct (TURED) is a primary surgical approach to treat ejaculatory duct obstruction (EDO) caused by the ejaculatory duct cyst. Intraoperative excision of the verumontanum is usually required to expose the ejaculatory ducts. However, preserving the verumontanum structure allows for a better simulation of normal physiological anatomy. Maintaining the verumontanum may increase the risk of postoperative distal ejaculatory duct scarring, leading to recurrent obstruction or reduced semen volume. Therefore, we attempted a novel technique that preserves the verumontanum, which is relatively easier and safer compared to TURED. The following were the procedural steps: 1. A 6F seminal vesiculoscope was introduced through the external urethral orifice to the vicinity of the verumontanum, locating the opening of the affected-side ejaculatory duct and introducing a guidewire into the cyst. This successful step preserved the verumontanum, maximizing the retention of the anti-reflux mechanism in the distal ejaculatory duct. 2. The holmium laser enlarged the affected-side ejaculatory duct opening to 5 mm, decreasing the likelihood of postoperative closure of the ejaculatory duct opening and simplifying the procedure. 3. A window was created within the cyst to access the contralateral seminal vesicle, and then a holmium laser was used to burn and dilate the opening to 5 mm, redirecting the contralateral ejaculatory duct into the cystic cavity. This modification preserved the opening of the healthy-side ejaculatory duct and provided a new outflow passage for semen, reducing the risk of decreased semen volume postoperatively. The patients experienced no complications postoperatively, had shorter hospital stays, and showed improvement in semen volume. Hence, this surgical approach is simple yet effective.

Autor im Rampenlicht: Fortgeschrittene Behandlung von Samengangverstopfungen mit endoskopisch vermittelter Samenkanal-Refluviation 

This protocol introduces the clinical application of seminal vesicle endoscopy combined with holmium laser in the treatment of ejaculatory duct obstruction caused by ejaculatory duct cyst.

Behandlung der Obstruktion des Ejakulationsgangs durch seminale Vesikuloskopie assistierte Flussmodifikation

Transurethral resection of ejaculatory duct (TURED) is a primary surgical approach to treat ejaculatory duct obstruction (EDO) caused by the ejaculatory ...

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

Zusammenfassung

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Intubation bei Mäusen

Chirurgische Behandlung der benignen Prostatahyperplasie: Holmium Laser Enukleation der Prostata (HoLEP).

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

Endoskopiegeführte Photoablation von Endometriumzysten mit einem 980-nm-Laser mit einer Kontaktfaser in Stuten

Fokale Laserablation von Prostatakrebs: Ein Büroverfahren

Behandlung der Obstruktion des Ejakulationsgangs durch seminale Vesikuloskopie assistierte Flussmodifikation

Behandlung der Obstruktion des Ejakulationsgangs durch seminale Vesikuloskopie assistierte Flussmodifikation

Behandlung der Obstruktion des Ejakulationsgangs durch seminale Vesikuloskopie assistierte Flussmodifikation