著者の謝辞があります。

ここで説明したすべてのメソッドは、北京病院の倫理委員会によって承認されています。手術の適応はヨーロッパ泌尿器科学会のガイドラインによると、nonneurogenic の男性 LUTS のための。禁忌には、疑いのある前立腺がんや排尿機能障害が含まれます。
1. 操作の器械
<ol><li>160 ワットの最大電力と LBO 結晶レーザの可用性を確保します。</li>
	<li>術中膀胱を潅漑するための endfiring レーザー繊維と生理食塩水ソリューションを採用してください。</li>
	<li>26F レーザー尿道を使用して良好な視力を得るし、切除の効率を向上させます。</li>
</ol>2. 操作のための準備
<ol><li>術前静脈内抗生物質を提供 (セフロキシム ナトリウム 1.5 g 100 mL 0.9%sodium 塩化物溶液、操作の前に 30 分の静脈内投与) すべての患者に。</li>
	<li>麻酔科の前に操作テーブルの上に置く患者を作る。 注:全身麻酔は、効果的かつこの操作に適切な麻酔は最後に患者の全身状態に応じて麻酔のモードを決定します。</li>
	<li>ヘアレスドッグ砕石位で滅菌方法の患者をおいましょう。任意の皮膚の準備を実行しないでください。</li>
</ol>3. 手順
<ol><li>
中央の葉の Vaporesection
	<ol>
<li>全体膀胱腔から前立腺部尿道を注意深く確認、尿道を介して膀胱が膨張されている後。 注:この手順は、泌尿器科医は両側の尿管口と verumontanum を含むいくつかのキーの解剖学的歌うを見つけることできます。</li>
		<li>最初の 2 行をマークします。これらの線を起点として 5 と膀胱頸部に 7 と中央と、verumontanum の近位端を最後に終了、側葉の間の境界に沿って続けることを確認します。</li>
		<li>セット レーザーまでの電源を介して前立腺組織蒸発させなさい w. 80 でファイバーこれらの線に沿ってレーザー蒸発法による白環状線維が見られます。 注:これは、前立腺のカプセルのサインです。2 つの行は、verumontanum に隣接して 1 つの行にマージされます。</li>
		<li>レーザーのファイバー経由で中葉の表面にいくつかの行マーク ・ w ・ 100 に 80 でレーザー出力を設定します。Wedgeshaped 中葉を気化技術によってこれらのラインに従って複数のチャンクに分割します。中葉から各チャンクを分割します。最後に、全体の中の葉を削除します。</li>
	</ol>
</li>
	<li>
側葉の Vaporesection
	<ol>
<li>膀胱鏡で検査 180 ° を回転させることにより膀胱頚部に前立腺の頂点から 12 で組織を蒸発させます。術後尿失禁を引き起こすことができる 12 の頂点に余りに近く行ってレーザーのファイバーをさせてください。 注:この手法は、前立腺の屋根周辺組織の切除率を向上させます。</li>
		<li>側葉の両方の下のマージンを明確に識別が完了する vaporesection。</li>
		<li>外側の葉を削除する前に、verumontanum の近位端に 3 と 9 で膀胱頸部に属します別 2 と同様の溝を設定します。</li>
		<li>外側の腺の組織を削除します。80 を 100 W レーザー パワーを設定し、気化技術によってこれらのラインに従っていくつかの塊に左葉を分割するレーザー光経由で左葉の表面にいくつかの行をマークします。耳たぶから各チャンクを分割し、最終的に全体の左側の葉を削除します。右葉を削除するこの手順を繰り返します。</li>
		<li>カプセルの既存の境界に沿って残腺組織を削除します。</li>
	</ol>
</li>
	<li>
チャネルのトリミング
	<ol>
<li>空洞の整合性を高めるために、腺の頂点の周りいくつかの突出の組織をトリムしてください。</li>
		<li>(すなわち、カプセル穿孔または括約筋損傷) 術中の合併症を避けるためには、外尿道括約筋付近の組織をトリミングし、80 ワット未満の電源を下げる切除ではなく気化技術を使用します。</li>
	</ol>
</li>
	<li>
止血とカテーテル
	<ol>
<li>水の流れによって組織のチャンクを削除する尿道のインターフェースにマッチするガラスの注射器を採用してください。そのまま尿管オリフィスの識別し、膀胱と、尿道を介して前立腺窩残存組織の証拠がないかどうかを確認します。</li>
		<li>手術部位の周りの出血を止めるため低いレーザー力 (30 に 50 W) を採用してください。通常 3 ~ 5 mm 繊維および満足の止血効果を取得する血管との適切な距離を保ちます。</li>
		<li>尿道から、尿道を削除します。リドカイン ジェルによって尿道を十分に潤滑後バルーンに 30 mL の水で軽く膀胱腔に尿道口から 22 フランス フォーリー カテーテルを配置します。</li>
	</ol>
</li>
	<li>
術後のケア
	<ol>
<li>彼らは完全に麻酔から覚ますまで介護単位で術後約 3 時間ベッドに横たわってを患者に伝えます。一方、この時間の間に患者モニターと医療用酸素が利用可能であることを確認します。</li>
		<li>完全に目を覚ます、時に、患者を病棟に戻ります。いくつかの水を飲むし、いくつかの食品を取るを開始を患者に伝えます。尿量を記録し、尿の色に注意を払います。</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>

この研究は、国立キー R & D 中国プログラムの (2017YFC0840100 および 2017YFC0840102) によって後援されました。

ここでは、PVRP と私たちの経験を共有します。まず、PVRP は適切な境界画定が前立腺のカプセルの良い露出を有効にし、カプセル穿孔のリスクの減少します。第二に、組織の除去を外科的被膜、とくに前立腺部尿道の屋根の周りの組織の切除を容易にし満足のいく組織除去率を提供する 12 の溝に沿って実施します。第三に、前立腺部尿道の広いチャネルを取得し手術のビジュアライゼーショ?...

経尿道的前立腺切除術 (TURP) は、良性前立腺過形成 (BPH) の治療のゴールド スタンダードとしてまだ受け入れられているがレーザー手術が徐々 により良い患者の耐性より術中のため人気となってください。出血量、満足のいく効果、短く術後の回復1,2,3。現在、世界中の前立腺肥大症治療のための最も一般的に使用されるレーザーは、チタンリン酸カリウム リチウムやリチウム三ほう酸 (LBO) 結晶4,5によって生成されます。従来、これらは sidefiring レーザー レーザー ホルミウム レーザーなどの他のタイプと比較して、ツリウム レーザーに分類されます。
前立腺 (PVP) 外科 Photoselective 蒸発による生理食塩水灌漑6、7、TURP 症候群を大幅に低下可能性があり、レーザーによる下部尿路症候群 (LUT) の信頼性の高い有効性の他のタイプに比べてPVP は、研究8,9,10のシリーズによって確認されました。ただし、横置き焼成レーザー放射に関連付けられた PVP レーザー繊維11,12,13の短い寿命のほぼ 20% のエネルギー損失など、いくつかの欠点があります。また、PVP には完全な組織の蒸発による前立腺癌の診断の可能性が高くなります。
Photoselective Vaporesection 終わり焼成繊維前立腺 (PVRP) の導入は、PVP の上記の欠点のほとんどを克服に成功しました。まず、先端は術中送信レーザー エネルギーの損失ほとんどなしで組織することができます。第二に、繊維残骸は、先端に徴収する場合は、影響を受ける部分を削除するだけで理想的な出力を維持するために簡単です。最後に、レーザー切除術後病理組織検査用試料の収集を有効にします。したがって、前立腺肥大症の治療にこのプロトコルを使用して組織の除去率を高める、手術時間を節約でき術中の安全性を向上します。

<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

良性前立腺過形成 (BPH) による下部尿路症状 (LUT) の発生は、男性人口の高齢化で発生率が高いと共通の問題です。それは命にかかわる病気ではないが、BPH は真剣に生活の質に影響を与える問題を引き起こします。前立腺肥大症は、前立腺 (PVP) の photoselective 気化のバリエーションとして見ることができる治療に前立腺 (PVRP) の photoselective vaporesection と呼ばれる新しい技術を紹介します。この手順では、レーザー エネルギー損失が小さい、以下の術中合併症より組織切除率など PVP 法に比べていくつかの利点を示します。

PVRP を施行した 35 例の合計は、我々 の研究の 1 つに含まれていた。患者の平均年齢は 72.1 ± 7.1 年 (範囲 53-85 年)。
周術期データは表 1のとおりです。平均レーザー発光時間は、平均手術時間の約 50% を占めています。ほとんどの患者の血液喪失 < 200 mL であった。しかし、平均は、いくつかの中程度の場合の出?...

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

ここで良性前立腺過形成 (BPH) の治療のため Photoselective Vaporesection 前立腺 (PVRP) を実行するためのプロトコルを提案する.

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

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

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

Universidad de Cartagena UDEC

Research

JoVE Journal

Medicine

7.9K ビュー.  Beijing Hospital, National Center of Gerontology. ここで良性前立腺過形成 (BPH) の治療のため Photoselective Vaporesection 前立腺 (PVRP) を実行するためのプロトコルを提案する.

ビデオ: 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.

生体内イメージングを使ってリアルタイムで腫瘍におけるナノ粒子の取り込みの評価

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

医学

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.

尿路のプローブベースの共焦点レーザーEndomicroscopy：テクニック

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.

マウスの気管内挿管<em&gt;経由</emオトスコープの使用&gt;直接喉頭鏡検査

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.

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

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

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.

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

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

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.

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

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

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.

前立腺がんの焦点レーザーアブレーション:事務処置

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

射精管閉塞を治療するための精嚢鏡レーザー支援手術

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.

著者スポットライト:内視鏡検査を介した精液チャネル再流動を用いた精管閉塞の高度治療 

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.

精嚢鏡検査支援フロー修正による射精管閉塞の治療

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

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

要約

さらに動画を探す

この動画の章

生体内イメージングを使ってリアルタイムで腫瘍におけるナノ粒子の取り込みの評価

尿路のプローブベースの共焦点レーザーEndomicroscopy：テクニック

マウスの気管内挿管

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

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

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

前立腺がんの焦点レーザーアブレーション:事務処置

精嚢鏡検査支援フロー修正による射精管閉塞の治療

精嚢鏡検査支援フロー修正による射精管閉塞の治療

精嚢鏡検査支援フロー修正による射精管閉塞の治療

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

要約

さらに動画を探す

この動画の章

生体内イメージングを使ってリアルタイムで腫瘍におけるナノ粒子の取り込みの評価

尿路のプローブベースの共焦点レーザーEndomicroscopy：テクニック

マウスの気管内挿管

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

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

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

前立腺がんの焦点レーザーアブレーション:事務処置

精嚢鏡検査支援フロー修正による射精管閉塞の治療

精嚢鏡検査支援フロー修正による射精管閉塞の治療

精嚢鏡検査支援フロー修正による射精管閉塞の治療

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

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