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1.
Zhongguo Yi Liao Qi Xie Za Zhi ; 44(6): 491-494, 2020 Dec 08.
Artigo em Chinês | MEDLINE | ID: mdl-33314855

RESUMO

With the development of laryngeal microsurgery, the requirements for the flexibility and convenience of surgical instruments are increasing. The research on related instruments has important value for the clinical application of laryngeal microsurgery. We have redesigned a gun-type tube-guide device of laser fiber by comparing the shortcomings of existing laser fiber introducers. The innovation of this design lies in its rotating nut device with adjustable laser angle and pre-bent tip. The corresponding in vitro laryngeal model experiment can realize multi-angle rotation of the instrument in the laryngeal cavity, which greatly increases the scope of laser surgery. During the operation, the rotating nut can be directly adjusted to avoid repeatedly removing the instrument to adjust the angle, which greatly improves the practicability and simplicity of the operation, which is worthy of further clinical research and promotion.


Assuntos
Laringe/cirurgia , Terapia a Laser/instrumentação , Microcirurgia/instrumentação , Instrumentos Cirúrgicos , Humanos , Lasers
2.
Arch. esp. urol. (Ed. impr.) ; 73(8): 699-708, oct. 2020. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-197469

RESUMO

OBJETIVO: La enucleación prostática se ha abierto camino dentro de la cirugía de la hiperplasia benigna de próstata (HBP) hasta convertirse en su técnica de referencia. Numerosos estudios avalan especialmente al láser de holmio (HoLEP) como la fuente de energía más representativa, segura y eficaz. Sin embargo, su larga curva de aprendizaje sigue dificultando su implantación. El propósito de esta revisión es describir paso a paso la técnica quirúrgica que empleamos en nuestro centro para ayudar a la extensión de la HoLEP, así como demostrar por qué creemos que esta variante es la más eficaz y eficiente de todas las variantes disponibles. MÉTODOS: Hemos realizado una detallada descripción paso a paso de nuestra técnica de enucleación prostática con láser de holmio, centrándonos en las principales diferencias que presenta con las variantes más extendidas y haciendo incapié en sus fortalezas frente a las series con más experiencia. RESULTADOS: Ninguna de las series publicadas hasta la fecha ha demostrado mejores resultados funcionales, mayor seguridad o menores complicaciones a corto o largo plazo que los datos de nuestra serie. No hay diferencias en cuanto a sangrado intra o post-operatorio, reintervenciones, perforaciones de cápsula o estenosis de uretra. Nuestra serie tiene mejores tiempos quirúrgicos que cualquier otra, demostrando una mayor eficiencia que técnicas en bloque o trilobulares. Todo ello logrando unas tasas de continencia temprana o inmediata iguales o mejores (4% vs 5-40%). Por último, el uso de dispositivos de morcelación mejorados hace que carezcamos de complicaciones durante esta fase del procedimiento. CONCLUSIONES: La HoLEP es la técnica de referencia a la que debería aspirar cualquier servicio de urología moderno, aunando los mejores datos funcionales y de seguridad que se pueden obtener actualmente en el tratamiento de la HBP. Para ello es necesario disponer de una técnica estandarizada y optimizada que permita su máxima difusión


OBJECTIVE: Prostate enucleation is becoming more relevant within BPH treatment. Nowadays is probably the gold standard for enucleation. Several studies have shown holmium laser as the most frequently used safe and efficient energy source. The long learning curve remains as its major drawback. The current review aims to describe step to step technique at our institution and describing the rational for its use. METHODS: A detailed description on our step-to-step Holep technique is provided. We focused on the main differences with other techniques already described highlighting the largest experience reported. RESULTS: None of the published series has shown better results in terms of functional, safety and less complications outcomes on the short and long term. No differences are shown in terms of intraoperative/postoperative blood loss, reoperations, capsular perforations or urethral strictures. Our techniques provides shorter surgical length and improved efficiency than blocking and trilobular techniques. The rates of early continence are 4% vs 5-40%. Lastly, improvement in morcellator devices delivered no complications related to that part of the surgery. CONCLUSIONS: Holep is the gold standard technique for prostate enucleation. It provides improved functional and safety outcomes than with other techniques. A standardized and optimized technique is mandatory


Assuntos
Humanos , Masculino , Terapia a Laser/métodos , Lasers de Estado Sólido/uso terapêutico , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata/métodos , Resultado do Tratamento , Terapia a Laser/instrumentação , Ressecção Transuretral da Próstata/instrumentação , Reprodutibilidade dos Testes
3.
Zhongguo Yi Liao Qi Xie Za Zhi ; 44(4): 346-352, 2020 Apr 08.
Artigo em Chinês | MEDLINE | ID: mdl-32762212

RESUMO

This paper analyzes the causes and risks of common design and development changes of laser treatment equipment, studies the changes of key components and their corresponding control measures, forms the identification method of design changes of laser treatment equipment, and gives suggestions on how to deal with design and development changes, so as to provide references for inspectors during on-site inspection.


Assuntos
Terapia a Laser/instrumentação , Humanos , Fatores de Risco
4.
J Laryngol Otol ; 134(6): 481-486, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32616097

RESUMO

BACKGROUND: Advances in endoscopic technology have allowed transnasal oesophagoscopy to be used for a variety of diagnostic and therapeutic procedures. METHOD: A review of the literature was carried out to look into the extended role of transnasal oesophagoscopy within otolaryngology, using the Embase, Cinahl and Medline databases. RESULTS: There were 16 studies showing that transnasal oesophagoscopy is safe and cost effective and can be used for removal of foreign bodies, tracheoesophageal puncture, laser laryngeal surgery and balloon dilatation. CONCLUSION: This study presents a summary of the literature showing that transnasal oesophagoscopy can be used as a safe and cost-effective alternative or adjunct to traditional rigid endoscopes for therapeutic procedures.


Assuntos
Esofagoscopia/métodos , Nariz/cirurgia , Otolaringologia/normas , Análise Custo-Benefício , Dilatação/instrumentação , Esofagoscopia/efeitos adversos , Esôfago/cirurgia , Corpos Estranhos/cirurgia , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Laringe/cirurgia , Terapia a Laser/instrumentação , Otolaringologia/estatística & dados numéricos , Punções , Segurança , Traqueia/cirurgia
5.
Pain Res Manag ; 2020: 1537875, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32566059

RESUMO

Objective: Nowadays, trans-sacral epiduroscopic laser decompression (SELD) using slender epiduroscopy and laser is one of the preferred options for minimally invasive treatment in lumbar disc diseases. However, SELD is still in the initial stages of the global field of spine surgery, and the clinical outcomes in patients with lumbar disc herniation are not established yet. Therefore, the authors investigated patients undergoing SELD to report the clinical results. Methods: Between November 2015 and November 2018, a total of 82 patients who underwent single-level SELD for lumbar disc herniation with a minimum follow-up of 6.0 months were enrolled. A retrospective review of clinical data was conducted. Clinical outcomes were evaluated using the visual analogue scale (VAS) for low back and leg pain and Odom's criteria. Also, surgical outcomes, including complications and symptom recurrences, and radiological outcomes were analyzed. Results: Low back pain and leg pain as determined by the VAS improved from an average of 5.43 ± 1.73 and 6.10 ± 1.67 to 2.80 ± 1.43 and 3.58 ± 2.08 at the final follow-up (p < 0.001). According to Odom's criteria, the success rate defined as excellent or good results at the final follow-up was 58.5%. There were no surgery-related complications such as neurologic deficits, infection, or epidural hematomas, except for transient mild paralysis in 3 patients and procedure-related nuchal pain in 2 patients. The rate of additional procedures was 17.0% (6 patients received revision surgery and 8 patients received an additional nerve block) during the follow-up. Conclusion: Our findings showed that SELD for lumbar herniated disc disease achieved less favorable clinical outcomes compared with those of previous studies. Further study is needed to clarify the influencing factors on the clinical outcomes of SELD.


Assuntos
Descompressão Cirúrgica/métodos , Deslocamento do Disco Intervertebral/cirurgia , Terapia a Laser/métodos , Lasers de Estado Sólido/uso terapêutico , Neuroendoscopia/métodos , Adulto , Descompressão Cirúrgica/instrumentação , Feminino , Humanos , Terapia a Laser/instrumentação , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Neuroendoscopia/instrumentação , Estudos Retrospectivos , Resultado do Tratamento
6.
Lasers Med Sci ; 35(8): 1681-1687, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32514864

RESUMO

Laser surgery is becoming an increasingly efficacious and customizable treatment modality for the management of pediatric vascular lesions. Proper use requires a thorough understanding of the scientific principles of laser surgery and knowledge of the various lasers available. Moreover, each laser has a multitude of settings that can be employed to properly target the lesion at hand. Each patient will present with unique challenges and variations in the presentation of their vascular lesion. This requires understanding of the most effective laser to use for each lesion and the factors that may alter the desired device settings. Using key search terms, a literature search was conducted on laser surgery for pediatric vascular lesions using PubMed/MEDLINE and Embase for articles published in English or French. Ultimately, 52 articles met our search criteria. The laser indications, limitations, and settings utilized for each type of vascular lesion were compiled for the purposes of this summative review. Laser surgery is an effective and appropriate option for the treatment of certain pediatric vascular lesions. Knowledge of optimal device parameters in every setting is essential to good clinical practice.


Assuntos
Terapia a Laser/instrumentação , Anormalidades da Pele/cirurgia , Pele/irrigação sanguínea , Pele/patologia , Criança , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Pele/efeitos da radiação
7.
J Vis Exp ; (159)2020 05 05.
Artigo em Inglês | MEDLINE | ID: mdl-32449714

RESUMO

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's arrow). Compared to other procedures, mDiLEP has fewer intraoperative complications, a shorter learning curve, and achieves more tissue resection.


Assuntos
Terapia a Laser/instrumentação , Lasers Semicondutores , Hiperplasia Prostática/cirurgia , Humanos , Complicações Intraoperatórias/etiologia , Terapia a Laser/efeitos adversos , Tempo de Internação , Masculino , Qualidade de Vida , Resultado do Tratamento
8.
Epilepsia ; 61(5): 841-855, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32227349

RESUMO

This article emphasizes the role of the technological progress in changing the landscape of epilepsy surgery and provides a critical appraisal of robotic applications, laser interstitial thermal therapy, intraoperative imaging, wireless recording, new neuromodulation techniques, and high-intensity focused ultrasound. Specifically, (a) it relativizes the current hype in using robots for stereo-electroencephalography (SEEG) to increase the accuracy of depth electrode placement and save operating time; (b) discusses the drawback of laser interstitial thermal therapy (LITT) when it comes to the need for adequate histopathologic specimen and the fact that the concept of stereotactic disconnection is not new; (c) addresses the ratio between the benefits and expenditure of using intraoperative magnetic resonance imaging (MRI), that is, the high technical and personnel expertise needed that might restrict its use to centers with a high case load, including those unrelated to epilepsy; (d) soberly reviews the advantages, disadvantages, and future potentials of neuromodulation techniques with special emphasis on the differences between closed and open-loop systems; and (e) provides a critical outlook on the clinical implications of focused ultrasound, wireless recording, and multipurpose electrodes that are already on the horizon. This outlook shows that although current ultrasonic systems do have some limitations in delivering the acoustic energy, further advance of this technique may lead to novel treatment paradigms. Furthermore, it highlights that new data streams from multipurpose electrodes and wireless transmission of intracranial recordings will become available soon once some critical developments will be achieved such as electrode fidelity, data processing and storage, heat conduction as well as rechargeable technology. A better understanding of modern epilepsy surgery will help to demystify epilepsy surgery for the patients and the treating physicians and thereby reduce the surgical treatment gap.


Assuntos
Epilepsia/cirurgia , Procedimentos Cirúrgicos Robóticos/instrumentação , Encéfalo/fisiopatologia , Encéfalo/cirurgia , Eletroencefalografia/instrumentação , Eletroencefalografia/métodos , Ablação por Ultrassom Focalizado de Alta Intensidade/instrumentação , Ablação por Ultrassom Focalizado de Alta Intensidade/métodos , Humanos , Fotocoagulação a Laser/instrumentação , Fotocoagulação a Laser/métodos , Terapia a Laser/instrumentação , Terapia a Laser/métodos , Imagem por Ressonância Magnética Intervencionista/instrumentação , Imagem por Ressonância Magnética Intervencionista/métodos , Neuronavegação/instrumentação , Neuronavegação/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Robótica
10.
J Vasc Surg ; 72(1): 356-366.e5, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32093910

RESUMO

OBJECTIVE: Our study aimed to perform a meta-analysis based on current evidence to investigate the efficacy of different debulking devices in the treatment of femoropopliteal in-stent restenosis (FP-ISR). METHODS: We systematically searched for articles reporting treatment of FP-ISR patients in the MEDLINE, Embase, and Cochrane databases. Randomized controlled trials, cohort studies, and retrospective studies were included, and clinical characteristic outcomes were extracted and pooled. The efficacy end points included primary patency and freedom from target lesion revascularization (TLR) at 1 year. Pooled estimates were calculated using the random effects model. For each point, effect size and 95% confidence intervals (CIs) were calculated. RESULTS: We identified 12 studies with 743 patients that could be included in this meta-analysis. The overall primary patency at 1 year was 58.3% (95% CI, 44.7%-71.9%), and freedom from TLR at 1 year was 67.0% (95% CI, 60.5%-74.6%). Subgroup analysis showed that the laser debulking + percutaneous transluminal angioplasty (PTA) group was associated with a similar primary patency and freedom from TLR compared with the mechanical debulking + PTA group (53.8% vs 52.8; 65.4% vs 62.1%). Subgroup analysis demonstrated that the long lesion and short lesion groups and the occlusive and stenosis groups shared similar results of primary patency and freedom from TLR. Laser + drug-coated balloon was associated with higher primary patency and freedom from TLR compared with laser + PTA (78.5% vs 58.3%; 76.7% vs 66.4%). CONCLUSIONS: Debulking devices show promising and favorable results for FP-ISR patients with complex lesions. Debulking devices combined with a drug-coated balloon might be an efficacious way to treat FP-ISR complex lesions in the future.


Assuntos
Angioplastia/instrumentação , Aterectomia/instrumentação , Artéria Femoral , Terapia a Laser/instrumentação , Doença Arterial Periférica/terapia , Artéria Poplítea , Trombectomia/instrumentação , Angioplastia/efeitos adversos , Aterectomia/efeitos adversos , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/fisiopatologia , Humanos , Terapia a Laser/efeitos adversos , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Artéria Poplítea/diagnóstico por imagem , Artéria Poplítea/fisiopatologia , Recidiva , Fatores de Risco , Trombectomia/efeitos adversos , Resultado do Tratamento , Grau de Desobstrução Vascular
11.
Urology ; 136: 196-201, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31790785

RESUMO

OBJECTIVE: To compare outcomes for patients undergoing holmium laser enucleation of the prostate (HoLEP) for lower urinary tract symptoms secondary to benign prostate hyperplasia using 3 different laser fibers and 2 different laser energy modes. MATERIALS AND METHODS: This is a review of a clinic registry of men with lower urinary tract symptoms secondary to benign prostate hyperplasia who underwent HoLEP between August 2018 and January 2019. Patients were assigned to group 1 (50 patients), group 2 (50 patients), and group 3 (50 patients) based on the HoLEP being completed with either a Slimline 550µm, Slimline 1000µm, or MOSES 550 µm laser, respectively. The groups were compared using SSPS for ANOVA comparison of means and multivariate logistic regression. RESULTS: Ten patients who underwent concomitant stone surgery (2 PCNL, 8 ureteroscopy , 3 bilateral cases) and 11 patients had bladder stones removed; ancillary procedures did not significantly differ between groups(P = .2). Prostate enucleation times differed significantly (22.5 + 7.3, 16.4 + 6.9, 18.1 + 8.6 minutes P ≤.001) between groups. However, statistical significance was lost once enucleation time was indexed against enucleated tissue weight. Time to achieve hemostasis (minutes) was statistically different between groups (10.6 + 6.1, 7.7 + 5.2, 6.3 + 4.8 P <.001). This difference in hemostatic time was maintained on multilogistic regression demonstrating that MOSES laser enucleation was associated with a 3.9-minute decrease time to achieve hemostasis after enucleation compared to Slimline 550 HoLEP (P <.001). CONCLUSION: Our findings suggest that modulated pulsed laser energy can improve hemostasis during the enucleation phase of a HoLEP resulting in shorter Operating Room times.


Assuntos
Terapia a Laser/instrumentação , Terapia a Laser/métodos , Lasers de Estado Sólido/uso terapêutico , Sintomas do Trato Urinário Inferior/cirurgia , Prostatectomia/métodos , Hiperplasia Prostática/cirurgia , Idoso , Idoso de 80 Anos ou mais , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Pessoa de Meia-Idade , Hiperplasia Prostática/complicações , Estudos Retrospectivos
12.
J Urol ; 203(4): 792-801, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31763948

RESUMO

PURPOSE: In a preliminary clinical trial we assessed the efficacy of ejaculatory hood sparing GreenLight™ Laser prostate photoselective vaporization to preserve antegrade ejaculation and urodynamic relief of obstruction compared to standard GreenLight prostate photoselective vaporization. MATERIALS AND METHODS: Standard prostate photoselective vaporization was classically performed in 24 patients. Ejaculatory hood sparing vaporization was performed with preservation of the paracollicular and supracollicular tissue proximal to the verumontanum in 25 patients. Patients were assessed at baseline, and 1, 3, 6 and 12 months postoperatively using the Ej-MSHQ (Ejaculatory Domain of Male Sexual Health Questionnaire) and the IIEF-15 (International Index of Erectile Function-15). The I-PSS (International Prostate Symptom Score), uroflowmetry and post-void residual urine volume were reported at each followup visit. A standard urodynamic study was performed at 6 months. RESULTS: Antegrade ejaculation was reported in 85% and 31.6% of patients after hood sparing and standard prostate vaporization, respectively (p=0.001). A significant reduction in the EJ-MSHQ score was reported after standard vaporization at 6 and 12 months (each p <0.001) with no significant difference after hood sparing vaporization (p=0.18 and 0.078, respectively). The median EJ-MSHQ score was 28.5 (range 1 to 33) and 27 (range 1 to 33) for hood sparing vaporization, and 9.5 (range 1 to 35) and 9 (range 0 to 33) for standard vaporization at 6 (p=0.005) and 12 months (p <0.001), respectively. Each group showed a decline in the mean total IIEF-15 score at 1 year but it was statistically significant only after standard vaporization (p=0.001). All urinary outcome measures revealed comparable significant improvement at all followups. Postoperative urodynamic assessment demonstrated a significant comparable decrease in the Bladder Outlet Obstruction Index from a median of 64 (range 21 to 207) to 23.5 (range 10 to 53) after hood sparing vaporization (p=0.005) and from 87 (range 38 to 186) to 19.5 (range 7 to 51) after standard vaporization (p=0.001). At 1 year the overall re-treatment rate was comparable in the 2 groups (p=0.26). CONCLUSIONS: In well informed, sexually interested patients ejaculatory hood sparing GreenLight prostate photoselective vaporization is feasible and effective treatment of small to moderate sized benign prostatic hyperplasia with a superior sexual function related outcome. Short-term relief of obstruction is objectively comparable to that of standard prostate photoselective vaporization.


Assuntos
Disfunção Erétil/diagnóstico , Terapia a Laser/efeitos adversos , Tratamentos com Preservação do Órgão/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Prostatectomia/efeitos adversos , Hiperplasia Prostática/cirurgia , Método Duplo-Cego , Ejaculação/fisiologia , Disfunção Erétil/etiologia , Disfunção Erétil/fisiopatologia , Disfunção Erétil/prevenção & controle , Estudos de Viabilidade , Seguimentos , Humanos , Terapia a Laser/instrumentação , Terapia a Laser/métodos , Lasers de Estado Sólido/efeitos adversos , Lasers de Estado Sólido/uso terapêutico , Masculino , Pessoa de Meia-Idade , Tratamentos com Preservação do Órgão/métodos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/prevenção & controle , Próstata/patologia , Próstata/cirurgia , Prostatectomia/métodos , Hiperplasia Prostática/patologia , Fatores de Tempo , Resultado do Tratamento , Urodinâmica/fisiologia
13.
Urology ; 135: 171-172, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31589882

RESUMO

OBJECTIVE: To demonstrate how bladder ultrasound can be useful in completing morcellation during difficult Holmium Laser Enucleation of the Prostate (HoLEP). As HoLEP has emerged as a standard of care for the treatment of benign prostatic hyperplasia, multiple studies have reported the potentially catastrophic complication of bladder injury during morcellation. This video aims to assist any urologist performing HoLEP by providing step-by-step instruction for using ultrasound to complete morcellation safely. METHODS: Enucleation is performed using a 26-French continuous flow scope, off-set laser bridge with a laser stabilization catheter, and a 550 µm holmium laser fiber. Once the median and lateral lobes have been enucleated, the outer sheath is removed and the nephroscope is inserted to facilitate morcellation. Under dual inflow irrigation, the Piranha morcellator (Richard Wolf, Knittlingen, Germany) is introduced and set to the manufacturer's recommended settings of 1500 rpm. A 3.5-MHz convex abdominal ultrasound transducer (Hitachi Prosound Alpha 7; Hitachi Aloka Medical America, Wallingford, CT) under B-mode is used to visualize the bladder, predominantly in the sagittal orientation. Morcellation proceeds under simultaneous ultrasound and direct cystoscopic guidance. RESULTS: The distended bladder is visualized concurrently with the ultrasound and via the nephroscope as the Piranha engages the adenoma and begins morcellation. Once the adenoma is engaged, the operator then drops their hands to place the morcellator in the center of the bladder. Ultrasound provides real-time feedback as to the location of the morcellator in relation to the adenoma and bladder. CONCLUSION: This video highlights the use of intraoperative bladder ultrasound as a visual aid to assist during the morcellation portion of HoLEP. This proof of concept demonstrates that ultrasound can be an additional tool to utilize during difficult cases when cystoscopic visualization during morcellation is limited.


Assuntos
Complicações Intraoperatórias/prevenção & controle , Terapia a Laser/métodos , Morcelação/métodos , Prostatectomia/métodos , Bexiga Urinária/diagnóstico por imagem , Humanos , Complicações Intraoperatórias/etiologia , Terapia a Laser/efeitos adversos , Terapia a Laser/instrumentação , Lasers de Estado Sólido/efeitos adversos , Lasers de Estado Sólido/uso terapêutico , Masculino , Morcelação/efeitos adversos , Morcelação/instrumentação , Estudo de Prova de Conceito , Próstata/diagnóstico por imagem , Próstata/cirurgia , Prostatectomia/efeitos adversos , Prostatectomia/instrumentação , Hiperplasia Prostática/cirurgia , Ultrassonografia , Bexiga Urinária/lesões
14.
J Voice ; 34(1): 140-144, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30337120

RESUMO

PURPOSE: To report the voice outcome measures of thulium laser therapy as an office procedure in patients with vocal fold polyps. METHOD: This is a retrospective chart review of all patients with vocal fold polyps who underwent office-based thulium laser treatment between November 2016 and December 2017. Demographic data were collected. Objective voice outcome measures included extent of resolution, type of closure, and mucosal wave characteristics. Also, subjective outcome measures were reported, namely, Voice Handicap Index-10. RESULTS: A total of 20 patients were enrolled with a mean age of 50.95 ± 14.70 years. All patients had unilateral vocal fold polyps except for one who had bilateral polyps. Out of the 20 patients, 16 had complete regression of disease and 4 had partial regression. The number of patients with incomplete glottal closure decreased from 12 pretreatment to only 1 patient posttreatment, and the number of patients with impaired mucosal waves decreased from 13 to 5. There was also a significant decrease in the mean VHI-10 score before and after treatment (15.61 vs. 4.61 P value < 0.001). CONCLUSION: Thulium laser can be used as an office procedure for the treatment of vocal fold polyps.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/instrumentação , Doenças da Laringe/cirurgia , Terapia a Laser/instrumentação , Lasers Semicondutores/uso terapêutico , Pólipos/cirurgia , Túlio , Prega Vocal/cirurgia , Distúrbios da Voz/cirurgia , Adulto , Idoso , Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Feminino , Humanos , Doenças da Laringe/diagnóstico , Doenças da Laringe/fisiopatologia , Terapia a Laser/efeitos adversos , Lasers Semicondutores/efeitos adversos , Masculino , Pessoa de Meia-Idade , Pólipos/diagnóstico , Pólipos/fisiopatologia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Túlio/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Prega Vocal/fisiopatologia , Distúrbios da Voz/diagnóstico , Distúrbios da Voz/fisiopatologia , Qualidade da Voz
15.
Cornea ; 39(2): 229-233, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31436636

RESUMO

PURPOSE: To evaluate in vitro the feasibility and tissue effects of using a slit-lamp neodymium-doped yttrium aluminum garnet (Nd:YAG) laser to create a central descemetorhexis in human donor corneas. METHODS: Twelve human donor corneas ineligible for transplantation were divided into 2 groups, A and B. Group A: 2 "healthy" corneas, which were used to validate the laser parameters; group B: 10 corneas with endothelial guttae, which were used to perform a 4-mm descemetorhexis. Slit-lamp photography, light microscopy, corneal endothelial microscopy, Scheimpflug imaging, optical coherence tomography (OCT) imaging, and histological staining were performed to visualize the efficacy of slit-lamp Nd:YAG laser removal of Descemet membrane and to assess potential tissue damage to the overlying stroma and peripheral endothelium. RESULTS: In all corneas, an Nd:YAG laser 4-mm central descemetorhexis could be consistently performed. The total energy required ranged from 1143 to 2784 mJ. Side effects such as stromal pitting and corneal swelling were observed. CONCLUSIONS: Creating a central descemetorhexis with a slit-lamp Nd:YAG laser proved feasible in vitro. This new technical approach might open the door to a customized in vivo "descemetorhexis-only" treatment for Fuchs endothelial corneal dystrophy eyes, while avoiding the risks associated with intraocular surgery.


Assuntos
Lâmina Limitante Posterior/cirurgia , Terapia a Laser/instrumentação , Lasers de Estado Sólido , Lâmpada de Fenda , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Viabilidade , Feminino , Humanos , Masculino , Microscopia , Pessoa de Meia-Idade , Fotografação , Doadores de Tecidos , Tomografia de Coerência Óptica
17.
Neurosurgery ; 86(4): 538-547, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-31076762

RESUMO

BACKGROUND: Stereotactic laser ablation (SLA) has demonstrated potential utility for a spectrum of difficult to treat neurosurgical pathologies in multiple small and/or retrospective single-institutional series. Here, we present the safety profile of SLA of intracranial lesions from the Laser Ablation of Abnormal Neurological Tissue using Robotic NeuroBlate System (LAANTERN; Monteris Medical) multi-institutional, international prospective observational registry. OBJECTIVE: To determine the procedural safety of SLA for intracranial lesions. METHODS: Prospective procedural safety and hospitalization data from the first 100 treated LAANTERN patients was collected and analyzed. RESULTS: Mean age and baseline Karnofsky Performance Status (KPS) were 51(± 17) yr and 83(± 15), respectively. In total, 81.2% of patients had undergone prior surgical or radiation treatment. Most patients had a single lesion (79%) ablated through 1 burr hole (1.2 ± 0.7 per patient), immediately following a lesion biopsy. In total, >90% of the lesion was ablated in 72% of treated lesions. Average total procedural time was 188.2 ± 69.6 min, and average blood loss was 17.7 ± 55.6 ccs. The average length of intensive care unit (ICU) and hospital stays before discharge were 38.1 ± 62.7 h and 61.1 ± 87.2 h, respectively. There were 5 adverse events (AEs) attributable to SLA (5/100; 5%). After the procedure, 84.8% of patients were discharged home. There was 1 mortality within 30 d of the procedure (1/100; 1%), which was not attributable to SLA. CONCLUSION: SLA is a safe, minimally invasive procedure with favorable postprocedural ICU and hospital utilization profiles.


Assuntos
Encefalopatias/cirurgia , Terapia a Laser/efeitos adversos , Terapia a Laser/métodos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Hospitalização , Humanos , Terapia a Laser/instrumentação , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Sistema de Registros , Procedimentos Cirúrgicos Robóticos/instrumentação , Técnicas Estereotáxicas/efeitos adversos , Técnicas Estereotáxicas/instrumentação , Adulto Jovem
18.
Artigo em Inglês | LILACS-Express | LILACS, BBO - Odontologia | ID: biblio-1135508

RESUMO

Abstract Objective: To discover the perceptions of pediatric patients, their parents and undergraduate Dentistry students of the use of the diode laser in frenectomy surgeries. Material and Methods: A qualitative study was conducted through semi-structured interviews, recorded and transcribed with subsequent content analysis. Twelve healthy children (5-8 years old) who needed a frenectomy were selected and invited, together with their parents, to undergo laser diode surgery. In addition, 28 undergraduate dentistry students were invited to attend the procedures. One week after performing the surgical procedures, the children (Group 1), their parents (Group 2) and the students who attended the procedures (Group 3) were individually interviewed for the thematic analysis. Results: The analysis of the conversations identified three emerging contents: positive thoughts on the use of diode laser; frustrations from the use of diode laser; and aspects related to professional training. Conclusion: The results pointed to the acceptance of surgical laser use in pediatric dentistry; however, the feelings of frustration indicate that its use requires guidance from the child and his/her parents, in addition to careful handling and specific training.


Assuntos
Odontopediatria , Terapia a Laser/instrumentação , Lasers Semicondutores/uso terapêutico , Doenças da Gengiva/cirurgia , Freio Labial/cirurgia , Percepção , Brasil/epidemiologia , Pesquisa Qualitativa
19.
J Biomed Opt ; 24(12): 1-7, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31849206

RESUMO

Sapphire capillary needles fabricated by edge-defined film-fed growth (EFG) technique hold strong potential in laser thermotherapy and photodynamic therapy, thanks to the advanced physical properties of sapphire. These needles feature an as-grown optical quality, their length is tens of centimeters, and they contain internal capillary channels, with open or closed ends. They can serve as optically transparent bearing elements with optical fibers introduced into their capillary channels in order to deliver laser radiation to biological tissues for therapeutic and, in some cases, diagnostic purposes. A potential advantage of the EFG-grown sapphire needles is associated with an ability to form the tip of a needle with complex geometry, either as-grown or mechanically treated, aimed at controlling the output radiation pattern. In order to examine a potential of the radiation pattern shaping, we present a set of fabricated sapphire needles with different tips. We studied the radiation patterns formed at the output of these needles using a He-Ne laser as a light source, and used intralipid-based tissue phantoms to proof the concept experimentally and the Monte-Carlo modeling to proof it numerically. The observed results demonstrate a good agreement between the numerical and experimental data and reveal an ability to control within wide limits the direction of tissue exposure to light and the amount of exposed tissue by managing the sapphire needle tip geometry.


Assuntos
Óxido de Alumínio , Terapia a Laser/instrumentação , Agulhas , Desenho de Equipamento , Imagens de Fantasmas , Fotoquimioterapia/instrumentação
20.
J Biomed Opt ; 24(12): 1-9, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31884746

RESUMO

Suturing of corneal incisions requires significant skill. We demonstrate a noncontact method that will simplify the bonding process. 5-mm-long penetrating vertical and slanted incisions were made in corneas of eyes, extracted from dead piglets. A fiber-optic laser system was used for laser soldering of the incisions, under close temperature control, using albumin solder. The burst-pressure PB immediately after the soldering was found to be PB ≈ 92 and 875 mmHg, for vertical and slanted incisions, respectively. PB = 875 mmHg is an exceptionally high figure, ≈10 times the clinically acceptable value for sutured incisions. Laser soldering was then performed on penetrating incisions made in the corneas of live healthy piglets, of weight ≈10 Kg. After a healing period, the eyes were extracted, and the corneas were examined by histopathology and by optical coherence tomography. Our method immediately generated watertight and strong bonding without noticeable corneal shape distortion. These results would be beneficial for cataract surgery and for corneal transplantations. The fiber-optic system makes it much easier to bond corneal incisions. In the future, laser soldering could be automated and efficiently used by less experienced surgeons, thereby reducing the workload on the experienced ones.


Assuntos
Córnea , Tecnologia de Fibra Óptica/instrumentação , Terapia a Laser/métodos , Animais , Córnea/fisiologia , Córnea/efeitos da radiação , Córnea/cirurgia , Terapia a Laser/instrumentação , Procedimentos Cirúrgicos sem Sutura , Suínos , Cicatrização
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