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首页> 外文期刊>BJU international >Real-time transrectal ultrasonography-guided hands-free technique for focal cryoablation of the prostate
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Real-time transrectal ultrasonography-guided hands-free technique for focal cryoablation of the prostate

机译：实时经直肠超声引导免提技术治疗前列腺局灶性冷冻消融

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Objectives To describe, step-by-step, our hands-free technique for focal cryoablation of prostate cancer. Materials and Methods After detailed discussion of its limitations and benefits, consent was obtained to perform focal cryoablation in patients with biopsy-proven unilateral low- to intermediate-risk prostate cancer. The procedure was performed transperineally, using a hands-free technique (without an external grid template) under real-time bi-plane transrectal ultrasonography (TRUS) guidance, using an argon/helium-gas-based third generation cryoablation system. Follow-up consisted of validated questionnaires, physical examination, PSA measures, multiparametric TRUS and/or magnetic resonance imaging (MRI) and mandatory biopsy. Results The important steps for achieving safety, satisfactory oncological and functional outcomes included: patient selection, including TRUS/MRI fusion target biopsy; thermocouple and cryoprobe placement with a hands-free technique, allowing delivery in unrestricted angulations according to the prostatic contour, the course of the neurovascular bundle and the rectal wall angle; and hands-free bi-plane TRUS probe manipulation to facilitate real-time monitoring of anatomical landmarks at the ideal angle of the image plane. To achieve a lethal temperature in the known cancer area, while preserving the urinary sphincter, neurovascular bundle, urethra and rectal wall, continuous intraoperative control of the thermocouple temperatures was necessary, as were real-time TRUS monitoring of ice-ball size, control of the energy delivered and the use of a warming urethral catheter. Conclusion We have described step-by-step the focal cryoablation of prostate cancer using a hands-free technique. This technique facilitates the effective delivery of cryoprobes and the intra-operative real-time quick manipulation of the TRUS probe.
机译：目的逐步描述我们的免提技术，用于前列腺癌的局部冷冻消融。材料和方法在详细讨论了其局限性和益处后，获得了对活检证实的单侧低危至中危前列腺癌患者进行局部冷冻消融的同意。该程序是在基于双氩经氦气的第三代冷冻消融系统的实时双平面经直肠超声检查（TRUS）指导下，使用免提技术（无外部栅格模板）经会阴进行的。随访包括经验证的问卷，身体检查，PSA措施，多参数TRUS和/或磁共振成像（MRI）和强制性活检。结果实现安全性，令人满意的肿瘤学和功能结果的重要步骤包括：患者选择，包括TRUS / MRI融合靶活检;采用免提技术的热电偶和冷冻探头放置，可根据前列腺轮廓，神经血管束的走向和直肠壁角度以不受限制的角度传送;以及免提双平面TRUS探针操纵功能，有助于在图像平面的理想角度实时监视解剖标志。为了在已知的癌症区域达到致死温度，同时保留尿道括约肌，神经血管束，尿道和直肠壁，必须在术中连续控制热电偶温度，同时实时TRUS监测冰球大小，控制温度传递的能量以及使用温暖的尿道导管。结论我们已经描述了使用免提技术逐步进行的前列腺癌局灶性冷冻消融。这项技术有助于有效地运送低温探针和术中对TRUS探针的实时快速操作。

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