Diseases that Harm Require Therapies that Harm Less

---Sir William Osler(1849-1919)
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ISMIVS Newsletter February, 2021
Newsletter 2021 February
2021 年 2月简报
About Us 国际微无创医学会简介
The International Society of Minimally Invasive and Virtual Surgery (ISMIVS, previously known as International Society of Minimally Invasive and Noninvasive Medicine) was founded in July 2013 at the gala of the 1st Yangtze International Summit of Minimally Invasive and Noninvasive Medicine in Chongqing, China. ISMIVS envisions to accelerating the progress in minimally invasive and noninvasive medicine by promoting research, education, communication, and international collaboration.
国际微无创医学会(ISMIVS)是在 2013 年 7 月在中国重庆召开的第一届国际微无创医学长江高峰论坛上宣布成立的,旨在通过学术研究、教育、交流以及国际合作加快微无创医学的发展。
Become a member 注册成为会员 >
The Personality in the Medical Education World 医学教育界的大人物
From the July issue of our ISMIVS Newsletter, we would like to introduce some pioneers in the field of minimally-invasive and noninvasive medicine. They are not only prestigious in their field but also willing to share their experience and ideas with younger doctors, hence making a great contribution to medical education. In this issue, we are going to introduce our deceased Professor Imankulov Suindyk Bopezhanovich (1957-2020) from Kazakhstan. We would like to commemorate and thank Professor Suindyk for his outstanding contribution to the field of minimally invasive and noninvasive medicine.
从 2020 年 7 月刊开始,国际微无创医学会将为大家介绍微无创医学领域的一些领军人物。他们不仅在各自的领域享负盛名,而且非常乐意与年轻医生分享他们的经验、理念和想法,从而为医学教育做出了巨大的贡献。本期月刊要介绍的医学教育界的大人物是哈萨克斯坦已故的伊曼库洛夫·苏伊迪克·博佩扎诺维奇(Imankulov Suindyk Bopezhanovich,苏伊迪克)教授(1957-2020),特此纪念并感谢苏伊迪克教授生前在微无创医学领域做出的杰出贡献。
Prof. Imankulov Suindyk Bopezhanovich, M.D.
Senior HIFU Physician
Board Member of ISMIVS

Professor Suindyk was born in 1957 in Kazakhstan and trained in Karaganda State Medical University of Kazakhstan. He also studied in St. Petersburg and Moscow, Russia, London, UK and Chongqing, China for further medical training. He dedicated more than 30 years of his life in clinical medicine with rich experience in ultrasound diagnosis and therapy. He had been working tirelessly during the COVID-19 pandemic since his hospital became the designated hospital for COVID-19 treatment, and fought until the last moment in his position. He passed away on September 1, 2020 due to severe COVID-19 infection at the age of 63.

Prof. Suindyk was Head of HIFU Therapy and Ultrasound Imaging Department of the "National Scientific Medical Center" JSC in Kazakhstan, author and co-author of many research papers and textbooks. He held 14 patents of invention for diagnosis using ultrasound, infrasound or sound waves. He was the winner of the European Prize“For Quality Innovation” for his pioneer clinical research and practice that applies HIFU for the treatment of parasitic diseases of the internal organs.
苏伊迪克教授是哈萨克斯坦国家科学医学中心JSC高强度聚焦超声治疗和超声影像科主任,独立或与人合作发表科研论文多篇、编写教科书多本。拥有14项 "利用超声波、次声波或声波进行诊断 "的相关发明专利。曾凭借应用HIFU治疗内脏寄生虫疾病的开创性临床研究与实践,荣获欧洲“质量创新”大奖。

Prof. Suindyk's letter of patent for HIFU treatment of liver alveococcosis and echinococcosis
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Please see below two papers by Prof. Suindyk:
1 High-intensity focused ultrasound ablation: a non-surgical approach to treat advanced and complicated liver alveococcosis
2 HIFU treatment for fibroadenoma - a clinical study at National Scientific Research Centre, Astana, Kazakhstan
News 新闻
ISMIVS launching its online training program
The International Society of Minimally Invasive and Virtual Surgery is pleased to announce the availability of a series of online training courses on the clinical application of noninvasive focused ultrasound therapy. A variety of courses related with ultrasound-guided high intensity focused ultrasound (HIFU) ablation of uterine fibroids will enlighten doctors about the physics and biological effect of HIFU, case screening, clinical protocol, anesthesia plan, nursing care, etc. In the meantime, more courses on focused ultrasound therapy of other diseases will be uploaded in the future, please follow us on www.ismivs.org for what you are interested in.
国际微无创医学会很高兴向大家宣布:我们的线上培训课程开始正式上线。课程将涵盖超声引导的高强度聚焦超声(HIFU)消融子宫肌瘤的物理学基础和生物学效应、病例筛选、临床方案、麻醉方案以及临床护理等。同时更多聚焦超声无创治疗其他疾病的课程将陆续上线,欲了解更多,请关注我们的官方网站 www.ismivs.org
The training courses are accessible only to part of ISMIVS members.
Sedation and Analgesia Planning for HIFU Ablation
This lecture shall introduce the regimen of sedation and analgesia for HIFU ablation of uterine fibroids. Through this lecture, trainees are expected to understand the principle of sedation and analgesia for HIFU therapy. Prepoperative preparation of patients, medicines, and apparatuses is important for HIFU therapy. Trainees need to pay attention to the indications and contraindications to different sedatives and analgesics. Three frequently used regimens are introduced and compared, and trainees must know how and when to administer the sedatives and analgesics. Last but not the least, trainees must be familiar with the possible risks and complications of sedation and analgesia and the corresponding preventive measures and countermeasures.
Application of Oxytocin in HIFU Treatment of Uterine Fibroids
The application of oxytocin in HIFU treatment of uterine fibroids started around the year of 2006. Clinical experience and research results indicate that application of oxytocin can shorten the treatment time of HIFU ablation of uterine fibroids and improve the treatment efficiency. Trainees are expected to understand preoperative oxytocin test, side effects of oxytocin and alternative drugs to oxytocin.
聚焦超声消融治疗中缩宫素的应用大约开始于2006年。临床经验与研究结果表明缩宫素可以缩短聚焦超声消融治疗时间、提高治疗效率。 通过本课程,医生须熟知掌握聚焦超声消融术前的缩宫素测试、缩宫素的副作用以及缩宫素的替代药品。
Become a member >
申请成为会员 >
To apply for the training courses,
please contact the ISMIVS Secretariat
HIFU Webinar in Nigeria: Treating Uterine Fibroids Without The Knife
An online fibroid conference themed Treating Uterine Fibroids Without The Knife: Minimally Invasive and Non-Invasive Methods of Treating Fibroids was held on the 13th of February, 2021, drawing attention of more than 2,000 international OBGYNs and ladies who are interested to know more about ultrasound-guided HIFU therapy.
2021 年 2 月 13 日, 主题为“无手术刀的子宫肌瘤治疗:子宫肌瘤的微无创治疗“ 的子宫肌瘤专题会议于线上举行,吸引了全球2000多名对超声引导下的 HIFU 感兴趣的妇科医生及妇女。

In the chair was Dr Abayomi Ajayi, Managing Director of Nordica Fertility Center, Nigeria, and two speakers were Dr Raymond Setzen, Director of HIFU center in Chris Hani Baragwanath Hospital, South Africa, and Dr Victor Ajayi, Consultant Gynecologist from Nordica Fertility Center, Nigeria.
本次研讨会主席为尼日利亚 Nordica 辅助生殖中心( Nordica Fertility Center )总经理阿巴约米·阿贾伊( Abayomi Ajayi )医生,演讲嘉宾为南非 Chris Hani Bara 医院HIFU中心主任雷蒙德·赛森( Raymond Setzen )医生和 尼日利亚 Nordica 辅助生殖中心妇科顾问维克多·阿贾伊( Victor Ajayi )医生。

To start with, Dr Abayomi Ajayi shared his thoughts on the theme of the webinar. He briefly introduced the knowledge concerning fibroid and the minimally invasive and non-invasive treatment methods available currently. Also he announced that the first HIFU center powered by Nordica Fertility Center Lagos in Nigeria was going to open in Mid-2021. Good news!
会议开场,阿巴约米·阿贾伊医生就会议主题分享了他的看法,并简要介绍了子宫肌瘤的相关知识以及现有的治疗方式。他在会上宣布, Nordica 辅助生殖中心将建立尼日利亚第一家HIFU治疗中心,并于2021年年中开始运营。这真是好消息!

Dr. Victor Ajayi gave one lecture themed”Fibroid-Minimally Invasive Treatment Methods”, introducing his clinical experiences of fibroid management with minimally invasive methods; Dr Raymond Setzen gave a lecture of “HIFU: High Intensity Focused Ultrasound Surgery”, he introduced the basic handling of HIFU therapy and the clinical results in Chris Hani Barawanath Hospital. In Chris Hani Baragwanath Hospital, more than 460 patients have been treated with HIFU therapy. He conclude that “HIFU provides safe and effective alternative in management of symptomatic fibroids”.
维克多·阿贾伊医生发表题为“子宫肌瘤的微创治疗”的演讲,分享了其应用微创治疗管理子宫肌瘤的临床经验。雷蒙德·赛森医生发表题为”HIFU:高强度聚焦超声手术“的演讲,介绍了南非 Chris Hani Bara 医院HIFU治疗基本操作及临床结局,已治疗460余例患者,认为HIFU治疗有症状的子宫肌瘤是安全、有效的。

Click the link below for the playback of this conference:

Tech Update 微无创技术新进展
A meta-analysis and comparison of thermal ablative techniques
An extended literature search was performed on Pubmed database by using the Mesh terms “ablation techniques” and “leiomyoma” or “uterine fibroid” or “symptomatic uterine fibroid”. Literature search was completed with the following terms: “interventional radiology," "percutaneous thermal ablation,”"percutaneous microwave ablation” or “MWA,” “radiofrequency” or “RF,” and “high-intensity focused ultrasound” and “HIFU.” 93 studies which fulfilled the inclusion criteria were finally analyzed.
通过Pubmed数据库进行大范围的文献检索,检索关键词为" ablation techniques " (消融技术)、" leiomyoma " (平滑肌瘤)、" uterine fibroid " (子宫肌瘤)或 " symptomatic uterine fibroid " (有症状的子宫肌瘤),以及" interventional radiology " (介入放射)、" percutaneous thermal ablation " (经皮热消融)、" percutaneous microwave ablation " 或 MWA (经皮微波消融)、" radiofrequency "或 RF (射频)、" high-intensity focused ultrasound "或 HIFU (高强度聚焦超声)。最终筛选出93项满足入选标准的研究,并对这些文章进行了分析。

Among the minimally invasive techniques, RF myolysis is currently considered a valid alternative for the treatment of UFs. It works delivering RF energy to myomas under US guidance in an attempt to destroy them directly through coagulative necrosis consequent to the oscillation and friction of water molecules. The ablation route can be laparoscopic, transvaginal, or transcervical, aiming to reduce the volume of the target fibroids with subsequent symptom relief.

Percutaneous MWA is capable of improving fibroid-related symptoms by reducing the volume of lesions, which offers numerous advantages when compared to other ablation techniques. Large volumes of necrosis (up to 6 cm in diameter) can be achieved introducing a single antenna via a single percutaneous access, thus reducing the risk of injury to the abdominal organs which may result from multiple insertions.
经皮微波消融可通过缩小病变组织达到缓解肌瘤相关症状的目的,与其他消融技术相比有许多优势。单根微波治疗针经皮穿刺可实现直径最大6 cm 的病灶坏死,降低了多孔穿刺损伤腹部器官的风险。

Several authors have evaluated the clinical utility of a microbubble US contrast agent (SonoVue) in the US-guided HIFU ablation. In a andomized control trial, the investigators found that SonoVue could be safely used to enhance the ablative effects of HIFU in the treatment for uterine fibroids, increasing the rate of massive gray-scale changes (P = 0.002) and shortening the sonication time (P = 0.001). This valuable effect was more remarkable when HIFU ablation started sooner after contrast media administration.
多项研究对超声造影剂微泡( SonoVue )在超声引导的HIFU消融中的临床使用进行了评估。在一项随机对照试验中,研究人员发现 SonoVue 可安全用于提高 HIFU 治疗子宫肌瘤的消融效果,增强团块灰度变化的范围(P = 0.002)并缩短辐照时间(P = 0.001)。使用造影剂后即刻开始HIFU消融,消融效果更明显。

US-guided intralesional ethanol injection combined with HIFU ablation required less treatment time and a lower dose than HIFU alone, reduced the periprocedural pain and adverse events commonly experienced by patients (P < 0.05).
与单独采用 HIFU 消融相比,超声引导的病灶内酒精注射联合 HIFU 消融所需的治疗时间更短、治疗剂量更低,常见围手术期疼痛以及副反应更少(P < 0.05)。

An increasing number of studies has demonstrated that HIFU ablation is a safe, “needle free,” minimally invasive therapeutic strategy for uterine fibroids, and affords speedy recovery. Despite these merits, HIFU ablation is less effective or even infeasible for certain conditions because of several limitations. Some of these factors can be surmounted, for instance, bowel loop interposition can be overcome by diverse manipulation techniques, whereas other limits related to tissue properties resistive to HIFU heating are more difficult to bypass.
越来越多的研究表明, HIFU 消融是治疗子宫肌瘤的一种安全、无需穿刺的微创方式,并且术后恢复快。但在特定条件限制下, HIFU 消融效果不佳甚至不可行。虽然其中一些因素可以克服,例如,肠道干扰可通过多种操作技巧避免,但其他因为组织特性对 HIFU 热量不敏感的情况就较难克服。

Therefore, an accurate pretreatment selection is crucial to reduce the number of unsatisfactory ineffective ablations. MR features of the fibroid to be treated by HIFU are relevant to predict the ablation efficacy; notably, high signal intensity on T2-weighted images has been identified as the most relevant predictor of poor efficacy of HIFU. Similarly, DCE-MRI quantitative parameters, namely Ktrans, BV, and BF were deemed to be prognostic determinant of HIFU efficacy, being negatively correlated with the immediate NPV ratio in symptomatic uterine fibroids. Indeed, in order to achieve substantial symptom relief, the NPV should be as large as safely achievable. Partially ablated fibroids tend to regrow, and this may explain the relatively high re-intervention rate reported in studies using a restricted protocol.
因此, HIFU 术前准确筛选患者对降低无效消融至关重要。待治疗肌瘤的 MR 影像特点与预测消融效果有关,尤其是T2高信号的肌瘤,其消融效果最差;类似的,动态增强 MRI 定量参数,即 Ktrans 、 BV 和 BF 可作为预测 HIFU 疗效的决定性参数,与有症状的子宫肌瘤消融后即刻非灌注率( NPV )呈负相关。的确,为了实现显著的症状缓解,应在安全治疗的前提下尽可能提高消融率。非完全消融的子宫肌瘤容易再生长,这可能就解释了为什么有些使用了限制方案的研究当中再干预率相对较高。
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Feasibility study of high intensity focused ultrasound (HIFU) for the treatment of hydatid cysts of the liver
高强度聚焦超声( HIFU )治疗肝包虫病的可行性研究
This study evaluates the feasibility of using high intensity focused ultrasound (HIFU) for the treatment of hydatid cysts of the liver. HIFU ablation was carried out in 62 patients with echinococcosis of the liver. The mean age of patients was 40.76 ± 14.84 (range: 17–72 years). The effectiveness of the treatment was monitored in real-time by changes in the gray-scale, and by morphological studies, computed tomography, magnetic resonance imaging, and ultrasound.
这项研究评估了使用高强度聚焦超声( HIFU )治疗肝包虫囊肿的可行性。 HIFU 消融术治疗了62例肝包虫病患者。患者的平均年龄为40.76±14.84(范围:17-72岁)。通过灰度变化、形态研究、计算机断层扫描、磁共振成像和超声实时监控治疗的有效性。

Criteria for evaluating the effectiveness of treatment in real time were outlined. Cytomorphological picture of destructive changes of parasitic elements was presented as well. Loss of embryonic elements of the parasite was observed at the subcellular level after HIFU ablation and underlines the effectiveness of HIFU.
这项研究概述了实时评估治疗效果的标准,也展示了寄生元素破坏性变化的细胞形态学图像。 HIFU 消融后,在亚细胞水平上观察到寄生虫胚胎成分出现损失,突出了 HIFU 的有效性。

In conclusion, HIFU ablation is an effective therapy for hydatid disease of liver. It can effectively destroy protoscolexes as well as all structures of cyst germinal layer, which holds all the vital functions of echinococcus. The crucial criterion for HIFU treatment effectiveness is the confirmation of embryonic death of the parasite elements at the subcellular level. In the case of hepatic hydatid, HIFU treatment can be applied as first-line therapy, or as preoperative preparation adjuvant for traditional echinococcectomy to preserve seeding.
总而言之, HIFU 消融术是治疗肝包虫病的有效方法。它可以有效破坏原头蚴以及囊肿生发层的所有结构,而后者承载着棘球幼虫的所有重要功能。 HIFU治疗有效性的关键标准是在亚细胞水平上确认寄生虫元素的胚胎死亡。对于肝包虫,HIFU治疗可用作首选治疗方式,或作为传统棘球蚴病切除术的术前准备辅助治疗,以防止播散。
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International Guidelines on Gynaecological Endoscopy  国际妇科腔镜指南
ESGE Recommendations on Gynaecological Laparoscopic Surgery during COVID-19 outbreak
欧洲妇科内镜学会( ESGE )关于新冠肺炎大流行期间妇科腹腔镜手术的建议

In order to guide ESGE members and other colleagues organise their priorities and minimise the risk to themselves and their patients, the ESGE Executive Board has released the following recommendations on gynaecological laparoscopic surgery during COVID-19 outbreak.
为了指导 ESGE 会员和其他医学同仁组织优先事项并最大程度地降低自身和患者的感染风险, ESGE 执行委员会针对新冠肺炎大流行期间的妇科腹腔镜手术发布了以下建议。

During the time of crisis the healthcare providers need to be able to concentrate their resources on the care of people severely affected by the coronavirus, hence elective operations for benign conditions should not be carried out during the pandemic. When possible, alternative medical treatment approaches should be considered to minimise suffering and keep women at home, away from hospitals.

Depending on the availability and priorities of the healthcare system, it would be useful to screen patients for corona virus infection before planned surgical treatment, when possible.

In suspected or documented Covid-19 positive patients, surgery should be postponed until full recovery, if there is no immediate life threatening situation. Consideration should be given to non-surgical alternatives when possible. If this is not possible, surgery must be performed with full Personal Protective Equipment (PPE) worn by the entire theatre staff to reduce the risk of transmission.
对于疑似或确诊并记录在案的新冠病毒阳性患者,如果目前没有任何危及生命的情况,应将手术推迟至其完全康复。应尽可能考虑非手术替代方案。如果无法做到这一点,则整个手术室的工作人员必须穿着完整的个人防护设备( PPE )方可进行手术,以降低传播风险。

Hospitals should have arrangements in place to be able to look after women with gynaecological emergencies. Hospitals should also be able to care for women with possible gynaecological cancer and treat those who have been diagnosed with gynaecological cancer. Surgery for gynaecological cancer should continue, unless alternative interim options are possible until the end of the outbreak.

Laparoscopic surgery for gynaecological emergencies and cancer would be beneficial for the health system by reducing hospital stay, compared to open surgery. However, this should be weighed against possible disadvantages of laparoscopic surgery during the outbreak.
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