Diseases that Harm Require Therapies that Harm Less

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ISMIVS Newsletter November, 2020

Newsletter 2020 November
2020 年 11 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 Prof. Filomena Santiago-San Juan.
从 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。本月刊要介绍的医学教育界的大人物是菲洛梅娜·圣地亚哥·圣胡安(Filomena Santiago-San Juan,圣胡安)教授。
Clinical Professor, Department of Obstetrics and Gynecology, UP-PGH
President, Philippine Society of Therapeutic High Intensity Focus Ultrasound in Obstetrics and Gynecology
Vice President, Society of Gynecologic Oncologists of the Philippines
Founding Incorporator and Past President, Philippine Society of Ultrasound in Obstetrics and Gynecology
Past President, Philippine Society for the Study of Trophoblastic Diseases and Philippine Society of Cervical Pathology and Colposcopy
菲律宾滋养细胞疾病研究学会会员(PSSTD)、菲律宾宫颈病理和阴道镜学会 (PSCPC)前主席

Prof. San Juan is the first Obstetrician-Gynecologist to obtain a PhD in Medical Sciences, the first Obstetrician-Gynecologist to be recognized as a multi-disciplinary specialist in 3 subspecialties (Gynecologic Oncology, Trophoblastic Disease and Ultrasonography) and the first Obstetrician-Gynecologist to serve as a Congresswoman in Philippines. POGS 1996 Tri-media Campaign in Women's Reproductive Health earned her national fame: she was the first to use newsprint, television and radio in information dissemination and public health campaign on Reproductive Health as part of her advocacy as the Public Relations Officer (PRO) with the activities during the 50th year Anniversary of POGS such as“Women's Cycle" – television program on Women's Health aired at PMTV Channel 40 for 1 year.
圣胡安教授是菲律宾首位获得医学博士学位的妇产科医生、菲律宾首位被公认为多学科专家的妇产科医生(擅长于妇科肿瘤学、滋养层疾病和超声检查三个分科)、菲律宾首位担任女国会议员的妇产科医生。菲律宾妇产科学会(POGS)1996 年发起的“妇女生殖健康-三媒体运动”让她举国成名:她是使用新闻纸媒、电视媒体和广播媒体进行生殖健康信息传播和公共卫生运动的第一人,这也是她担任菲律宾公共关系官员时所倡导的活动之一;此外,在菲律宾妇产科学会(POGS)成立 50 周年之际,她组织、开发并共同主持了一档有关妇女健康的电视节目——“女性周期”,在菲律宾医疗电视台PMTV 40 频道持续播出一年之久。

Prof. San Juan is Pioneer of the OB-GYN Ultrasound Fellowship Program and Pioneer of the Fellowship Program and Subspecialty of Obstetric and Gynecologic Ultrasound in terms of planning, development and implementation. She planned, organized and implemented the 1st 3 International Postgraduate Course in OB-GYN Ultrasound in Manila which was recognized by International Society of Ultrasound in Obstetrics and Gynecology (ISUOG). She introduced the OB-GYN training program in ultrasound for residents and specialty fellowship training at the Philippine General Hospital of the University of the Philippines (UP-PGH), and became the founding and first chief of the OB-GYN ultrasound section of UP-PGH, which became the model for a separate OB-GYN ultrasound unit in different hospitals in Philippines. In recent years, she has been taking an active part in the HIFU Training Workshops held by Chongqing Medical University respectively in Chongqing, China and Johannesburg, South Africa.

In addition to her achievements in medical field, Prof. San Juan also made great progress in improving local people's education opportunities. She used line agency budget and priority development funds to allocate from the National government necessary to do a wide range of meaningful things, including the building of 400 elementary and high school classrooms in the remotest baranggays, and the establishment of extension State Colleges of Margosatubig, Pitogo and Kumalarang, so that the poorest children of farmers and fishermen from three towns as well as surrounding areas can attain college education. Also, as a Congresswoman (2001-2004), she enacted laws geared towards improving health services and empowering women and thus awarded with Outstanding Congresswoman Award for three consecutive years (2002, 2003 and 2004).
圣胡安教授不仅在医学领域成果丰硕,在提升当地人民教育机遇这方面,也做出了卓越的贡献。她利用中央政府分配给直属机构的预算和优先发展资金做了一系列有意义的事情,包括在偏远村镇建立 400 个中小学教室;建立州立大学 Margosatubig、Pitogo 和 Kumalarang 分校,以便这三个城镇及周边地区的贫苦农渔两民的子女也能够获得大学教育。 此外,在担任国会议员期间(2001-2004 年),圣胡安教授促进国会制定通过了改善卫生服务和妇女赋能的法律,也因此连续三年(2002 年,2003 年和 2004 年)获得杰出女议员奖。

Please see below two papers by Prof. Filomena Santiago-San Juan:
A retrospective study on the accuracy of sassone, lerner and IOTA simple rules in determining malignancy of ovarian masses in a tertiary hospital ob-gyn ultrasound diagnostics unit.
《Sassone 评分系统、Lerner 评分系统和 IOTA 简单规则鉴别卵巢良恶性肿块的准确性:一项在三级医院妇产超声诊断科开展的回顾性研究》
Post curettage ultrasound monitoring to determine early gestational trophoblastic neoplasia after a hydatidiform mole.
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.

Online course: The Physics and Biological Effect of HIFU Ablation
This lecture shall explain the principle of HIFU ablation of uterine fibroids and elaborate the factors that influence the safety and effectiveness of HIFU ablation. Trainees are expected to have a general understanding of biological focal region, energy efficiency factor, acoustic environment in tissue and to grasp the relationship between treatment safety and acoustic pathway and the relationship between treatment effectiveness and treatment depth, treatment intensity, treatment time, tissue type, blood supply of tissue, and the distance from transducer to target tissue.
本课程将介绍 HIFU 消融子宫肌瘤的原理并详细分析影响 HIFU 消融安全性和有效性的因素。本课学习目标是基本理解生物学焦域、能效因子、组织内声环境三个概念,掌握安全性与声通道的关系,有效性与治疗深度、治疗强度、治疗时间、组织类型、组织血供、治疗头到靶组织的距离之间的关系。
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To apply for the training courses,
please contact the ISMIVS Secretariat
Debate: vaginal myomectomy VS HIFU for fibroids
辩论:经阴道肌瘤剔除术对比 HIFU 消融子宫肌瘤
On the call of the Vice President of Mumbai Obstetric & Gynecological Society, a unique and inspiring debate on the management of uterine fibroids by vaginal myomectomy or HIFU ablation was held on November 11, 2020.
2020 年 11 月 11 日,印度孟买妇产科协会副主席发起了一场别开生面的线上辩论,主题为”子宫肌瘤的管理:经阴道肌瘤剔除术对比 HIFU 消融“。

Dr. Ichnandy A. Rachman from Indonesia, Vice Secretary General of the Asia-Pacific Association for Gynecologic Endoscopy and Minimally Invasive Therapey (APAGE) and President of Indonesian executive board on German Indonesian Society of Minimal Access Surgery, played a video of vaginal myomectomy to show its advantages. The use of the vaginal route for endoscopic procedures started from 1901 for ventroscopy and was extended to fertiloscopy until 1998. Transvaginal endoscopy (TVE) and fertiloscopy is the only vaginal NOTES in office setting. Transvaginal endoscopy incorporates the advantages of vaginal procedures and single port laparoscopy, and therefore broadens the indications for vaginal procedures and avoids adbominal wall wounds and trocar-related complications while giving more ergonomic position for the surgeon. When performing TVE, the surgeon can sit down at ease. If the surgeons already manage the skills of laparoscopic surgery, it would be very easy for them to master vaginal NOTES. In addition, no extra equipment but a wound retractor is needed, and therefore the cost is low.
来自印度尼西亚的亚太妇产科内视镜暨微创治疗医学会(APAGE)副秘书长、德国-印尼微创手术协会印尼执行委员会主席伊兰迪·A·拉赫曼(Ichnandy A. Rachman)医生介绍了经阴道肌瘤剔除术的优势。第一例经阴道内窥镜手术起源于 1901 年,用于腹腔镜检查,而后发展至 1998 年用于生育镜检查。经阴道内窥镜检查与生育镜检查是唯一可以在诊室实施的经自然腔道内镜手术。经阴道内窥镜手术结合了经阴道手术和单孔腔镜手术的优势,既拓展了经阴道手术的适应症又避免了腹壁创伤和穿刺器相关并发症,同时操作医生操作更顺手更方便,还可以坐下来操作。如果操作医生已经掌握腹腔镜手术技巧,可以很容易掌握经阴道内窥镜手术。此外,经阴道内窥镜手术不需要其他特别的手术器械,只需要一个创口牵拉器,因此成本较低。

Dr. Sevellaraja Supermaniam from Malaysia, Past President of APAGE, introduced and commented on ultrasound-guided HIFU ablation of uterine fibroids. Ultrasound-guided HIFU ablation is a noninvasive treatment to preserve the integrity of organs without bleeding or incision caused. It is precise and does not require general anesthesia and sterilization of operating theater. The procedure is comfortable and relaxing. And the patient can resume normal activities in 1 or 2 days after treatment. The procedure can be finished within one or two hours by either a gynecologist or a trained doctor.
来自马来西亚的亚太妇产科内视镜暨微创治疗医学会(APAGE)主席塞尔瓦(Sevellaraja Supermaniam)医生介绍并评价了超声引导的 HIFU 消融子宫肌瘤。 超声引导的 HIFU 消融是一项无创治疗方式,不流血、无切口,可以保护器官的完整性。该治疗方式可以实现精准治疗,不需要全身麻醉,不需要无菌手术室。治疗过程中患者体验舒适放松,治疗后一到两天患者即可恢复正常活动。治疗时间一到两个小时,经过培训的妇科医生或其他科医生都可以操作。

For the playback of the webinar, please click the link below:
Tech Update 微无创技术新进展
Covid-19 pandemic and gynaecological laparoscopic surgery:
knowns and unknowns
R. Mallick from the Princess Hospital of the UK, et al reviewed all the latest evidence, including experiences from China and Italy, to guide the safe management of urgent gynecological and cancer patients when undergoing gynaecological procedures during Covid-19 pandemic. Below are the notes for implementation of gynecological laparoscopic surgery during Covid-19 pandemic:
1.Non-surgical treatments should be utilised where possible to reduce the risk of horizontal transmission of SARS-CoV-2 virus to health care workers, and reduce the need for hospital admission, provided they are a safe alternative.
2.Patients testing negative can proceed with the standard laparoscopic technique and routine surgical infection control procedures.
3.If urgent surgery is required and testing is not possible, manage as suspected COVID 19 with precautions described.
4.Hospitals should separate Covid-19 positive patients, clinical emergencies, clinically urgent cases, and trauma patients.
5.The laparascopic surgery should be performed by the most experienced surgeons to ensure the safety of procedure and shorten the treatment time as much as possible.
6.The operating staff should be well protected from any possible virus infection.
7.To aid artificial ventilation of operating theater.
8.To prevent and manage aerosol dispersion.
9.Only evacuate surgical smoke via the tap on ports when attached to a smoke evacuation filter and / or by direct suction using a vacuum suction unit.
10.Only evacuate the pneumoperitoneum via direct suction using a vacuum suction unit.
11.Gynaecological operations that carry a risk of bowel involvement, however small should be performed by laparotomy.
Deflation technique at the end of a procedure involves gas removal by using the combination of a suction device and releasing gas slowing via a filtered port. The accessory ports should be removed slowly and over a blunt probe, which is subsequently removed, to reduce the risk of hernia as removal under direct vision is not possible when avoiding inadvertent gas leakage.
The primary port should still be removed under direct vision once the abdomen has been completely deflated. Ports larger than 5mm should be closed as per standard practice, however a J needle closure (after all other ports are removed) is recommended rather than using an Endoclose device, which would increase the risk of gas escaping from the abdomen.
当腹腔气体完全排出时,直视下移除主操作孔。 大于 5 mm 的操作孔应按照标准操作进行缝合,推荐使用 J 形钩针缝合(当其他操作孔均被移除完毕),不使用内镜缝合设备缝合,以免增加腹腔气体泄漏的风险。
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Long term survival and local control outcomes from single dose targeted intraoperative
radiotherapy during lumpectomy (TARGIT-IORT) for early breast cancer:
TARGIT-A randomised clinical trial
TARGIT-A 随机临床试验
To determine whether risk adapted intraoperative radiotherapy during lumpectomy, delivered as a single dose during lumpectomy, can effectively replace postoperative whole breast radiotherapy for early breast cancer, a randomised controlled clinical trial was conducted in 32 centres in 10 countries enrolling 2298 women aged 45 years and older with invasive ductal carcinoma up to 3.5 cm in size, cN0-N1, eligible for breast conservation and randomised before lumpectomy (1:1 ratio, blocks stratified by centre) to either risk adapted targeted intraoperative radiotherapy (TARGIT-IORT) or external beam radiotherapy (EBRT).
为确定在乳房切除术中进行根据风险调整的单剂量靶向放疗能否有效替代术后全乳放疗,一项随机对照临床试验 TARGIT-A 研究在全球 10 个国家 32 个临床中心开展。2298 名受试者均为 45 岁及以上患有早期浸润性乳腺导管癌(肿瘤大小:3.5 cm)且符合保乳手术条件的 cN0-N1 患者。受试者 1:1 随机分组接受了根据风险调整的术中靶向放疗(TARGIT-IORT)或外照射放疗(EBRT)。
For patients with early breast cancer who met this trial selection criteria, risk adapted immediate single dose TARGIT-IORT during lumpectomy was an effective alternative to EBRT, with comparable long term efficacy for cancer control and lower non-breast cancer mortality.
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International Guidelines on HIFU in OBGYN 国际妇科领域与HIFU相关的临床指南
Expert consensus on technical specifications for
clinical application of focused ultrasound ablation surgery (2020 Edition)
聚焦超声消融手术临床应用技术规范专家共识(2020 年版)
On April 7, 2020, the Expert consensus on technical specifications for clinical application of focused ultrasound ablation surgery (FUAS) (2020 Edition) was published by the Expert Committee of Chinese Medical Doctor Association (CMDA) on the Formulation of Technical Specifications for Clinical Application of Focused Ultrasound Ablation Surgery on the National Medical Journal of China, introducing technical indications and non-indications, equipment, basic operation steps, clinical indications and contraindications, efficacy evaluation and dosage control, and major complications and prevention for FUAS.
2020 年 4 月 7 日,中华医学杂志发布了《聚焦超声消融手术临床应用技术规范专家共识(2020 年版)》(以下简称“共识”)。共识由中国医师协会聚焦超声消融手术临床应用技术规范制定专家委员会 20 余名专家教授讨论达成,就聚焦超声消融手术的技术适应证及非适应证、仪器设备、操作基本步骤、临床治疗适应证和禁忌证、疗效评价及剂量控制、主要并发症及预防等达成了一致意见。
FUAS or focused ultrasound ablation (FUA) refers to the ablative treatment technology that achieves ablation with a high-intensity focused ultrasound (HIFU) treatment system. FUAS treatment aims to induce volumetric coagulative necrosis of the lesion; it is suitable for the treatment of benign and malignant solid tumors and the treatment of benign diseases of some organs such as uterus and prostate; it is an effective complement to the traditional surgical treatments.
FUAS 是指通过高强度聚焦超声(high intensity focused ultrasound,HIFU)治疗系统进行的消融治疗技术,也称之为聚焦超声消融(focused ultrasound ablation,FUA)。FUAS 治疗的主要目的是使病灶组织产生整块的凝固性坏死,适用于治疗组织器官的实体良恶性肿瘤以及子宫、前列腺等器官的良性疾病,是对传统外科手术治疗的有效补充。
The Consensus includes 15 benign and malignant diseases as the clinical indications for FUAS and they are: uterine fibroids, uterine adenomyosis, placenta accreta, primary liver cancer, metastatic liver cancer, pancreatic cancer, soft tissue tumors, breast cancer, breast fibroadenomas, primary malignant bone tumors, metastatic bone tumors, renal cell carcinoma, benign tumors of the kidney, prostate cancer and benign prostatic hyperplasia.
共识将 15 种良恶性疾病纳入为 FUAS 的临床适应证,分别是:1.子宫:子宫肌瘤、子宫腺肌病、胎盘植入;2.肝脏:原发性肝癌、转移性肝癌;3.胰腺癌;4.软组织肿瘤;5.乳腺:乳腺癌、乳腺纤维腺瘤;6.骨肿瘤:原发性恶性骨肿瘤、转移性骨肿瘤;7.肾脏:肾细胞癌、肾脏良性肿瘤;8.前列腺:前列腺癌、良性前列腺增生。
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