153 results on '"Darzi, Ara"'
Search Results
2. An eye-tracking based robotic scrub nurse: proof of concept
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Ezzat, Ahmed, Kogkas, Alexandros, Holt, Josephine, Thakkar, Rudrik, Darzi, Ara, and Mylonas, George
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- 2021
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3. Real-time classification of tumour and non-tumour tissue in colorectal cancer using diffuse reflectance spectroscopy and neural networks to aid margin assessment.
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Nazarian, Scarlet, Gkouzionis, Ioannis, Murphy, Jamie, Darzi, Ara, Patel, Nisha, Peters, Christopher J., and Elson, Daniel S.
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Background: Colorectal cancer is the third most commonly diagnosed malignancy and the second leading cause of mortality worldwide. A positive resection margin following surgery for colorectal cancer is linked with higher rates of local recurrence and poorer survival. The authors investigated diffuse reflectance spectroscopy (DRS) to distinguish tumour and non-tumour tissue in exvivo colorectal specimens, to aid margin assessment and provide augmented visual maps to the surgeon in real-time. Methods: Patients undergoing elective colorectal cancer resection surgery at a London-based hospital were prospectively recruited. A hand-held DRS probe was used on the surface of freshly resected ex-vivo colorectal tissue. Spectral data were acquired for tumour and non-tumour tissue. Binary classification was achieved using conventional machine learning classifiers and a convolutional neural network (CNN), which were evaluated in terms of sensitivity, specificity, accuracy and the area under the curve. Results: A total of 7692 mean spectra were obtained for tumour and non-tumour colorectal tissue. The CNN-based classifier was the best performing machine learning algorithm, when compared to contrastive approaches, for differentiating tumour and nontumour colorectal tissue, with an overall diagnostic accuracy of 90.8% and area under the curve of 96.8%. Live on-screen classification of tissue type was achieved using a graduated colourmap. Conclusion: A high diagnostic accuracy for a DRS probe and tracking system to differentiate ex-vivo tumour and non-tumour colorectal tissue in real-time with on-screen visual feedback was highlighted by this study. Further in-vivo studies are needed to ensure integration into a surgical workflow. [ABSTRACT FROM AUTHOR]
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- 2024
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4. Evaluating the impact of image guidance in the surgical setting: a systematic review
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Dilley, James, Camara, Mafalda, Omar, Ismail, Carter, Alex, Pratt, Philip, Vale, Justin, Darzi, Ara, and Mayer, Erik K.
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- 2019
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5. Human robotic surgery with intraoperative tissue identification using rapid evaporation ionisation mass spectrometry.
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Manoli, Eftychios, Higginson, James, Tolley, Neil, Darzi, Ara, Kinross, James, Temelkuran, Burak, and Takats, Zoltan
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SURGICAL robots ,MASS spectrometry ,MOLECULAR biology ,IMAGE registration ,MATRIX-assisted laser desorption-ionization ,SURGERY - Abstract
Instantaneous, continuous, and reliable information on the molecular biology of surgical target tissue could significantly contribute to the precision, safety, and speed of the intervention. In this work, we introduced a methodology for chemical tissue identification in robotic surgery using rapid evaporative ionisation mass spectrometry. We developed a surgical aerosol evacuation system that is compatible with a robotic platform enabling consistent intraoperative sample collection and assessed the feasibility of this platform during head and neck surgical cases, using two different surgical energy devices. Our data showed specific, characteristic lipid profiles associated with the tissue type including various ceramides, glycerophospholipids, and glycerolipids, as well as different ion formation mechanisms based on the energy device used. This platform allows continuous and accurate intraoperative mass spectrometry-based identification of ablated/resected tissue and in combination with robotic registration of images, time, and anatomical positions can improve the current robot-assisted surgical platforms and guide surgical strategy. [ABSTRACT FROM AUTHOR]
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- 2024
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6. Interventions for sustainable surgery: a systematic review.
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Lam, Kyle, Gadi, Nishita, Acharya, Amish, Beatty, Jasmine Winter, Darzi, Ara, and Purkayastha, Sanjay
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Objective: To systematically evaluate interventions designed to improve the sustainability of surgical practice with respect to their environmental and financial impact. Background: Surgery contributes significantly to emissions attributed to healthcare due to its high resource and energy use. Several interventions across the operative pathway have, therefore, been trialed to minimize this impact. Few comparisons of the environmental and financial effects of these interventions exist. Materials and methods: A search of studies published up to 2nd February 2022 describing interventions to increase surgical sustainability was undertaken. Articles regarding the environmental impact of only anesthetic agents were excluded. Data regarding environmental and financial outcomes were extracted with a quality assessment completed dependent upon the study design. Results: In all, 1162 articles were retrieved, of which 21 studies met inclusion criteria. Twenty-five interventions were described, which were categorized into five domains: 'reduce and rationalize', 'reusable equipment and textiles', 'recycling and waste segregation', 'anesthetic alternatives', and 'other'. Eleven of the 21 studies examined reusable devices; those demonstrating a benefit reported 40-66% lower emissions than with single-use alternatives. In studies not showing a lower carbon footprint, the reduction in manufacturing emissions was offset by the high environmental impact of local fossil fuel-based energy required for sterilization. The per use monetary cost of reusable equipment was 47-83% of the single-use equivalent. Conclusions: A narrow repertoire of interventions to improve the environmental sustainability of surgery has been trialed. The majority focuses on reusable equipment. Emissions and cost data are limited, with longitudinal impacts rarely investigated. Real-world appraisals will facilitate implementation, as will an understanding of how sustainability impacts surgical decision-making. [ABSTRACT FROM AUTHOR]
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- 2023
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7. Type 1 Diabetes Mellitus and Bariatric Surgery: A Systematic Review and Meta-Analysis
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Ashrafian, Hutan, Harling, Leanne, Toma, Tania, Athanasiou, Christina, Nikiteas, Nikolaos, Efthimiou, Evangelos, Darzi, Ara, and Athanasiou, Thanos
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- 2016
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8. Development and implementation of the Structured Training Trainer Assessment Report (STTAR) in the English National Training Programme for laparoscopic colorectal surgery
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Wyles, Susannah M., Miskovic, Danilo, Ni, Zhifang, Darzi, Ara W., Valori, Roland M., Coleman, Mark G., and Hanna, George B.
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- 2016
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9. Bariatric Surgery and Non-Alcoholic Fatty Liver Disease: a Systematic Review of Liver Biochemistry and Histology
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Bower, Guy, Toma, Tania, Harling, Leanne, Jiao, Long R, Efthimiou, Evangelos, Darzi, Ara, Athanasiou, Thanos, and Ashrafian, Hutan
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- 2015
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10. Inattention blindness in surgery
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Hughes-Hallett, Archie, Mayer, Erik K., Marcus, Hani J., Pratt, Philip, Mason, Sam, Darzi, Ara W., and Vale, Justin A.
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- 2015
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11. Bariatric Surgery or Non-Surgical Weight Loss for Obstructive Sleep Apnoea? A Systematic Review and Comparison of Meta-analyses
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Ashrafian, Hutan, Toma, Tania, Rowland, Simon P., Harling, Leanne, Tan, Alan, Efthimiou, Evangelos, Darzi, Ara, and Athanasiou, Thanos
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- 2015
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12. Adhesions after abdominal surgery: a systematic review of the incidence, distribution and severity
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Okabayashi, Koji, Ashrafian, Hutan, Zacharakis, Emmanouil, Hasegawa, Hirotoshi, Kitagawa, Yuko, Athanasiou, Thanos, and Darzi, Ara
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- 2014
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13. A framework to establish a mentoring programme in surgery
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Kirresh, Ali, Patel, Vanash M., Warren, Oliver J., Ali, Mariam, Ashrafian, Hutan, Almoudaris, Alex M., Darzi, Ara, and Athanasiou, Thanos
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- 2011
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14. Stress impairs psychomotor performance in novice laparoscopic surgeons
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Arora, Sonal, Sevdalis, Nick, Aggarwal, Rajesh, Sirimanna, Pramudith, Darzi, Ara, and Kneebone, Roger
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- 2010
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15. A hidden markov model-based analysis framework using eye-tracking data to characterise re-orientation strategies in minimally invasive surgery
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Sodergren, Mikael Hans, Orihuela-Espina, Felipe, Clark, James, Darzi, Ara, and Yang, Guang-Zhong
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- 2010
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16. Development and validation of mental practice as a training strategy for laparoscopic surgery
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Arora, Sonal, Aggarwal, Rajesh, Sevdalis, Nick, Moran, Aidan, Sirimanna, Pramudith, Kneebone, Roger, and Darzi, Ara
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- 2010
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17. A Meta-Analysis Comparing Conventional End-to-End Anastomosis vs. Other Anastomotic Configurations After Resection in Crohn’s Disease
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Simillis, Constantinos, Purkayastha, Sanjay, Yamamoto, Takayuki, Strong, Scott A., Darzi, Ara W., and Tekkis, Paris P.
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- 2007
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18. Self-assessment of performance among surgical trainees during simulated procedures in a simulated operating theater
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Moorthy, Krishna, Munz, Yaron, Adams, Sally, Pandey, Vikas, and Darzi, Ara
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Surgery ,Health - Abstract
To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.amjsurg.2005.09.017 Byline: Krishna Moorthy, Yaron Munz, Sally Adams, Vikas Pandey, Ara Darzi Keywords: Simulation; Tecnical skills; Assessment; Self-assessment; Crew resource management Abstract: The ability of surgeons to assess their own performance is essential for training and self-regulation. The latter is based on the premise that they recognize their weaknesses and seek remedial action accordingly. Author Affiliation: Department of Surgical Oncology and Technology, Imperial College, St. Mary's Hospital, 28, Carless Ave., Birmingham, London B17 9EQ, UK Article History: Received 18 October 2004; Revised 12 September 2005 Article Note: (footnote) The SOT project was supported in part by the BUPA organization.
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- 2006
19. Development of assessing generic and specific technical skills in laparoscopic surgery
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Sarker, Sudip K., Chang, Avril, Vincent, Charles, and Darzi, Ara W.
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Surgery ,Health - Abstract
To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.amjsurg.2005.07.031 Byline: Sudip K. Sarker, Avril Chang, Charles Vincent, Sir Ara W. Darzi Keywords: Assessment; Laparoscopic; Skills; Surgery; Technical Abstract: Assessing live laparoscopic surgery using structured methodology is still in its infancy; however, it removes bias and subjectivity. We critique a new assessment tool for technical skills in laparoscopic surgery. Author Affiliation: Clinical Safety Research Unit, Department of Surgical Oncology and Technology, South Wharf Rd., 10th Floor QEQM Bldg., St Mary's Hospital, London, UK Article History: Received 20 April 2005; Revised 29 July 2005
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- 2006
20. A competency-based virtual reality training curriculum for the acquisition of laparoscopic psychomotor skill
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Aggarwal, Rajesh, Grantcharov, Teodor, Moorthy, Krishna, Hance, Julian, and Darzi, Ara
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Surgery ,Health - Abstract
To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.amjsurg.2005.10.014 Byline: Rajesh Aggarwal (a), Teodor Grantcharov (b), Krishna Moorthy (a), Julian Hance (a), Ara Darzi (a) Keywords: Laparoscopic skills; Training; Surgical competence; Virtual reality Abstract: Studies have demonstrated the beneficial effect of training novice laparoscopic surgeons using virtual reality (VR) simulators, although there is still no consensus regarding an optimal VR training curriculum. This study aims to establish and validate a structured VR curriculum to provide an evidence-based approach for laparoscopic training programmes. Author Affiliation: (a) Department of Surgical Oncology and Technology, Imperial College, Imperial College, 10th Floor, QEQM Building, St. Mary's Hospital, Praed Street, London W2 1NY, UK (b) Department of Surgical Gastroenterology, Glostrup University Hospital, Glostrup, Denmark Article History: Received 30 March 2005; Revised 15 June 2005
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- 2006
21. The reliability of multiple objective measures of surgery and the role of human performance
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Bann, Simon, Davis, Iain Mackay, Moorthy, Krishna, Munz, Yaron, Hernandez, Juan, Khan, Mansoor, Datta, Vivek, and Darzi, Ara
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Surgery ,Health - Abstract
To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.amjsurg.2005.03.020 Byline: Simon Bann, Iain Mackay Davis, Krishna Moorthy, Yaron Munz, Juan Hernandez, Mansoor Khan, Vivek Datta, Ara Darzi Abstract: There is a need for reliable and valid objective methods of technical skills in surgery. Six-bench surgical top stations have been combined to assess basic surgical trainees (BSTs) objectively. The current study examines its reliability and validity across repeat sittings. Author Affiliation: Faculty of Medicine, Imperial College of Science, Technology and Medicine, 10th Floor QEQM Wing, St. Mary's Hospital, London, W2 1NY United Kingdom
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- 2005
22. A clinical 'near miss' highlights risk management issues surrounding ultrasound-guided and wire-localised breast resections
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Leff Daniel, Vincent Charles, Al-Mufti Ragheed, Cunningham Deborah, Darzi Ara, and Hadjiminas Dimitri J
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Breast ,Cancer ,Ultrasound ,Mammography ,Wire ,Surgery ,RD1-811 - Abstract
Abstract Background The introduction of the National Health Service (NHS) Breast Screening Programme has led to a considerable increase in the detection of impalpable breast cancer. Patients with impalpable breast cancer typically undergo oncological resection facilitated either by the insertion of guide wires placed stereo-tactically or through ultra-sound guided skin markings to delineate the extent of a lesion. The need for radiological interventions on the day of surgery adds complexity and introduces the risk that a patient may accidentally transferred to the operating room directly without the image guidance procedure. Case report A case is described of a patient who required a pre-operative ultrasound scan in order to localise an impalpable breast cancer but who was accidentally taken directly to the operating theatre (OR) and anaesthetised without pre-operative intervention. The radiologist was called to the OR and an on-table ultrasound was performed without further consequence. Conclusion It is evident that breast cancer patients undergoing image-guided resection are exposed to an additional layer of clinical risks. These risks are not offset by the World Health Organisation surgical safety checklist in its present guise. Here, we review a number of simple and inexpensive changes to the system that may improve the safety of the breast cancer patient undergoing surgery.
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- 2012
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23. Does preservation of the sub-valvular apparatus during mitral valve replacement affect long-term survival and quality of life? A Microsimulation Study
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Murtuza Bari, Tsalafouta Polyxeni, Siannis Fotios, Chow Andre, Hart Jonathan, Rao Christopher, Darzi Ara, Wells Frank C, and Athanasiou Thanos
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Surgery ,RD1-811 ,Anesthesiology ,RD78.3-87.3 - Abstract
Abstract Background Techniques to preserve the sub-valvular apparatus in order to reduce morbidity and mortality following mitral valve replacement have been frequently reported. However, it is uncertain what impact sub-valvular apparatus preservation techniques have on long-term outcomes following mitral valve replacement. This study investigated the effect of sub-valvular apparatus preservation on long-term survival and quality of life following mitral valve replacement. Methods A microsimulation model was used to compare long-term survival and quality-adjusted life years following mitral valve replacement after conventional valve replacement and sub-valvular apparatus preservation. Probabilistic sensitivity analysis and alternative analysis were performed to investigate uncertainty associated with the results. Results Our Analysis suggests that patients survive longer if the sub-valvular apparatus are preserved (65.7% SD 1.5%, compared with 58.1% SD 1.6% at 10 years). The quality adjusted life years gained over a 10 year period where also greater after sub-valvular apparatus preservation. (6.54 QALY SD 0.07 QALY, compared with 5.61 QALY, SD 0.07 QALY). The superiority of preservation techniques was insensitive to patient age, parameter or model uncertainty. Conclusion This study suggests that long-term outcomes may be improved when the sub-valvular apparatus are preserved. Given the lack of empirical data further research is needed to investigate health-related quality of life after mitral valve replacement, and to establish whether outcomes differ between preservation techniques.
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- 2008
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24. Axillary artery to left anterior descending coronary artery bypass with an externally stented graft: a technical report
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Salvador Loris, Rao Christopher, Kapetanakis Emmanouil I, Athanasiou Thanos, and Darzi Ara
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Surgery ,RD1-811 ,Anesthesiology ,RD78.3-87.3 - Abstract
Abstract With the proliferation of minimally invasive cardiac surgery a number of alternative inflow sites for coronary artery bypass grafting have been utilized, especially in higher risk patients. The use of axillary-coronary artery bypass is a safe and effective alternative especially in the case of patients requiring redo coronary revascularization. However, the length and convoluted course of the axillary-coronary vein graft makes is susceptible to twisting, trauma and neointimal hyperplasia. We therefore report a case of an axillary-coronary artery bypass in a high risk patient in which a Dacron conduit was used to externally support and protect the vein graft to the left anterior descending artery. Surgical technique and considerations are presented and discussed.
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- 2008
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25. Recombinant activated factor VII in cardiac surgery – first, do no harm
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Athanasiou Thanos, Darzi Ara W, and Warren Oliver J
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Surgery ,RD1-811 ,Anesthesiology ,RD78.3-87.3 - Published
- 2007
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26. Skeletonization of radial and gastroepiploic conduits in coronary artery bypass surgery
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Darzi Ara, Kokotsakis John, Leff Daniel R, Wallace Sophie, Szczeklik Michal, Warren Oliver J, Massey Rachel M, and Athanasiou Thanos
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Surgery ,RD1-811 ,Anesthesiology ,RD78.3-87.3 - Abstract
Abstract The use of a skeletonized internal thoracic artery in coronary artery bypass graft surgery has been shown to confer certain advantages over a traditional pedicled technique, particularly in certain patient groups. Recent reports indicate that radial and gastroepiploic arteries can also be harvested using a skeletonized technique. The aim of this study is to systematically review the available evidence regarding the use of skeletonized radial and gastroepiploic arteries within coronary artery bypass surgery, focusing specifically on it's effect on conduit length and flow, levels of endothelial damage, graft patency and clinical outcome. Four electronic databases were systematically searched for studies reporting the utilisation of the skeletonization technique within coronary revascularisation surgery in humans. Reference lists of all identified studies were checked for any missing publications. There appears to be some evidence that skeletonization may improve angiographic patency, when compared with pedicled vessels in the short to mid-term. We have found no suggestion of increased complication rates or increased operating time. Skeletonization may increase the length of the conduit, and the number of sequential graft sites, but no clear clinical benefits are apparent. Our study suggests that there is not enough high quality or consistent evidence to currently advocate the application of this technique to radial or gastroepiploic conduits ahead of a traditional pedicled technique.
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- 2007
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27. Emergency laparoscopy – current best practice
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Paraskeva Paraskevas, Kinross James, Warren Oliver, and Darzi Ara
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Surgery ,RD1-811 ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Emergency laparoscopic surgery allows both the evaluation of acute abdominal pain and the treatment of many common acute abdominal disorders. This review critically evaluates the current evidence base for the use of laparoscopy, both diagnostic and interventional, in the emergency abdomen, and provides guidance for surgeons as to current best practise. Laparoscopic surgery is firmly established as the best intervention in acute appendicitis, acute cholecystitis and most gynaecological emergencies but requires further randomised controlled trials to definitively establish its role in other conditions.
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- 2006
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28. Pre-operative serum VCAM-1 as a biomarker of atrial fibrillation after coronary artery bypass grafting
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Harling, Leanne, Lambert, Jonathan, Ashrafian, Hutan, Darzi, Ara, Gooderham, Nigel J., Athanasiou, Thanos, and Wellcome Trust
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Male ,Vascular cell adhesion molecule ,Post operative atrial fibrillation ,Respiratory System ,lcsh:Surgery ,Vascular Cell Adhesion Molecule-1 ,Enzyme-Linked Immunosorbent Assay ,Coronary Artery Disease ,lcsh:RD78.3-87.3 ,Postoperative Complications ,Risk Factors ,Atrial Fibrillation ,Humans ,Prospective Studies ,Coronary Artery Bypass ,VCAM-1 ,1103 Clinical Sciences ,lcsh:RD1-811 ,Biomarker ,Middle Aged ,lcsh:Anesthesiology ,Preoperative Period ,Female ,Surgery ,Biomarkers ,Research Article - Abstract
Objective Systemic inflammation is a recognised contributory factor in the pathogenesis of de novo post-operative atrial fibrillation after cardiac surgery. This study aims to determine whether serum soluble vascular endothelial cell adhesion molecule (sVCAM-1) may predict the onset of POAF in patients under going coronary artery bypass grafting. Methods 34 patients undergoing non-emergent, on-pump CABG were prospectively recruited. Plasma was obtained at 24 h pre-operatively and at 48 and 96 h post-operatively. POAF was defined by continuous Holter recording. Inter-group comparisons were performed using student t-test or ANOVA as appropriate. Results Thirteen (13/34) patients developed POAF at a mean of 2.5 days post-operatively. Serum sVCAM-1 was significantly increased in the pre-operative serum of POAF when compared to non-POAF patients (p = 0.022). No significant difference was observed between the groups at 48 h (p = 0.073) or 96 h (p = 0.135) post-operatively. sVCAM-1 had a sensitivity of 60.0% and specificity of 77.27%, with an overall diagnostic accuracy of 75.2% in predicting POAF. Conclusions sVCAM-1 concentration in the pre-operative serum of patients undergoing CABG may accurately predict the onset of de novo POAF. As such, serum sVCAM-1 may be used as a predictive biomarker for this common arrhythmia. Further work must now perform prospective, targeted validation of these results in a larger patient cohort.
- Published
- 2017
29. Surgical Innovation in the Era of Global Surgery: A Network Analysis.
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Garas, George, Cingolani, Isabella, Patel, Vanash, Panzarasa, Pietro, Alderson, Derek, Darzi, Ara, and Athanasiou, Thanos
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Objective: To present a novel network-based framework for the study of collaboration in surgery and demonstrate how this can be used in practice to help build and nurture collaborations that foster innovation. Background: Surgical innovation is a social process that originates from complex interactions among diverse participants. This has led to the emergence of numerous surgical collaboration networks. What is still needed is a rigorous investigation of these networks and of the relative benefits of various collaboration structures for research and innovation. Methods: Network analysis of the real-world innovation network in robotic surgery. Hierarchical mixed-effect models were estimated to assess associations between network measures, research impact and innovation, controlling for the geographical diversity of collaborators, institutional categories, and whether collaborators belonged to industry or academia. Results: The network comprised of 1700 organizations and 6000 links. The ability to reach many others along few steps in the network (closeness centrality), forging a geographically diverse international profile (network entropy), and collaboration with industry were all shown to be positively associated with research impact and innovation. Closed structures (clustering coefficient), in which collaborators also collaborate with each other, were found to have a negative association with innovation (P < 0.05 for all associations). Conclusions: In the era of global surgery and increasing complexity of surgical innovation, this study highlights the importance of establishing open networks spanning geographical boundaries. Network analysis offers a valuable framework for assisting surgeons in their efforts to forge and sustain collaborations with the highest potential of maximizing innovation and patient care. [ABSTRACT FROM AUTHOR]
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- 2020
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30. Initial Experience With a New Robotic Surgical System for Cholecystectomy.
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Aggarwal, Ravi, Winter Beatty, Jasmine, Kinross, James, von Roon, Alexander, Darzi, Ara, and Purkayastha, Sanjay
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SURGICAL robots ,RETROSPECTIVE studies ,SURGICAL complications ,CHOLECYSTECTOMY ,PRODUCT design ,GALLBLADDER ,EQUIPMENT & supplies - Abstract
Background. Laparoscopic cholecystectomy has been the gold standard treatment for symptomatic cholelithiasis for more than 3 decades. Robotic techniques are gaining traction in surgery, and recently, the Senhance™ robotic system was introduced. The system offers advantages over other robotic systems such as improved ergonomics, haptic feedback, eye tracking, and usability of standard laparoscopic trocars and reusable instruments. The Senhance was evaluated to understand the feasibility, benefits, and drawbacks of its use in cholecystectomy. Study Design. A prospectively maintained database of the first 20 patients undergoing cholecystectomy with the Senhance was reviewed at a single hospital. Data including operative time, console time, set up time, and adverse events were collected, with clinical outcome and operative time as primary outcome measures. A cohort of 20 patients having laparoscopic cholecystectomy performed by the same surgeon was used as a comparator group. Results. The 2 groups had comparable demographic data (age, sex, and body mass index). In the Senhance group, 19 of the 20 procedures (95%) were completed robotically. The median (interquartile range) total operating, docking, and console times were 86.5 (60.5-106.5), 11.5 (9-13), and 30.8 (23.5-35) minutes, respectively. In the laparoscopic group, the median (interquartile range) operating time was 31.5 (26-41) minutes. Postoperatively, only one patient had a surgical complication, namely a wound infection treated with antibiotics. Conclusion. Our results suggest that Senhance-assisted cholecystectomy is safe, feasible, and effective, but currently has longer operative times. Further prospective and randomized trials are required to determine whether this approach can offer any other benefits over other minimally invasive surgical techniques. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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31. Key Components of the Safe Surgical Ward: International Delphi Consensus Study to Identify Factors for Quality Assessment and Service Improvement.
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Hassen, Yasmin A. M., Johnston, Maximilian J., Singh, Pritam, Pucher, Philip H., and Darzi, Ara
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Objective: The aim of this study was to prioritize key factors contributing to safety on the surgical ward Background: There is a variation in the quality and safety of postoperative care between institutions. These variations may be attributed to a combination of process-related issues and structural factors. The aim of this study is to reach a consensus, by means of Delphi methodology, on the most influential of these components that may determine safety in this environment. Methods: The Delphi questionnaire was delivered via an online questionnaire platform. The panel were blinded. An international panel of safety experts, both clinical and nonclinical, and safety advocates participated. Individuals were selected according to their expertise and extent of involvement in patient safety research, regulation, or patient advocacy. Results: Experts in patient safety from the UK, Europe, North America, and Australia participated. The panel identified the response to a deteriorating patient and the care of outlier patients as error-prone processes. Prioritized structural factors included organizational and environmental considerations such as use of temporary staff, out-of-hours reduction in services, ward cleanliness, and features of layout. The latter includes dedicated areas for medication preparation and adequate space around the patient for care delivery. Potential quality markers for safe care that achieved the highest consensus include leadership, visibility between patients and nurses, and nursing team skill mix and staffing levels. Conclusion: International consensus was achieved for a number of factors across process-related and structural themes that may influence safety in the postoperative environment. These should be championed and prioritized for future improvements in patient safety at the ward-level. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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32. Rapid evaporative ionisation mass spectrometry of electrosurgical vapours for the identification of breast pathology: towards an intelligent knife for breast cancer surgery.
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John, Edward R. St, Balog, Julia, McKenzie, James S., Rossi, Merja, Covington, April, Muirhead, Laura, Bodai, Zsolt, Rosini, Francesca, Speller, Abigail V. M., Shousha, Sami, Ramakrishnan, Rathi, Darzi, Ara, Takats, Zoltan, Leff, Daniel R., and St John, Edward R
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BREAST cancer diagnosis ,BREAST cancer treatment ,LUMPECTOMY ,ELECTROSPRAY ionization mass spectrometry ,ONCOLOGY ,BREAST surgery ,BREAST ,BREAST tumors ,ELECTROSURGERY ,MASS spectrometry ,EQUIPMENT & supplies - Abstract
Background: Re-operation for positive resection margins following breast-conserving surgery occurs frequently (average = 20-25%), is cost-inefficient, and leads to physical and psychological morbidity. Current margin assessment techniques are slow and labour intensive. Rapid evaporative ionisation mass spectrometry (REIMS) rapidly identifies dissected tissues by determination of tissue structural lipid profiles through on-line chemical analysis of electrosurgical aerosol toward real-time margin assessment.Methods: Electrosurgical aerosol produced from ex-vivo and in-vivo breast samples was aspirated into a mass spectrometer (MS) using a monopolar hand-piece. Tissue identification results obtained by multivariate statistical analysis of MS data were validated by histopathology. Ex-vivo classification models were constructed from a mass spectral database of normal and tumour breast samples. Univariate and tandem MS analysis of significant peaks was conducted to identify biochemical differences between normal and cancerous tissues. An ex-vivo classification model was used in combination with bespoke recognition software, as an intelligent knife (iKnife), to predict the diagnosis for an ex-vivo validation set. Intraoperative REIMS data were acquired during breast surgery and time-synchronized to operative videos.Results: A classification model using histologically validated spectral data acquired from 932 sampling points in normal tissue and 226 in tumour tissue provided 93.4% sensitivity and 94.9% specificity. Tandem MS identified 63 phospholipids and 6 triglyceride species responsible for 24 spectral differences between tissue types. iKnife recognition accuracy with 260 newly acquired fresh and frozen breast tissue specimens (normal n = 161, tumour n = 99) provided sensitivity of 90.9% and specificity of 98.8%. The ex-vivo and intra-operative method produced visually comparable high intensity spectra. iKnife interpretation of intra-operative electrosurgical vapours, including data acquisition and analysis was possible within a mean of 1.80 seconds (SD ±0.40).Conclusions: The REIMS method has been optimised for real-time iKnife analysis of heterogeneous breast tissues based on subtle changes in lipid metabolism, and the results suggest spectral analysis is both accurate and rapid. Proof-of-concept data demonstrate the iKnife method is capable of online intraoperative data collection and analysis. Further validation studies are required to determine the accuracy of intra-operative REIMS for oncological margin assessment. [ABSTRACT FROM AUTHOR]- Published
- 2017
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33. Longitudinal analysis of serum oxylipin profile as a novel descriptor of the inflammatory response to surgery.
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Wolfer, Arnaud M., Scott, Alasdair J., Rueb, Claudia, Gaudin, Mathieu, Darzi, Ara, Nicholson, Jeremy K., Holmes, Elaine, and Kinross, James M.
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OXYLIPINS ,LIPIDS ,INFLAMMATION ,TRAUMATOLOGY ,POSTOPERATIVE care - Abstract
Background: Oxylipins are potent lipid mediators demonstrated to initiate and regulate inflammation yet little is known regarding their involvement in the response to surgical trauma. As key modulators of the inflammatory response, oxylipins have the potential to provide novel insights into the physiological response to surgery and the pathophysiology of post-operative complications. We aimed to investigate the effects of major surgery on longitudinal oxylipin profile.Methods: Adults patients undergoing elective laparoscopic or open colorectal resections were included. Primary outcomes were serum oxylipin profile quantified by ultra high-performance liquid chromatography-mass spectrometry, serum white cell count and C-reactive protein concentration. Serum samples were taken at three time-points: pre-operative (day zero), early post-operative (day one) and late post-operative (day four/five).Results: Some 55 patients were included, of which 33 (60%) underwent surgery that was completed laparoscopically. Pre-operative oxylipin profiles were characterised by marked heterogeneity but surgery induced a common shift resulting in more homogeneity at the early post-operative time-point. By the late post-operative phase, oxylipin profiles were again highly variable. This evolution was driven by time-dependent changes in specific oxylipins. Notably, the levels of several oxylipins with anti-inflammatory properties (15-HETE and four regioisomers of DHET) were reduced at the early post-operative point before returning to baseline by the late post-operative period. In addition, levels of the pro-inflammatory 11-HETE rose in the early post-operative phase while levels of anti-thrombotic mediators (9-HODE and 13-HODE) fell; concentrations of all three oxylipins then remained fairly static from early to late post-operative phases. Compared to those undergoing laparoscopic surgery, patients undergoing open surgery had lower levels of some anti-inflammatory oxylipins (8,9-DHET and 17-HDoHE) in addition to reduced concentrations of anti-thrombotic mediators (9-HODE and 13-HODE) with increased concentration of their pro-thrombotic counterpart (TxB2).Conclusions: Serum oxylipin profile is modified by surgical intervention and may even be sensitive to the degree of surgical trauma and therefore represents a novel descriptor of the surgical systemic inflammatory response. [ABSTRACT FROM AUTHOR]- Published
- 2017
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34. "Contemplating the Next Maneuver''.
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Leff, Daniel Richard, Yongue, Gabriella, Vlaev, Ivo, Orihuela-Espina, Felipe, James, David, Taylor, Michael J., Athanasiou, Thanos, Dolan, Ray, Guang-Zhong Yang, and Darzi, Ara
- Abstract
Objective: To investigate differences in the quality, confidence, and consistency of intraoperative surgical decision making (DM) and using functional neuroimaging expose decision systems that operators use. Summary Background Data: Novices are hypothesized to use conscious analysis (effortful DM) leading to activation across the dorsolateral prefrontal cortex, whereas experts are expected to use unconscious automation (habitual DM) in which decisions are recognition-primed and prefrontal cortex independent. Methods: A total of 22 subjects (10 medical student novices, 7 residents, and 5 attendings) reviewed simulated laparoscopic cholecystectomy videos, determined the next safest operative maneuver upon video termination (10 s), and reported decision confidence. Video paradigms either declared (''primed'') or withheld (''unprimed'') the next operative maneuver. Simultaneously, changes in cortical oxygenated hemoglobin and deoxygenated hemoglobin inferring prefrontal activation were recorded using Optical Topography. Decision confidence, consistency (primed vs unprimed), and quality (script concordance) were assessed. Results: Attendings and residents were significantly more certain (P < 0.001), and decision quality was superior (script concordance: attendings = 90%, residents = 78.3%, and novices = 53.3%). Decision consistency was significantly superior in experts (P < 0.001) and residents (P < 0.05) than novices (P = 0.183). During unprimed DM, novices showed significant activation of the dorsolateral prefrontal cortex, whereas this activation pattern was not observed among residents and attendings. During primed DM, significant activation was not observed in any group. Conclusions: Expert DM is characterized by improved quality, consistency, and confidence. The findings imply attendings use a habitual decision system, whereas novices use an effortful approach under uncertainty. In the presence of operative cues (primes), novices disengage the prefrontal cortex and seem to accept the observed operative decision as correct. [ABSTRACT FROM AUTHOR]
- Published
- 2017
- Full Text
- View/download PDF
35. Diagnostic Accuracy of Intraoperative Techniques for Margin Assessment in Breast Cancer Surgery.
- Author
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St John, Edward Robert, Al-Khudairi, Rashed, Ashrafian, Hutan, Athanasiou, Thanos, Takats, Zoltan, Hadjiminas, Dimitri John, Darzi, Ara, and Leff, Daniel Richard
- Abstract
Objective: The aim of this study was to conduct a systematic review and meta-analysis to clarify the diagnostic accuracy of intraoperative breast margin assessment (IMA) techniques against which the performance of emerging IMA technologies may be compared. Summary of Background Data: IMA techniques have failed to penetrate routine practice due to limitations, including slow reporting times, technical demands, and logistics. Emerging IMA technologies are being developed to reduce positive margin and re-excision rates and will be compared with the diagnostic accuracy of existing techniques. Method: Studies were identified using electronic bibliographic searches up to January 2016. MESH terms and all-field search terms included ''Breast Cancer" AND "Intraoperative" AND "Margin." Only clinical studies with raw diagnostic accuracy data as compared with final permanent section histopathology were included. A bivariate model for diagnostic meta-analysis was used to attain overall pooled sensitivity and specificity. Results: Eight hundred thirty-eight unique studies revealed 35 studies for meta-analysis. Pooled sensitivity (Sens), specificity (Spec), and area under the receiver operating characteristic curve (AUROC) values were calculated per group (Sens, Spec, AUROC): frozen section = 86%, 96%, 0.96 (n = 9); cytology = 91%, 95%, 0.98 (n = 11); intraoperative ultrasound = 59%, 81%, 0.78 (n = 4); specimen radiography = 53%, 84%, 0.73 (n = 9); optical spectroscopy = 85%, 87%, 0.88 (n = 3). Conclusions: Pooled data suggest that frozen section and cytology have the greatest diagnostic accuracy. However, these methods are resource intensive and turnaround times for results have prevented widespread international adoption. Emerging technologies need to compete with the diagnostic accuracy of existing techniques while offering advantages in terms of speed, cost, and reliability. [ABSTRACT FROM AUTHOR]
- Published
- 2017
- Full Text
- View/download PDF
36. Elevated serum microRNA 483-5p levels may predict patients at risk of post-operative atrial fibrillation.
- Author
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Harling, Leanne, Lambert, Jonathan, Ashrafian, Hutan, Darzi, Ara, Gooderham, Nigel J., and Athanasiou, Thanos
- Subjects
MICRORNA ,POSTOPERATIVE period ,SERUM ,ATRIAL arrhythmias ,BODY fluids ,ATRIAL fibrillation ,INPATIENT care - Abstract
OBJECTIVES: Post-operative atrial fibrillation (POAF) is the commonest post-operative cardiac arrhythmia, affecting ∼1 in 3 patients undergoing coronary artery bypass grafting (CABG). Although its aetiology is complex, atrial substrate changes may pre-dispose to its onset. This study aims to ascertain the atrial microRNA signature of POAF and determine the potential for circulating microRNA as a pre-operative biomarker for this arrhythmia. METHODS: Thirty-four patients undergoing non-emergent, on-pump CABG were prospectively recruited. Right atrial biopsies were taken intra-operatively and snap frozen for RNA extraction. Plasma was obtained at 24 h pre-operatively and at 2 and 4 days post-operatively. POAF was defined by continuous Holter recording. Inter-group comparisons were performed using Student's t-test or analysis of variance as required. Receiver operating characteristic (ROC) analysis was used to determine the diagnostic accuracy of pre-operative serum miRNA as a POAF biomarker. RESULTS: Sixteen microRNAs were differentially expressed in the atrial myocardium of POAF patients when compared with those maintaining sinus rhythm. miR-208a was the most underexpressed [fold change (FC) = 2.458] and miR-483-5p the most overexpressed (FC = 1.804). miR-483-5p also demonstrated significant overexpression in the pre-operative serum of these patients, with ROC analysis demonstrating an overall predictive accuracy of 78%. CONCLUSIONS: This study provides the first description of atrial myocardial and circulating plasma microRNA in POAF patients. Our findings suggest POAF may be associated with pre-existing atrial substrate differences predisposing to arrhythmogenesis. Moreover, this study highlights the potential for miR-483-5p in biomarker development. Further work must now perform prospective, targeted validation of these results in a larger patient cohort. [ABSTRACT FROM AUTHOR]
- Published
- 2017
- Full Text
- View/download PDF
37. Colorectal endoscopic submucosal dissection: Systematic review of mid-term clinical outcomes.
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Patel, Nisha, Patel, Kinesh, Ashrafian, Hutan, Athanasiou, Thanos, Darzi, Ara, and Teare, Julian
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ENDOSCOPIC surgery ,GASTRIC mucosa ,TISSUE wounds ,PRECANCEROUS conditions ,COLON cancer treatment ,SURGERY - Abstract
With a drive towards minimally invasive surgery, endoscopic submucosal dissection (ESD) is now gaining popularity. In a number of East Asian countries, ESD is now the treatment of choice for early non-metastatic gastric cancer, but the outcomes of ESD for colorectal lesions are unclear. The present review summarizes the mid-term outcomes of colorectal ESD including complication and recurrence rates. A systematic literature search was done in May 2014, identifying 20 publications reporting the outcomes of colorectal ESD which were included in this review. En-bloc resection rates, complete (R0) resection rates, endoscopic clearance rates, complication and recurrences rates were analyzed. Statistical pooling was done to calculate weighted means using random effects modeling. Twenty studies reporting the outcomes of 3060 colorectal ESD procedures were reported. Overall weighted en-bloc resection rate was 89% (95% CI: 83-94%), R0 resection rate 76% (95% CI: 69-83%), endoscopic clearance rate 94% (95% CI: 90-97%) and recurrence rate 1% (95% CI: 0.5-2%). Studies that followed up patients for over 1 year were found to have an en-bloc resection rate of 91% (95% CI: 86-96%), R0 resection rate of 81% (95% CI: 75-88%), endoscopic clearance rate 93% (95% CI: 90-97%) and recurrence rate of 0.8% (95% CI: 0.4-1%). Colorectal ESD can be carried out effectively and safely with a 1% recurrence rate. Further studies with longer follow-up periods are required to determine whether colorectal ESD is a viable alternative to conventional surgical therapy. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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- View/download PDF
38. Long-term prospective evaluation comparing robotic parathyroidectomy with minimally invasive open parathyroidectomy for primary hyperparathyroidism.
- Author
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Tolley, Neil, Garas, George, Palazzo, Fausto, Prichard, Alexa, Chaidas, Konstantinos, Cox, Jeremy, Darzi, Ara, and Arora, Asit
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PARATHYROIDECTOMY ,HYPERPARATHYROIDISM ,SURGICAL robots ,QUALITY of life ,POSTOPERATIVE pain - Abstract
Background Targeted parathyroidectomy is a popular technique for localized pathology. No single technique is established as superior. The purpose of this study was to compare robotic-assisted parathyroidectomy (RAP) with the most common approach. Methods This was a prospective, nonrandomized study. Fifteen consecutive patients who underwent RAP were compared to 15 matched controls undergoing focused lateral parathyroidectomy (FLP). Results Biochemical cure occurred in 29 of 30 patients (97%). No major complications occurred, although there was 1 robotic conversion. RAP demonstrated a significant time reduction (R
2 = 0.436; p = .01) but took much longer to perform than FLP (119 minutes vs 34 minutes; p = .001). RAP was associated with less initial postoperative pain ( p = .036) and higher satisfaction with scar cosmesis ( p = .002) until 6 months. Quality of life (QOL) improved in both groups ( p = .007). Conclusion RAP provides superior early cosmesis with equivalent global health improvement compared to FLP. The high cost and learning curve may preclude widespread adoption. Further evaluation is necessary to establish its clinical efficacy regarding scar cosmesis. © 2015 Wiley Periodicals, Inc. Head Neck 38: E300-E7, 2016 [ABSTRACT FROM AUTHOR]- Published
- 2016
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39. Improving Escalation of Care.
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Johnston, Maximilian J., Arora, Sonal, Pucher, Philip H., McCartan, Niall, Reissis, Yannis, Chana, Prem, and Darzi, Ara
- Abstract
Objective: This study aimed to determine whether an intervention could improve the escalation of care skills of junior surgeons. Summary Background Data: Escalation of care involves the recognition, communication, and response to patient deterioration until a satisfactory outcome has been achieved. Although failure to escalate care can lead to increased morbidity and mortality, there is no formal training in how to perform this vital process safely. Methods: This randomized controlled trial recruited postgraduate year (PGY)-1 and PGY-2 surgeons to participate in 2 scenarios involving simulated patients requiring escalation of care. A control group performed both scenarios before receiving the intervention; the intervention group received the educational intervention before their second scenario. Scenarios were video recorded and rated by 2 independent, blinded assessors using validated scales to measure patient assessment, communication, management and nontechnical skills of participants, and the number of medical errors they detected. Results: A total of 33 PGY-1 and PGY-2 surgeons, all with equivalent skill at baseline, participated. Postintervention, the intervention group demonstrated significantly better patient assessment (P < 0.001), communication (P < 0.001), and nontechnical skills (P < 0.001). They also detected more medical errors (P < 0.05). Conclusions: Teaching junior surgeons a systematic approach to escalation of care improved multiple core skills required to maintain patient safety and avoid preventable harm. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
40. Fifty Years of Innovation in Plastic Surgery.
- Author
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Kwasnicki, Richard M., Hughes-Hallett, Archie, Marcus, Hani J., Guang-Zhong Yang, Darzi, Ara, and Hettiaratchy, Shehan
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BOTULINUM toxin ,PLASTIC surgery ,SURGICAL complications - Abstract
Background Innovation has molded the current landscape of plastic surgery. However, documentation of this process only exists scattered throughout the literature as individual articles. The few attempts made to profile innovation in plastic surgery have been narrative, and therefore qualitative and inherently biased. Through the implementation of a novel innovation metric, this work aims to identify and characterise the most prevalent innovations in plastic surgery over the last 50 years. Methods Patents and publications related to plastic surgery (1960 to 2010) were retrieved from patent and MEDLINE databases, respectively. The most active patent codes were identified and grouped into technology areas, which were subsequently plotted graphically against publication data. Expertderived technologies outside of the top performing patents areas were additionally explored. Results Between 1960 and 2010, 4,651 patents and 43,118 publications related to plastic surgery were identified. The most active patent codes were grouped under reconstructive prostheses, implants, instruments, noninvasive techniques, and tissue engineering. Of these areas and other expertderived technologies, those currently undergoing growth include surgical instruments, implants, noninvasive practices, transplantation and breast surgery. Innovations related to microvascular surgery, liposuction, tissue engineering, lasers and prostheses have all plateaued. Conclusions The application of a novel metric for evaluating innovation quantitatively outlines the natural history of technologies fundamental to the evolution of plastic surgery. Analysis of current innovation trends provides some insight into which technology domains are the most active. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
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41. Surgical Checklist Implementation Project: The Impact of Variable WHO Checklist Compliance on Risk-adjusted Clinical Outcomes After National Implementation.
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Mayer, Erik K., Sevdalis, Nick, Rout, Shantanu, Caris, Jochem, Russ, Stephanie, Mansell, Jenny, Davies, Rachel, Skapinakis, Petros, Vincent, Charles, Athanasiou, Thanos, Moorthy, Krishna, and Darzi, Ara
- Abstract
Objective: To evaluate impact of WHO checklist compliance on riskadjusted clinical outcomes, including the influence of checklist components (Sign-in, Time-out, Sign-out) on outcomes. Background: There remain unanswered questions surrounding surgical checklists as a quality and safety tool, such as the impact in cases of differing complexity and the extent of checklist implementation. Methods: Data were collected from surgical admissions (6714 patients) from March 2010 to June 2011 at 5 academic and community hospitals. The primary endpoint was any complication, including mortality, occurring before hospital discharge. Checklist usage was recorded as checklist completed in full/partly. Multilevel modeling was performed to investigate the association between complications/mortality and checklist completion. Results: Significant variability in checklist usage was found: although at least 1 of the 3 components was completed in 96.7% of cases, the entire checklist was only completed in 62.1% of cases. Checklist completion did not affectmortality reduction, but significantly lowered risk of postoperative complication (16.9% vs. 11.2%), and was largely noticed when all 3 components of the checklist had been completed (odds ratio=0.57, 95% confidence interval: 0.37-0.87, P<0.01). Calculated population-attributable fractions showed that 14% (95% confidence interval: 7%-21%) of the complications could be prevented if full completion of the checklist was implemented. Conclusions: Checklist implementation was associated with reduced casemix- adjusted complications after surgery and was most significant when all 3 components of the checklist were completed. Full, as opposed to partial, checklist completion provides a health policy opportunity to improve checklist impact on surgical safety and quality of care. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
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42. Raising the Alarm: A Cross-Sectional Study Exploring the Factors Affecting Patients' Willingness to Escalate Care on Surgical Wards.
- Author
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Johnston, Maximilian, Davis, Rachel, Arora, Sonal, King, Dominic, Reissis, Yannis, and Darzi, Ara
- Subjects
PUBLIC health research ,HOSPITALS ,MEDICAL care research ,SURGERY ,HOSPITAL patients - Abstract
Background: Delays in escalation of care for patients may contribute to poor outcome. The factors that influence surgical patients' willingness to call for help on wards are currently unknown. This study explored the factors that affect patients' willingness to call for help on surgical wards; how patients call for help and to whom; how to encourage patients to call for help, and the barriers to patients calling for help. Methods: A cross-sectional study was conducted in three London hospitals using a questionnaire designed through expert opinion and the published literature. A total of 155 surgical patients (83 % response rate) participated. Results: Patients were more willing to call for help using the bedside buzzer or by calling a nurse compared to a doctor ( p < 0.001). The prompts to calling for help patients were most likely to act on were bleeding and pain. Patients were more willing to call for help if encouraged by a healthcare professional than a relative or fellow patient ( p < 0.01). Patients were more likely to worry about taking up too much time when calling for help than being perceived as difficult ( p < 0.001). For some prompts, male patients were more willing to call for help ( p < 0.05). Conclusions: This is the first study to identify factors affecting patients' willingness to call for help on surgical wards. Interventions that take these factors into account can be developed to encourage patients to call for help and may avoid delays in treatment. [ABSTRACT FROM AUTHOR]
- Published
- 2015
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- View/download PDF
43. A Randomized Controlled Study to Evaluate the Role of Video-based Coaching in Training Laparoscopic Skills.
- Author
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Singh, Pritam, Aggarwal, Rajesh, Tahir, Muaaz, Pucher, Philip H., and Darzi, Ara
- Published
- 2015
- Full Text
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44. Escalation of Care in Surgery.
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Johnston, Maximilian, Arora, Sonal, Anderson, Oliver, King, Dominic, Behar, Nebil, and Darzi, Ara
- Published
- 2015
- Full Text
- View/download PDF
45. Consumer demand for surgical innovation: a systematic review of public perception of NOTES.
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Pucher, Philip, Sodergren, Mikael, Lord, Amy, Teare, Julian, Yang, Guang-Zhong, and Darzi, Ara
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LAPAROSCOPY ,NATURAL orifice transluminal endoscopic surgery ,LAYPERSONS ,SURGERY ,PATIENTS' attitudes - Abstract
Background: The full scope of benefits offered by NOTES over traditional laparoscopy, if any, is not yet fully clear. Perceived patient demand for truly 'scarless surgery' is often referenced one of the driving factors in the continued development of this relatively new technique. The true scale of patient preference and demand for NOTES as a surgical technique is unknown. This review aims to summarise currently available literature on the topic of patient perceptions of NOTES to guide future development of the technique. Methods: A comprehensive search of PubMed and Web of Science electronic databases was performed on 1st Jan 2014. To be considered for inclusion, articles were required to assess and report the perception of NOTES in a sample of laypersons (patients or general public). The primary endpoint assessed was acceptance or preference rates expressed by patients for NOTES procedures. Reasons given for preference or rejection of NOTES were recorded, as well as preferred access routes and any predicting factors of NOTES acceptance. Results: Initial search returned 1,334 results, resulting in 15 articles included in final data synthesis. These polled a total of 4,420 subjects. Acceptance of NOTES ranged between 41 and 84 %. Compared to a laparoscopic approach, preference rates for NOTES ranged from 0 to 78 %. Reasons for preferring NOTES were largely centred on potentially reduced recovery time, complications (particularly with reference to hernias) and postoperative pain. Improved cosmesis also played a role, but was secondary to the above issues. Overall, study quality was poor. Conclusions: This review suggests significant public interest in NOTES and scarless surgery in general. Further research and consideration of differences in public perceptions across regions, countries and cultures are required. [ABSTRACT FROM AUTHOR]
- Published
- 2015
- Full Text
- View/download PDF
46. A Qualitative Evaluation of the Barriers and Facilitators Toward Implementation of the WHO Surgical Safety Checklist Across Hospitals in England.
- Author
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Russ, Stephanie J., Sevdalis, Nick, Moorthy, Krishna, Mayer, Erik K., Rout, Shantanu, Caris, Jochem, Mansell, Jenny, Davies, Rachel, Vincent, Charles, and Darzi, Ara
- Published
- 2015
- Full Text
- View/download PDF
47. Real-Time Pervasive Monitoring for Postoperative Care.
- Author
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Magjarevic, R., Nagel, J. H., Leonhardt, Steffen, Falck, Thomas, Mähönen, Petri, Lo, Benny, Atallah, Louis, Aziz, Omer, El ElHew, Mohammed, Darzi, Ara, and Yang, Guang-Zhong
- Abstract
Post surgical care is an important part of the surgical recovery process. With the introduction of minimally invasive surgery (MIS), the recovery time of patients has been shortened significantly. This has led to a shift of postoperative care from hospital to home environment. To prevent the occurrence of adverse events, the care of these patients is mainly relied on routine visits by home-care nurses. This type of episodic examination can only capture a snapshot of the overall recovery process, and many early signs of potential complication can go undetected. The development of Body Sensor Networks (BSNs) has enabled the use of miniaturised wireless sensors for continuous monitoring of postoperative patients. This paper examines the potential of processing-on-node algorithms for further reducing the wireless bandwidth, and therefore the overall power consumption of the sensors. The accuracy and robustness of the technique are demonstrated with lab experiments and a preliminary clinical case study. [ABSTRACT FROM AUTHOR]
- Published
- 2007
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- View/download PDF
48. The Incidence of Bowel Perforations Is Positively Related to the Intensity of Pain Experienced During Simulated Colonoscopy
- Author
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Darzi Ara and Tariq Mahmood
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Incidence (epidemiology) ,Gastroenterology ,Medicine ,Colonoscopy ,Radiology, Nuclear Medicine and imaging ,Bowel perforation ,Radiology ,business ,Intensity (physics) ,Surgery - Published
- 2004
49. Development of an evidence-based curriculum for training of ward-based surgical care.
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Pucher, Philip H., Darzi, Ara, and Aggarwal, Rajesh
- Subjects
- *
EVIDENCE-based education , *CURRICULUM , *SURGICAL education , *HOSPITAL wards , *SIMULATION methods & models , *COMMUNICATIVE competence , *COST effectiveness - Abstract
BACKGROUND: Ward-based care of surgical patients is a complex and variable process, centered on the surgical ward round (WR). The authors describe the development of an evidence-based curriculum to improve ward-based care in the form of surgical WRs. METHODS: A modular, simulation-based curriculum was developed according to validated methods, incorporating the most recent evidence in the design of each educational module. RESULTS: A predevelopmental analysis questionnaire identified themes of patient assessment and management, communication skills, and teamwork as areas to be addressed. Curricular development incorporated knowledge and confidence assessment, lecture-based teaching, and simulated WR, followed by individualized assessment, debriefing, and feedback. Each module is evidence based and assesses trainees using validated tools. CONCLUSIONS: A comprehensive and cost-effective simulation-based curriculum, developed according to a validated framework, has been developed for surgical WRs and ward-based care. This may improve trainees' WR performance, improving patient care and surgical outcomes in turn. [ABSTRACT FROM AUTHOR]
- Published
- 2014
- Full Text
- View/download PDF
50. Which Hemostatic Device in Thyroid Surgery? A Network Meta-Analysis of Surgical Technologies.
- Author
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Garas, George, Okabayashi, Koji, Ashrafian, Hutan, Shetty, Kunal, Palazzo, Fausto, Tolley, Neil, Darzi, Ara, Athanasiou, Thanos, and Zacharakis, Emmanouil
- Subjects
MEDICAL equipment ,META-analysis ,SURGERY ,THYROID diseases ,HEMOSTATICS ,CLINICAL trials ,SONIC coagulation ,THERAPEUTICS - Abstract
Background: Energy-based hemostatic devices are increasingly being used in thyroid surgery. However, there are several limitations with regard to the existing evidence and a paucity of guidelines on the subject. The goal of this review is to employ the novel evidence synthesis technique of a network meta-analysis to assess the comparative effectiveness of surgical technologies in thyroid surgery and contribute to enhanced governance in the field of thyroid surgery. Methods: Articles published between January 2000 and June 2012 were identified from Embase, Medline, Cochrane Library, and PubMed databases. Randomized controlled trials of any size comparing the use of ultrasonic coagulation (harmonic scalpel) or Ligasure either head-to-head or against the 'clamp-and-tie' technique were included. Two reviewers independently critically appraised and extracted the data from each study. The number of patients who experienced postoperative events was extracted in dichotomous format or continuous outcomes. Odds ratios were calculated by a Bayesian network meta-analysis, and metaregression was used for pair-wise comparisons. Indirect and direct comparisons were performed and inconsistency was assessed. Results: Thirty-five randomized controlled trials with 2856 patients were included. Ultrasonic coagulation ranked first (followed by Ligasure and then clamp-and-tie) with the lowest risk of postoperative hypoparathyroidism (odds ratio 1.43 [95% confidence interval (CI) 0.77-2.67] and 0.70 [CI 0.43-1.13], ultrasonic coagulation vs. Ligasure and ultrasonic coagulation vs. clamp-and-tie, respectively), least blood loss (−0.25 [CI −0.84 to −0.35] and −1.22 [CI −1.85 to −0.59]), and drain output (0.28 [CI −0.35 to −0.91] and −0.36 [CI −0.70 to −0.03]). From a health technology viewpoint, ultrasonic coagulation was associated with the shortest operative time (−0.66 [CI −1.17 to −0.14] and −1.29 [CI −1.59 to −1.00]) and hospital stay (−0.28 [CI −0.78 to 0.22] and −0.56 [CI −1.28 to 0.15]). The only exception occurs with the clinically important complication of recurrent laryngeal nerve paralysis, where the reverse trend applies (1.36 [CI 0.25-7.46] and 1.74 [CI 0.94-3.26]). Conclusions: The comparative effectiveness of ultrasonic coagulation in thyroid surgery outcomes seems superior to other techniques with the exception of recurrent laryngeal nerve injury. This network meta-analysis, one of a handful in a surgical field, offers preliminary and robust evidence to guide clinical decisions and policy makers to adopt safer thyroid operations. [ABSTRACT FROM AUTHOR]
- Published
- 2013
- Full Text
- View/download PDF
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