Αρχειοθήκη ιστολογίου

Τετάρτη 27 Ιανουαρίου 2021

Can the Japanese National Clinical Database risk calculator predict long-term survival of patients who undergo palliative segmentectomy for primary lung cancer?

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Abstract

Objectives

Selection criteria for palliative limited surgery in patients with non-small cell lung cancer (NSCLC) can vary by institution or surgeon. We retrospectively reviewed outcomes of poor-risk patients who underwent palliative segmentectomy (PS), using the National Clinical Database Risk Calculator (RC).

Methods

We retrospectively analyzed medical records of patients with NSCLC tumors ≥ 20 mm and consolidation/tumor ratios ≥ 0.5 on computed tomography, who underwent PS from January 2009 to March 2016. Median follow-up time was 47 months (range 2–102 months).

Results

We enrolled 67 patients (median age: 73.0 years), of whom 54 received thoracoscopic surgery and 28 received medial lymph-node dissection. The RC's mean predictive probability rate for perioperative mortality or severe complications was 7.1%. Of the 67 patients, 24 patients (43.0%) suffered post-surgical complications, including 2 (3%) who died in hospital; 17 eventually suffered NSCLC recurrences and/or metastases, 11 eventually died from NSCLC, and 17 died from other diseases. Five-year overall survival (OS) was 59.4%. When the patients were divided into high-risk (HR) and low-risk (LR) groups based on the RC, 5-year OS was significantly less in the HR group (43.9%) than in the LR group (82.2%; P < 0.05).

Conclusion

The RC, which was developed primarily to determine perioperative risk, can predict long-term prognosis for compromised patients who undergo PS.

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Efficacy of three-dimensional computed tomography volumetry for recipients in downsizing oversized grafts in brain-dead donor lung transplantation

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Abstract

Objective

Brain-dead donor lung transplantation frequently requires reduction in the size of oversized lung grafts for patients with a small chest cavity. We focused on the role of three-dimensional computed tomography (3D-CT) volumetry for recipients on downsizing oversized lung grafts.

Methods

We performed 53 brain-dead donor bilateral lung transplantations, including 15 lobar lung transplants (Lobar group) and 38 standard lung transplants with full-sized grafts (Full group), between December 2010 and December 2018. Recipient chest volume before transplantation was measured using 3D-CT volumetry, and donor lung volume was evaluated by predicted total lung capacity. Post-transplant outcomes and pulmonary function were retrospectively compared between the groups.

Results

The ratio of the recipient chest volume to the donor lung volume was significantly lower in the Lobar group (0.42 ± 0.15) than in the Full group (0.77 ± 0.30, P < 0.01). The calculated size matching between the donor and recipient after downsizing the grafts was significantly correlated to the ratio of the recipient chest volume to the donor lung volume (Spearman r = 0.69; P < 0.01). Early post-transplant outcomes did not significantly differ between the groups. Although the Full group showed slightly better pulmonary function after transplantation, the 1-, 3-, and 5-year overall survival rates were similar to the Lobar group (100%, 93%, and 81% in the Lobar group vs. 92%, 78%, and 70% in the Full group; P = 0.50).

Conclusions

Brain-dead donor lobar lung transplantation showed favorable post-transplant outcomes. The assessment of recipient chest cavity volume using 3D-CT volumetry may help surgeons precisely downsize oversized lung grafts prior to transplantation.

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Prostate Multiparametric MRI: Common Pitfalls in Primary Diagnosis and How to Avoid Them

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Abstract

Purpose of Review

To provide the radiologist with basic knowledge about normal and abnormal findings in the prostatic mp-MRI, taking a look at the possible diagnostic pitfalls commonly seen in daily clinical practice, allowing him to recognize and consequently avoid them.

Recent Findings

Prostate mp-MRI has now become commonly used in most diagnostic imaging centers, as a precise, accurate and above all non-invasive tool, useful in the diagnosis, staging and follow-up of prostate diseases, first of all prostatic carcinoma. For this reason, it is important to take into account the existence of numerous possible anatomic and pathologic processes which can mimick or masquerade as prostate cancer.

Summary

Through the combination of anatomical (T2WI) and functional sequences (DWI/ADC and DCE), the mp-MRI of the prostate provides all the information necessary for a correct classification of patients with prostate disease, cancer in particular. It is not uncommon, however, for the radiologist to make errors in the interpretation of imaging due to conditions, pathological or otherwise, that mimic prostate cancer and that, consequently, affect the diagnostic/therapeutic process of patients. The strategy, and what this pictorial review aims at, is to learn to recognize the potential pitfalls of the prostatic mp-MRI and avoid them.

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Diffusion-weighted imaging for predicting tumor consistency and extent of resection in patients with pituitary adenoma

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Abstract

This study aimed to investigate the role of diffusion-weighted imaging (DWI) in predicting tumor consistency, extent of surgical resection, and recurrence in pituitary adenoma (PA). We reviewed a prospectively collected database of surgically treated PA between March 2016 and October 2017. Predictors for extent of resection and recurrence/progression were assessed with logistic and Cox regression analysis. Of the 183 patients, the tumor consistency was found soft in 107 (58.5%) patients, intermediate in 41 (22.4%) patients, and hard in 35 (19.1%) patients. The mean of ADC ratio was 0.92 ± 0.22 for hard tumor, 1.03 ± 0.22 for intermediate tumor, and 1.41 ± 0.62 for soft tumor (P < 0.001). The mean collagen content was 25.86% ± 15.00% for hard tumor, 16.05% ± 9.90% for intermediate tumor, and 5.00% ± 6.00% for soft tumor (P < 0.001). Spearman analysis showed a significant correlation between ADC ratio and collagen content (ρ = − 0.367; P < 0.001). Gross-total resection (GTR) was obtained in 68.3% of patients, and multivariable logistic regression analysis showed that ADC ratio (OR, 12.135; 95% CI, 4.001–36.804; P < 0.001), giant PA (OR, 0.233; 95% CI, 0.105–0.520; P < 0.001), and invasion (OR, 0.459; 95% CI, 0.220–0.960; P = 0.039) were significantly predictive of GTR. Twenty-seven (14.8%) patients suffered recurrence/progression in the mean follow-up of 35.14 months. Invasion (HR, 2.728; 95% CI, 1.262–5.899; P = 0.011) was identified as independent predictors of recurrence/progression. ADC ratio of DWI could be used for preoperative assessment of tumor consistency, tumor collagen content, and extent of surgical resection, which might be useful in preoperative planning for patients with PA.

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Automatic Segmentation of Temporal Bone Structures from Clinical Conventional CT Using a CNN Approach

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Abstract

Background

Automatic segmentation of temporal bone structures from patients' conventional CT data plays an important role in the image‐guided cochlear implant surgery. Existing convolutional neural network approaches have difficulties in segmenting such small tubular structures.

Methods

We propose a light‐weight 3D CNN referred to as W‐Net to achieve multi‐objective segmentation of temporal bone structures including the cochlear labyrinth, ossicular chain and facial nerve from conventional temporal bone CT images. Data augmentation with morphological enhancement is proposed to increase the segmentation accuracy of small tubular structures. Evaluation against the state‐of‐the‐art methods is performed.

Results

Our method achieved mean Dice similarity coefficients (DSCs) of 0.90, 0.85 and 0.77 for the cochlear labyrinth, ossicular chain and facial nerve, respectively. These results were also close to the DSCs between human expert annotators (0.91, 0.91, 0.72).

Conclusions

Our method achieves human‐level accuracy in the segmentation of the cochlear labyrinth, ossicular chain and facial nerve.

This article is protected by copyright. All rights reserved.

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An electromagnetic tracking implantation navigation system in dentistry with virtual calibration

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Abstract

Background

Dental implant placement navigation systems based on optical tracking have been widely used in clinics. However, electromagnetic (EM) navigation method that does not suffer from problems of hidden line‐of‐light has not yet been described.

Methods

This work proposes an EM‐guided navigation method named TianShu‐ESNS with virtual calibration. Model (12 implants) and animal experiments (pig head: six implants) were conducted to evaluate its performance and stability.

Result

The mean virtual calibration error was 0.83 ± 0.20 mm. The mean deviations at the entry point, end point and angle in the phantom experiment of TianShu‐ESNS were 1.23 ± 0.17 mm, 1.59 ± 0.20 mm and 1.83 ± 0.27°, respectively. In the animal experiment, the same deviations were 1.25 ± 0.07 mm, 1.57 ± 0.35 mm and 1.90 ± 0.60°, respectively.

Conclusions

The experimental results show that TianShu‐ESNS with the virtual calibration method could serve as a promising tool to eliminate the line‐of‐light hidden problem and simplify operation procedure in dental implant placement.

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Research on Spatial Motion Safety Constraints and Cooperative Control of Robot‐Assisted Craniotomy: Beagle model experiment verification

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Abstract:

Background

Traditional craniotomy depends primarily on the experience of the surgeon. However, the accuracy of manual operation is limited and carries certain surgical risks. The interaction method of current robot‐assisted craniotomy is unnatural and inadaptive to the operating style of the surgeon. In this research, we built a hands‐on synergistic robotics craniotomy system with human‐machine collaboration. Safe isometric surfaces and virtual restraint methods are combined to achieve highly accurate, efficient, minimally invasive, and safe craniotomy.

Materials and methods

Fifteen 3D‐printed beagle skull models were used to evaluate system accuracy and the related image guidance process. It mainly includes: the design of the surgical plan, the adopted strategy based on motion constraint and safe isometric surface, and the impedance control method based on the position inner loop experiment via the human‐machine collaboration method. The trajectory tracking experiment was performed by applying human‐machine collaboration, and completing an experiment on the 3D printed beagle skull models involving drilling and milling of the skull performed by the robot, and evaluation of accuracy via computed tomographic (CT) scanning verification after the operation.

Results

The 3D‐printed beagle skull model experiment shows that the average errors for the top surface and the bottom surface, and the angle error were 0.81 ± 0.15 mm, 0.89 ± 0.12 mm, and 1.74 ± 0.16 degrees, respectively. The average milling position errors for the top and bottom surfaces were 0.87 ± 0.19 mm and 0.93 ± 0.22 mm, respectively.

Conclusion

The performance of the robot system was evaluated and verified using a 3D printed beagle model experiment. The proposed collaborative surgical robot system is feasible and can complete a craniotomy, with improved accuracy and surgical safety.

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Development of a novel deployable arm for natural orifice transluminal endoscopic surgery(NOTES)

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Abstract:

Background

NOTES is aided by the instrument channel of an endoscope. Limited by the diameter of the endoscope, the construction of the operation triangle is affected. This paper presents a deployable arm that can increase the distance between the arms.

Methods

The manipulation arm is composed of a continuum arm and a deployable arm. The deployable arm can be locked by a stay cable and a mechanical structure. The angle between the end‐effectors and the common workspace of the two manipulation arms are comprehensively analyzed. Through experiments, the design parameters are validated and justified.

Results

The experiment shows that the deployment arm can maintain the deformation within 3.5 mm under a 300 g load, and the angle between the two end‐effectors can be maintained within the range of [88o ,110o].

Conclusions

The novel deployment arms enlarge the angle between the end effectors, which significantly improves the flexibility of the arms.

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Fluorescence‐guided D3 lymphadenectomy in robotic right colectomy with complete mesocolic excision

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Abstract

Background

In robotic right hemicolectomy for cancer, appropriate lymphadenectomy is essential. Visualization of draining lymph nodes and blood flow with near‐infrared (NIR) fluorescence DaVinci® imaging system is a recent development. We present the technique of robotic right colectomy with complete mesocolic excision (CME) and D3 lymphadenectomy using Indocyanine Green (ICG) endoscopic submucosal injection to intraoperatively identify tumour lymphatic basin.

Methods

The day before surgery, in patients scheduled for robotic right colectomy an endoscopic submucosal injection of 3 mg of ICG solution around the tumor is realized. Robotic right hemicolectomy is performed with suprapubic trocars layout and "bottom to up dissection", realizing a CME with central vessel ligation and D3 lymphadenectomy. Site of primary tumor and lymphatic basin are visible with the FireflyTM camera modality.

Results

From July 2016 to July 2020, 85 patients received a robotic right colectomy with CME and D3 lymphadenectomy. In 50 patients, ICG submucosal injection was performed: visualisation of the site of primary tumour and of LN in the D3 area was possible in all cases; in 17/50 patients (34%), LN out from anatomical lymphatic basin were identified. No side effects were observed.

Conclusions

In this series, submucosal ICG injection showed to be feasible and safe. The accuracy in identification of D3 lymphatic basin was high, thus permitting an image‐guided radical lymphadenectomy. Fluorescent technology represents an interesting innovation to ameliorate surgery of colon cancer.

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Master manipulator optimisation for robot assisted minimally invasive surgery

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Abstract

Background

In robot‐assisted minimally invasive surgery, the surgeon controls a robot by operating a pair of master manipulators. Thus, the performance of a master manipulator directly affects the work of the surgeon physiologically and psychologically.

Aims

In order to improve the operability and quality of operation, a structure optimisation method of master manipulator is proposed.

Materials & Methods

The optimisation index of workspace and dexterity of main manipulator based on ergonomics and kinematics is established, and the reasonable weight coefficient of optimisation index is determined by using combination weighting method.

Results

Experiments verified that the proposed optimisation method ensures a large workspace and good kinematic performance for the master manipulator.

Conclusion

This improves the comfort of the surgeon and can effectively avoid the problem of cutting off master–slave communication to adjust the position of the master manipulator owing to the small workspace.

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Urological and sexual function after robotic and laparoscopic surgery for rectal cancer: A systematic review, meta‐analysis and meta‐regression

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Abstract

Background

This systematic review sought to compare the urogenital functions after laparoscopic (LAP) and robotic (ROB) surgery for rectal cancer.

Methods

This study conformed to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines.

Results

Twenty‐six studies (n = 2709 for ROB, n = 2720 for LAP) were included. There was a lower risk of 30‐day urinary retention in the ROB group (risk ratios 0.78, 95% confidence interval [CI] 0.61–0.99), but the long‐term risk was comparable (p = 0.460). Meta‐regression showed a small, positive relationship between age and risk of 30‐day urinary retention in both the ROB (p = 0.034) and LAP groups (p = 0.004). The International Prostate Symptom Score was better in the ROB group at 3 months (mean difference [MD] −1.58, 95% CI −3.10 to −0.05). The International Index of Erectile Function score was better in the ROB group at 6 months (MD 4.06, 95% CI 2.38 – 5.74).

Conclusion

While robotics may improve urogenital function after rectal surgery, the quality of evidence is low based on the Grading of Recommendations, Assessment, Development and Evaluation approach.

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Acceptance of patients towards task‐autonomous robotic cochlear implantation: An exploratory study

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Abstract

Background

Recently, task‐autonomous image‐guided robotic cochlear implantation has been successfully completed in patients. However, no data exist on patients' perspective of this new technology. The aim of this study was to evaluate the acceptance of patients towards task‐autonomous robotic cochlear implantation (TARCI).

Methods

We prospectively surveyed 63 subjects (51 patients and 12 parents of infants) scheduled for manual cochlear implantation. We collected sociodemographic and clinico‐pathological characteristics and their attitude towards TARCI for themselves or their child using a questionnaire. Differences between variables were analysed using one‐way analysis of variance and Spearman's rho was used to test for correlation.

Results

Seventy‐three percent of patients and 84% of parents expressed a high acceptance towards TARCI for themselves, or their child, respectively. Interestingly, patients with a negative attitude towards TARCI were significantly younger.

Conclusion

The attitude of patients and parents likely does not represent a barrier towards application of this new technology.

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