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Patel M, Hugh TJ. A Comparison of Three-Dimensional Visualization Systems and Two-Dimensional Visualization Systems During Laparoscopic Cholecystectomy: A Narrative Review. J Laparoendosc Adv Surg Tech A 2023; 33:957-962. [PMID: 37486672 DOI: 10.1089/lap.2023.0270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023] Open
Abstract
Background: Laparoscopic cholecystectomy is a common procedure for the definitive treatment for cholecystitis and symptomatic cholelithiasis. One advancement in minimally invasive surgery has been the development of three-dimensional (3D) visualization systems to provide stereopsis. It is yet to be determined whether this innovation is beneficial to the surgeon or simply just a gimmick. This narrative review aims to answer the following research question, what is the impact of 3D visualization systems on surgical efficiency compared with two-dimensional visualization systems in laparoscopic cholecystectomy? Methods: Through a broad literature search it was determined that operative time and intraoperative errors have been used in published research to assess intraoperative efficiency. Results: Studies published to date have used operative time, intraoperative errors, and intraoperative bleeding as current measures for intraoperative efficiency. Previous meta-analysis have shown a slight improvement in operative time for 3D visualization systems; however, subsequent randomized control trials have not shown a significant difference in operative time. Reporting of intraoperative errors has been quite subjective and a difference between visualisation modality has not been shown. Conclusion: 3D visualization systems have shown a minor improvement in operative time compared with traditional laparoscopic systems and it is unlikely to be of any clinical significance. Studies that measure intraoperative error vary greatly in what they report, and which assessment tool is used. Across existing literature, studies do not control for surgeon's experience, elective/emergent cases, and grade of gallbladder/difficulty. Further research is required, using novel tools for assessment in laparoscopic cholecystectomy to determine intraoperative differences through objective and quantitative variables.
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Affiliation(s)
- Meet Patel
- Northern Clinical School, University of Sydney, Sydney, Australia
- Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
- Northern Beaches Hospital, Frenches Forrest, Australia
| | - Thomas J Hugh
- Northern Clinical School, University of Sydney, Sydney, Australia
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital, St Leonards, Australia
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McClean A, Huo B, Kwan JY, Long J, Walshaw J, Mesri M, Francis N, Arulampalam TH, Chetter I, Yiasemidou M. The impact of the European Association of Endoscopic Surgery research grant scheme-a mixed qualitative quantitative methodology study protocol. Front Surg 2023; 10:1197103. [PMID: 37405059 PMCID: PMC10315820 DOI: 10.3389/fsurg.2023.1197103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/31/2023] [Indexed: 07/06/2023] Open
Abstract
Background The European Association of Endoscopic Surgery (EAES) is a surgical society who promotes the development and expansion of minimally invasive surgery to surgeons and surgical trainees. It does so through its activities in education, training, and research. The EAES research committee aims to promote the highest quality clinical research in endoscopic and minimally invasive surgery. They have provided grant funding since 2009 in education, surgery, and basic science. Despite the success and longevity of the scheme, the academic and non-academic impact of the research funding scheme has not been evaluated. Aims The primary aim of this project is to assess the short, long term academic and real world impact of the EAES funding scheme. The secondary aims are to identify barriers and facilitators for achieving good impact. Methods This will be a mixed qualitative and quantitative study. Semi-structured interviews will be performed with previous grant recipients. The questions for the interviews will be selected after a consensus is achieved amongst the members of the steering committee of this project. The responses will be transcribed and thematic analysis will be applied. The results of the thematic analysis will be used to populate a questionnaire which will be disseminated to grant recipients. This study is kindly funded by the EAES. Discussion The first question this project is expected to answer is whether the EAES research funding scheme had a significant positive impact on research output, career progression but also non-academic output such as change in clinical guidelines, healthcare quality and cost-effectiveness improvement. This project however is also expected to identify facilitators and barriers to successful completion of projects and to achieving high impact. This will inform EAES and the rest of the surgical and academic communities as to how clinicians would like to be supported when conducting research. There should also be a positive and decisive change towards removing factors that hinder the timely and successful completion of projects.
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Affiliation(s)
- Adam McClean
- Clinical Fellow General Surgery, Bradford Teaching Hospitals, Bradford, United Kingdom
| | - Bright Huo
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Jing Yi Kwan
- NIHR Academic Clinical Fellow, Vascular Surgery, Leeds Teaching Hospitals, Leeds, United Kingdom
| | - Judith Long
- Research Manager, Academic Vascular Surgical Unit, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - Josephine Walshaw
- Department of Health Research, University of York, York, United kingdom
| | - Mina Mesri
- Department of Medicine, Hull York MedicalSchool, York, United kingdom
| | - Nader Francis
- Consultant Colorectal Surgeon, Department of Surgery, Yeovil District Hospital NHS Foundation Trust, Honorary Professor of Surgery UCL, Yeovil, United Kingdom
| | - Tan H. Arulampalam
- Consultant Colorectal Surgeon, ICENI Centre, Colchester Hospital University NHS Foundation Trust, Colchester, Essex, United Kingdom
| | - Ian Chetter
- Professor of Surgery, Hull University Teaching Hospital, Hull, United Kingdom
| | - Marina Yiasemidou
- Department of Medicine, NIHR Academic Clinical Lecturer in General Surgery, Hull York Medical School, Hull, United Kingdom
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Ahmad OF, Mori Y, Misawa M, Kudo SE, Anderson JT, Bernal J, Berzin TM, Bisschops R, Byrne MF, Chen PJ, East JE, Eelbode T, Elson DS, Gurudu SR, Histace A, Karnes WE, Repici A, Singh R, Valdastri P, Wallace MB, Wang P, Stoyanov D, Lovat LB. Establishing key research questions for the implementation of artificial intelligence in colonoscopy: a modified Delphi method. Endoscopy 2021; 53:893-901. [PMID: 33167043 PMCID: PMC8390295 DOI: 10.1055/a-1306-7590] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND : Artificial intelligence (AI) research in colonoscopy is progressing rapidly but widespread clinical implementation is not yet a reality. We aimed to identify the top implementation research priorities. METHODS : An established modified Delphi approach for research priority setting was used. Fifteen international experts, including endoscopists and translational computer scientists/engineers, from nine countries participated in an online survey over 9 months. Questions related to AI implementation in colonoscopy were generated as a long-list in the first round, and then scored in two subsequent rounds to identify the top 10 research questions. RESULTS : The top 10 ranked questions were categorized into five themes. Theme 1: clinical trial design/end points (4 questions), related to optimum trial designs for polyp detection and characterization, determining the optimal end points for evaluation of AI, and demonstrating impact on interval cancer rates. Theme 2: technological developments (3 questions), including improving detection of more challenging and advanced lesions, reduction of false-positive rates, and minimizing latency. Theme 3: clinical adoption/integration (1 question), concerning the effective combination of detection and characterization into one workflow. Theme 4: data access/annotation (1 question), concerning more efficient or automated data annotation methods to reduce the burden on human experts. Theme 5: regulatory approval (1 question), related to making regulatory approval processes more efficient. CONCLUSIONS : This is the first reported international research priority setting exercise for AI in colonoscopy. The study findings should be used as a framework to guide future research with key stakeholders to accelerate the clinical implementation of AI in endoscopy.
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Affiliation(s)
- Omer F. Ahmad
- Wellcome/EPSRC Centre for Interventional & Surgical Sciences, University College London, London, UK
| | - Yuichi Mori
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan,Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Masashi Misawa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Shin-ei Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - John T. Anderson
- Department of Gastroenterology, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - Jorge Bernal
- Computer Science Department, Universitat Autonoma de Barcelona and Computer Vision Center, Barcelona, Spain
| | - Tyler M. Berzin
- Center for Advanced Endoscopy, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, TARGID KU Leuven, Leuven, Belgium
| | - Michael F. Byrne
- Division of Gastroenterology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peng-Jen Chen
- Division of Gastroenterology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - James E. East
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK,Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Tom Eelbode
- Medical Imaging Research Center, ESAT/PSI, KU Leuven, Leuven, Belgium
| | - Daniel S. Elson
- Hamlyn Centre for Robotic Surgery, Institute of Global Health Innovation, Imperial College London, London, UK,Department of Surgery and Cancer, Imperial College London, London, UK
| | - Suryakanth R. Gurudu
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Aymeric Histace
- ETIS, Universite de Cergy-Pointoise, ENSEA, CNRS, Cergy-Pointoise Cedex, France
| | - William E. Karnes
- H. H. Chao Comprehensive Digestive Disease Center, Division of Gastroenterology & Hepatology, Department of Medicine, University of California, Irvine, California, USA
| | - Alessandro Repici
- Department of Gastroenterology, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy,Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan, Italy
| | - Rajvinder Singh
- Department of Gastroenterology and Hepatology, Lyell McEwan Hospital, Adelaide, South Australia, Australia
| | - Pietro Valdastri
- School of Electronics and Electrical Engineering, University of Leeds, Leeds, UK
| | - Michael B. Wallace
- Division of Gastroenterology & Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Pu Wang
- Department of Gastroenterology, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, Chengdu, China
| | - Danail Stoyanov
- Wellcome/EPSRC Centre for Interventional & Surgical Sciences, University College London, London, UK
| | - Laurence B. Lovat
- Wellcome/EPSRC Centre for Interventional & Surgical Sciences, University College London, London, UK,Gastrointestinal Services, University College London Hospital, London, UK
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Dunstan M, Smith R, Schwab K, Scala A, Gatenby P, Whyte M, Rockall T, Jourdan I. Is 3D faster and safer than 4K laparoscopic cholecystectomy? A randomised-controlled trial. Surg Endosc 2020; 34:1729-1735. [PMID: 31321536 PMCID: PMC7093366 DOI: 10.1007/s00464-019-06958-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 07/01/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Laparoscopic surgery has well-established benefits for patients; however, laparoscopic procedures have a long and difficult learning curve, in large part due to the lack of stereoscopic depth perception. Developments in high-definition and stereoscopic imaging have attempted to overcome this. Three-dimensional high-definition (3D HD) systems are thought to improve operating times compared to two-dimensional high-definition systems. However their performance against new, ultra-high-definition ('4K') systems is not known. METHODS Patients undergoing laparoscopic cholecystectomy were randomised to 3D HD or 4K laparoscopy. Operative videos were recorded, and the time from gallbladder exposure to separation from the liver (minus on table cholangiogram) was calculated. Blinded video assessment was performed to calculate intraoperative error scores. RESULTS One hundred and twenty patients were randomised, of which 109 were analysed (3D HD n = 54; 4K n = 55). No reduction in operative time was detected with 3D HD compared to 4K laparoscopy (median [IQR]; 23.41 min [17.00-37.98] vs 20.90 min [17.67-33.03]; p = 0.91); nor was there any decrease observed in error scores (60 [56-62] vs 58 [56-60]; p = 0.27), complications or reattendance. Stone spillage occurred more frequently with 3D HD, but there were no other differences in individual error rates. Gallbladder grade and operating surgeon had significant effects on time to complete the operation. Gallbladder grade also had a significant effect on the error score. CONCLUSIONS A 3D HD laparoscopic system did not reduce operative time or error scores during laparoscopic cholecystectomy compared with a new 4K imaging system.
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Affiliation(s)
- Matt Dunstan
- Royal Surrey County Hospital, Minimal Access Therapy Training Unit (MATTU), Leggett Building, Daphne Jackson Road, Manor Park, Guildford, Surrey, GU2 7WG, UK.
| | - Ralph Smith
- Royal Surrey County Hospital, Minimal Access Therapy Training Unit (MATTU), Leggett Building, Daphne Jackson Road, Manor Park, Guildford, Surrey, GU2 7WG, UK
| | - Katie Schwab
- Royal Surrey County Hospital, Minimal Access Therapy Training Unit (MATTU), Leggett Building, Daphne Jackson Road, Manor Park, Guildford, Surrey, GU2 7WG, UK
| | - Andrea Scala
- Royal Surrey County Hospital, Minimal Access Therapy Training Unit (MATTU), Leggett Building, Daphne Jackson Road, Manor Park, Guildford, Surrey, GU2 7WG, UK
| | - Piers Gatenby
- Royal Surrey County Hospital, Minimal Access Therapy Training Unit (MATTU), Leggett Building, Daphne Jackson Road, Manor Park, Guildford, Surrey, GU2 7WG, UK
| | - Martin Whyte
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, GU2 7XH, UK
| | - Tim Rockall
- Royal Surrey County Hospital, Minimal Access Therapy Training Unit (MATTU), Leggett Building, Daphne Jackson Road, Manor Park, Guildford, Surrey, GU2 7WG, UK
| | - Iain Jourdan
- Royal Surrey County Hospital, Minimal Access Therapy Training Unit (MATTU), Leggett Building, Daphne Jackson Road, Manor Park, Guildford, Surrey, GU2 7WG, UK
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Wilson MSJ, Knight S, Vaughan-Shaw P, Blakemore AI, O'Kane M, Boyle C, Small P, Mahawar K. A modified AUGIS Delphi process to establish research priorities in bariatric and metabolic surgery. Clin Obes 2020; 10:e12344. [PMID: 31646737 DOI: 10.1111/cob.12344] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 09/15/2019] [Accepted: 09/17/2019] [Indexed: 11/30/2022]
Abstract
Delphi methodology may be utilized to develop consensus opinion among a group of experts. The aim of our study was to use a modified Delphi process to determine the future research priorities among bariatric and metabolic healthcare professionals in the United Kingdom. Members of the Association of Upper Gastrointestinal Surgeons and the British Obesity and Metabolic Surgery Society were invited to submit individual research questions via an online survey (phase I). Two rounds of prioritization by multidisciplinary expert healthcare professionals (phase II and III) were completed to determine a final list of high-priority research questions. Fifty-one bariatric and metabolic surgery-focused questions were identified in phase I. Thirty-five questions were taken forward for prioritization in phase II. Eleven high-priority questions were identified in phase III. The final list of high-priority questions had an emphasis on the pathophysiology and long-term sequelae of bariatric and metabolic surgery. A modified Delphi process has produced a list of 11 high-priority research questions in bariatric and metabolic surgery. Future studies and awards from funding bodies should reflect this consensus list of prioritized questions in the interest of improving patient care and encouraging collaborative research across multiple centres.
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Affiliation(s)
| | - Stephen Knight
- Centre for Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Peter Vaughan-Shaw
- Department of Colorectal Surgery, Western General Hospital, Edinburgh, UK
| | - Alex I Blakemore
- College of Health and Life Sciences, Brunel University, London, UK
- Department of Medicine, Imperial College, London, UK
| | - Mary O'Kane
- Dietetic Department, Leeds General Infirmary, Leeds, UK
| | - Christopher Boyle
- Graduate School of Education, University of Exeter, Exeter, UK
- Department of General Surgery, Sunderland Royal Hospital, Sunderland, UK
| | - Peter Small
- Department of General Surgery, Sunderland Royal Hospital, Sunderland, UK
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
| | - Kamal Mahawar
- Department of General Surgery, Sunderland Royal Hospital, Sunderland, UK
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
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Development of a novel tool to assess skills in laparoscopic gastrectomy using the Delphi method: the Japanese operative rating scale for laparoscopic distal gastrectomy (JORS-LDG). Surg Endosc 2019; 33:3945-3952. [PMID: 30756172 DOI: 10.1007/s00464-019-06681-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 01/23/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND Assessment of the performance of laparoscopic gastrectomy is yet unreported, likely because of the complexity of the procedure. We aimed to develop a tool to assess the skills required for laparoscopic distal gastrectomy (LDG) through cognitive task analysis (CTA) and expert consensus using the Delphi method. METHODS CTA involved the listing of the knowledge and criteria required for completing each step of LDG as subtasks based on interviews by experts and novices and text book, instructional video, and procedural review. The Delphi evaluation method involved anonymous online surveys, conducted to merge the opinions of experts in laparoscopic gastrectomy. The experts were asked to rate (from 1 to 5) the importance of subtasks for skill evaluation and training for LDG using a Likert scale. Consensus among expert viewpoints was determined by the internal consistency of each item using Cronbach's approach. RESULTS Essential subtasks drafted for the assessment of LDG performance were determined based on the CTA. Thirty-one LDG experts participated in the online-survey with a response rate over 90%. A consensus was achieved after 2 rounds of surveys with a Cronbach alpha of 0.86, and 34 subtasks of LDG were selected. We finally created the Japanese Operative Rating Scale for Laparoscopic Distal Gastrectomy (JORS-LDG) based on the 34 subtasks. CONCLUSIONS We developed the JORS-LDG using CTA and the Delphi method.
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