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Moynihan A, Killeen D, Cahill R, Singaravelu A, Healy D, Malone C, Mulvany E, O'Brien F, Ridgway P, Ryan K, Barry M, Brennan D, Caird J, Carroll C, Coffey C, Conlon K, Cronin K, Cullivan O, Devitt A, Donohoe C, Doris J, Gallagher T, Gilbride M, Hardy N, Heneghan H, Hill A, Hinchion J, Kerin M, Killeen D, Lowery A, McElvanna K, McHugh A, McHugh N, Meireles O, Moynihan A, Mulvany E, Neary P, O'Brien F, Paul S, Foley MP, Raftery N, Rice D, Ridgway P, Rowan F, Ryan K, Sheahan P, Viani L, Vukanic D, Wilson M. New technologies for future of surgery in Ireland: An RCSI working Group report 2024. Surgeon 2025; 23:120-132. [PMID: 39788867 DOI: 10.1016/j.surge.2024.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2024] [Revised: 11/21/2024] [Accepted: 11/30/2024] [Indexed: 01/12/2025]
Abstract
INTRODUCTION Surgery is a cognitive discipline whose practitioners characteristically use technology during operations for patients. With accelerating technological innovation throughout society and healthcare, we sought to develop a shared position for Irish surgery via a commissioned work programme by the Royal College of Surgeons in Ireland. METHODS Using Stanford design principles, representative clinical specialty and academic leads and higher trainee representatives across 15 specialties were surveyed regarding sentiments, perspectives and concerns regarding now and near future technology in clinical practice, career considerations and training/education. Selected participants proceeded to semi-structured interview as deeper dive including use-case exemplar development with narrative thematic analysis. RESULTS New technologies matter to surgeons and surgical practice for patients as evidenced by the high level of engagement and rich perspectives provided. However there is concern, particularly among academic groups, that Irish Surgery could be better positioned for the opportunities inherent in new technologies and better prepared strategically regarding stakeholder (surgical units, healthcare institutions, universities and especially management, health service executive and government) alignment. Investment levels are felt to be insufficient to maximally leverage new technology effectively including training investment where new ways of learning are needed as technologies such as artificial intelligence and data and analytics become more important to surgical practice beyond the current prioritisation of robotics and biomaterials. CONCLUSION While there is high engagement, clear ambition and confidence with role of new technologies in the now and near future of Irish Surgery, there is opportunity to demonstrate leadership and synergise stake holders for better healthcare.
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Affiliation(s)
- Alice Moynihan
- UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
| | - Debbie Killeen
- UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
| | - Ronan Cahill
- UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland.
| | | | - David Healy
- UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
| | - Carmel Malone
- UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
| | - Enda Mulvany
- UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
| | - Fergal O'Brien
- UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
| | - Paul Ridgway
- UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
| | - Kieran Ryan
- UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
| | - Mary Barry
- UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
| | - Donal Brennan
- UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
| | - John Caird
- UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
| | - Camilla Carroll
- UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
| | - Calvin Coffey
- UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
| | - Kevin Conlon
- UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
| | - Kevin Cronin
- UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
| | - Orla Cullivan
- UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
| | - Aiden Devitt
- UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
| | - Claire Donohoe
- UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
| | - John Doris
- UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
| | - Tom Gallagher
- UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
| | - Michael Gilbride
- UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
| | - Niall Hardy
- UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
| | - Helen Heneghan
- UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
| | - Arnold Hill
- UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
| | - John Hinchion
- UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
| | - Michael Kerin
- UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
| | - Debbie Killeen
- UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
| | - Aoife Lowery
- UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
| | - Kevin McElvanna
- UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
| | - Alison McHugh
- UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
| | - Nathaniel McHugh
- UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
| | - Ozanan Meireles
- UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
| | - Alice Moynihan
- UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
| | - Enda Mulvany
- UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
| | - Peter Neary
- UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
| | - Fergal O'Brien
- UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
| | - Sharjeel Paul
- UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
| | - Megan Power Foley
- UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
| | - Nicola Raftery
- UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
| | - Darragh Rice
- UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
| | - Paul Ridgway
- UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
| | - Fiachra Rowan
- UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
| | - Kieran Ryan
- UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
| | - Patrick Sheahan
- UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
| | - Laura Viani
- UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
| | - Danilo Vukanic
- UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
| | - Mark Wilson
- UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
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Kearns EC, Moynihan A, Dalli J, Khan MF, Singh S, McDonald K, O'Reilly J, Moynagh N, Myles C, Brannigan A, Mulsow J, Shields C, Jones J, Fenlon H, Lawler L, Cahill RA. Clinical validation of 3D virtual modelling for laparoscopic complete mesocolic excision with central vascular ligation for proximal colon cancer. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108597. [PMID: 39173461 DOI: 10.1016/j.ejso.2024.108597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 05/26/2024] [Accepted: 08/09/2024] [Indexed: 08/24/2024]
Abstract
INTRODUCTION Laparoscopic Complete Mesocolic Excision (CME) with Central Vascular Ligation (CVL) in colon cancer surgery has not been broadly adopted in part because of safety concerns. Pre-operative 3-D virtual modelling (3DVM) may help but needs validation. METHODS 3DVM were routinely constructed from CT mesenteric angiograms (CTMA) using a commercial service (Visible Patient, Strasbourg, France) for consecutive patients during our CMECVL learning curve over three years. 3DVMs were independently checked versus CTMA and operative findings. CMECVL outcomes were compared versus other patients undergoing standard mesocolic excision (SME) surgery laparoscopically in the same hospital as control. Stakeholders were studied regarding 3DVM use and usefulness (including detail retention) versus CTMA and a physical 3D-printed model. RESULTS 26 patients underwent 3DVM with intraoperative display during laparoscopic CMECVL within existing workflows. 3DVM accuracy was 96 % re arteriovenous variations at patient level versus CTMA/intraoperative findings including accessory middle colic artery identification in three patients. Twenty-two laparoscopic CMECVL with 3DVM cases were compared with 49 SME controls (age 69 ± 10 vs 70.9 ± 11 years, 55 % vs 53 % males). There were no intraoperative complications with CMECVL and similar 30-day postoperative morbidity (30 % vs 29 %), hospital stay (9 ± 3 vs 12 ± 13 days), 30-day readmission (6 % vs 4 %) and reoperation (0 % vs 4 %) rates. Intraoperative times were longer (215.7 ± 43.9 vs 156.9 ± 52.9 min, p=<0.01) but decreased significantly over time. 3DVM surveys (n = 98, 20 surgeons, 48 medical students, 30 patients/patient relatives) and comparative study revealed majority endorsement (90 %) and favour (87 %). CONCLUSION 3DVM use was positively validated for laparoscopic CMECVL and valued by clinicians, students, and patients alike.
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Affiliation(s)
- Emma C Kearns
- UCD Centre for Precision Surgery, University College Dublin, Ireland
| | - Alice Moynihan
- UCD Centre for Precision Surgery, University College Dublin, Ireland
| | - Jeffrey Dalli
- UCD Centre for Precision Surgery, University College Dublin, Ireland
| | | | - Sneha Singh
- Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Katherine McDonald
- Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Jessica O'Reilly
- Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Niamh Moynagh
- UCD Centre for Precision Surgery, University College Dublin, Ireland
| | | | - Ann Brannigan
- Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Jurgen Mulsow
- Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Conor Shields
- Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Helen Fenlon
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Leo Lawler
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Ronan A Cahill
- UCD Centre for Precision Surgery, University College Dublin, Ireland; Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland.
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Nally DM, Kearns EC, Dalli J, Moynagh N, Hanley K, Neary P, Cahill RA. Patient public perspectives on digital colorectal cancer surgery (DALLAS). EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024:108705. [PMID: 39532576 DOI: 10.1016/j.ejso.2024.108705] [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: 06/03/2024] [Revised: 09/15/2024] [Accepted: 09/23/2024] [Indexed: 11/16/2024]
Abstract
INTRODUCTION The importance of patient perspectives is increasingly appreciated in clinical practice and academia with formal engagement processes developing worldwide. Digital surgery encompasses intraoperative patient data (including surgical video) analysis and so requires public-patient involvement (PPI). METHODS Engagement events were conducted based on NIHR and GRIPP2 LF guidelines. Following informative talks on digital surgery, invited patients and patient relatives were split into focus groups regarding 1) Research; 2) Data; 3) Industry Involvement; and 4) Artificial Intelligence in surgery. Scribed feedback was thematically analysed by two researchers independently. A pre and post event survey was sought voluntarily. RESULTS 36 participant perspectives were analysed. In general, patients were enthusiastic about having a voice in surgical research and sharing their journey, with most groups concluding that capturing this was most appropriate after treatment recovery. The use of patient data for surgical development (i.e. research and education) was endorsed unanimously for the purpose of future patient benefit when responsibly and transparently managed and the value of industry was acknowledged. From 30 pre/post surveys (all p > 0.05), participants afforded the greatest data (including video) ownership claim to the surgical team (52 %/48 %) versus patients (32 %/24 %) and the hospital (12 %/24 %). While most (73 %/80 %) agreed that AI should be applied in surgical care, most felt the surgeon most valuable (93 %/80 %) with participants disagreeing that AI should make diagnoses (57 %/64 %) or treat patients (70 %/70 %) without human input. CONCLUSION Patients capably represent stable views and expectations that can strengthen modern and evolving surgical development involving data privacy, ownership and management.
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Affiliation(s)
- Deirdre M Nally
- UCD Centre for Precision Surgery, University College Dublin, Ireland
| | - Emma C Kearns
- UCD Centre for Precision Surgery, University College Dublin, Ireland
| | - Jeffrey Dalli
- UCD Centre for Precision Surgery, University College Dublin, Ireland
| | - Niamh Moynagh
- UCD Centre for Precision Surgery, University College Dublin, Ireland
| | - Kate Hanley
- Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Peter Neary
- Department of Academic Surgery, University College Cork, Cork, Ireland; Department of Colorectal Surgery, University Hospital Waterford, Waterford City, Ireland
| | - Ronan A Cahill
- UCD Centre for Precision Surgery, University College Dublin, Ireland; Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland.
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Moynihan A, Hardy N, Dalli J, Aigner F, Arezzo A, Hompes R, Knol J, Tuynman J, Cucek J, Rojc J, Rodríguez-Luna MR, Cahill R. CLASSICA: Validating artificial intelligence in classifying cancer in real time during surgery. Colorectal Dis 2023; 25:2392-2402. [PMID: 37932915 DOI: 10.1111/codi.16769] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/14/2023] [Accepted: 09/16/2023] [Indexed: 11/08/2023]
Abstract
AIM Treatment pathways for significant rectal polyps differ depending on the underlying pathology, but pre-excision profiling is imperfect. It has been demonstrated that differences in fluorescence perfusion signals following injection of indocyanine green (ICG) can be analysed mathematically and, with the assistance of artificial intelligence (AI), used to classify tumours endoscopically as benign or malignant. This study aims to validate this method of characterization across multiple clinical sites regarding its generalizability, usability and accuracy while developing clinical-grade software to enable it to become a useful method. METHODS The CLASSICA study is a prospective, unblinded multicentre European observational study aimed to validate the use of AI analysis of ICG fluorescence for intra-operative tissue characterization. Six hundred patients undergoing transanal endoscopic evaluation of significant rectal polyps and tumours will be enrolled in at least five clinical sites across the European Union over a 4-year period. Video recordings will be analysed regarding dynamic fluorescence patterns centrally as software is developed to enable analysis with automatic classification to happen locally. AI-based classification and subsequently guided intervention will be compared with the current standard of care including biopsies, final specimen pathology and patient outcomes. DISCUSSION CLASSICA will validate the use of AI in the analysis of ICG fluorescence for the purposes of classifying significant rectal polyps and tumours endoscopically. Follow-on studies will compare AI-guided targeted biopsy or, indeed, AI characterization alone with traditional biopsy and AI-guided local excision versus traditional excision with regard to marginal clearance and recurrence.
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Affiliation(s)
- A Moynihan
- University College Dublin, Dublin, Ireland
| | - N Hardy
- University College Dublin, Dublin, Ireland
| | - J Dalli
- University College Dublin, Dublin, Ireland
| | - F Aigner
- Krankenhaus der Barmherzigen Brüder Graz, Graz, Austria
| | - A Arezzo
- Department of Surgical Sciences, University of Torino, Torino, Italy
- European Association for Endoscopic Surgery, Eindhoven, The Netherlands
| | - R Hompes
- Ziekenhuis Oost-Limburg Autonome Verzorgingsinstelling, Genk, Belgium
| | - J Knol
- Ziekenhuis Oost-Limburg Autonome Verzorgingsinstelling, Genk, Belgium
| | - J Tuynman
- Stitching VUMC, Amsterdam, The Netherlands
| | - J Cucek
- Arctur, Nova Gorica, Slovenia
| | - J Rojc
- Arctur, Nova Gorica, Slovenia
| | | | - R Cahill
- University College Dublin, Dublin, Ireland
- Mater Misericordiae University Hospital, Dublin, Ireland
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Dalli J, Shanahan S, Hardy NP, Chand M, Hompes R, Jayne D, Ris F, Spinelli A, Wexner S, Cahill RA. Deconstructing mastery in colorectal fluorescence angiography interpretation. Surg Endosc 2022; 36:8764-8773. [PMID: 35543771 PMCID: PMC9652172 DOI: 10.1007/s00464-022-09299-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 04/23/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Indocyanine green fluorescence angiography (ICGFA) is commonly used in colorectal anastomotic practice with limited pre-training. Recent work has shown that there is considerable inconsistency in signal interpretation between surgeons with minimal or no experience versus those consciously invested in mastery of the technique. Here, we deconstruct the fluorescence signal patterns of expert-annotated surgical ICGFA videos to understand better their correlation and combine this with structured interviews to ascertain whether such interpretative capability is conscious or unconscious. METHODS For fluorescence signal analysis, expert-annotated ICGFA videos (n = 24) were quantitatively interrogated using a boutique intensity tracker (IBM Research) to generate signal time plots. Such fluorescence intensity data were examined for inter-observer correlation (Intraclass Correlation Coefficients, ICC) at specific curve milestones: the maximum fluorescence signal (Fmax), the times to both achieve this maximum (Tmax), as well as half this maximum (T1/2max) and the ratio between these (T1/2/Tmax). Formal tele-interview with contributing experts (n = 6) was conducted with the narrative transcripts being thematically mapped, plotted, and qualitatively analyzed. RESULTS Correlation by mathematical measures was excellent (ICC0.9-1.0) for Fmax, Tmax, and T1/2max (0.95, 0.938, and 0.925, respectively) and moderate (0.5-0.75) for T1/2/Tmax (0.729). While all experts narrated a deliberate viewing strategy, their specific dynamic signal appreciation differed in the manner of description. CONCLUSION Expert ICGFA users demonstrate high correlation in mathematical measures of their signal interpretation although do so tacitly. Computational quantification of expert behavior can help develop the necessary lexicon and training sets as well as computer vision methodology to better exploit ICGFA technology.
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Affiliation(s)
- Jeffrey Dalli
- UCD Centre for Precision Surgery, School of Medicine, Catherine McAuley Centre, University College Dublin, 21 Nelson St, Phibsborough, Dublin 7, D07 KX5K, Ireland
| | - Sarah Shanahan
- UCD Centre for Precision Surgery, School of Medicine, Catherine McAuley Centre, University College Dublin, 21 Nelson St, Phibsborough, Dublin 7, D07 KX5K, Ireland
| | - Niall P Hardy
- UCD Centre for Precision Surgery, School of Medicine, Catherine McAuley Centre, University College Dublin, 21 Nelson St, Phibsborough, Dublin 7, D07 KX5K, Ireland
| | - Manish Chand
- UCL Division of Surgery and Interventional Sciences, WEISS Centre, University College London, London, UK
| | - Roel Hompes
- Department of Surgery, Amsterdam UMC (AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - David Jayne
- Leeds Institute for Medical Research, University of Leeds, Leeds, UK
| | - Frederic Ris
- Service of Visceral Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - Antonino Spinelli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, MI, Italy
| | - Steven Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, 33331, USA
| | - Ronan A Cahill
- UCD Centre for Precision Surgery, School of Medicine, Catherine McAuley Centre, University College Dublin, 21 Nelson St, Phibsborough, Dublin 7, D07 KX5K, Ireland.
- Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland.
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