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Abdelaziz MEMK, Zhao J, Gil Rosa B, Lee HT, Simon D, Vyas K, Li B, Koguna H, Li Y, Demircali AA, Uvet H, Gencoglan G, Akcay A, Elriedy M, Kinross J, Dasgupta R, Takats Z, Yeatman E, Yang GZ, Temelkuran B. Fiberbots: Robotic fibers for high-precision minimally invasive surgery. SCIENCE ADVANCES 2024; 10:eadj1984. [PMID: 38241380 PMCID: PMC10798568 DOI: 10.1126/sciadv.adj1984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 12/20/2023] [Indexed: 01/21/2024]
Abstract
Precise manipulation of flexible surgical tools is crucial in minimally invasive surgical procedures, necessitating a miniature and flexible robotic probe that can precisely direct the surgical instruments. In this work, we developed a polymer-based robotic fiber with a thermal actuation mechanism by local heating along the sides of a single fiber. The fiber robot was fabricated by highly scalable fiber drawing technology using common low-cost materials. This low-profile (below 2 millimeters in diameter) robotic fiber exhibits remarkable motion precision (below 50 micrometers) and repeatability. We developed control algorithms coupling the robot with endoscopic instruments, demonstrating high-resolution in situ molecular and morphological tissue mapping. We assess its practicality and safety during in vivo laparoscopic surgery on a porcine model. High-precision motion of the fiber robot delivered endoscopically facilitates the effective use of cellular-level intraoperative tissue identification and ablation technologies, potentially enabling precise removal of cancer in challenging surgical sites.
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Affiliation(s)
- Mohamed E. M. K. Abdelaziz
- The Hamlyn Centre for Robotic Surgery, Imperial College London, London SW7 2AZ, UK
- Department of Electrical and Electronic Engineering, Faculty of Engineering, Imperial College London, London SW7 2AZ, UK
| | - Jinshi Zhao
- The Hamlyn Centre for Robotic Surgery, Imperial College London, London SW7 2AZ, UK
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London SW7 2AZ, UK
| | - Bruno Gil Rosa
- The Hamlyn Centre for Robotic Surgery, Imperial College London, London SW7 2AZ, UK
- Department of Electrical and Electronic Engineering, Faculty of Engineering, Imperial College London, London SW7 2AZ, UK
| | - Hyun-Taek Lee
- Department of Mechanical Engineering, Inha University, Incheon 22212, South Korea
| | - Daniel Simon
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London SW7 2AZ, UK
- The Rosalind Franklin Institute, Didcot OX11 0QS, UK
| | - Khushi Vyas
- The Hamlyn Centre for Robotic Surgery, Imperial College London, London SW7 2AZ, UK
- Department of Electrical and Electronic Engineering, Faculty of Engineering, Imperial College London, London SW7 2AZ, UK
| | - Bing Li
- The UK DRI Care Research and Technology Centre, Department of Brain Science, Imperial College London, London W12 0MN, UK
- Institute for Materials Discovery, University College London, London WC1H 0AJ, UK
| | - Hanifa Koguna
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London SW7 2AZ, UK
| | - Yue Li
- The Hamlyn Centre for Robotic Surgery, Imperial College London, London SW7 2AZ, UK
| | - Ali Anil Demircali
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London SW7 2AZ, UK
| | - Huseyin Uvet
- Department of Mechatronics Engineering, Faculty of Engineering, Yildiz Technical University, Istanbul 34349, Turkey
| | - Gulsum Gencoglan
- Department of Dermatology and Venereology, Liv Hospital Vadistanbul, Istanbul 34396, Turkey
- Department of Skin and Venereal Diseases, Faculty of Medicine, Istinye University, Istanbul 34010, Turkey
| | - Arzu Akcay
- Department of Pathology, Faculty of Medicine, Yeni Yüzyıl University, Istanbul 34010, TR
- Pathology Laboratory, Atakent Hospital, Acibadem Mehmet Ali Aydinlar University, Istanbul 34303, TR
| | - Mohamed Elriedy
- Anesthesiology, University Hospitals of Derby and Burton, Derby, DE22 3NE, UK
| | - James Kinross
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London SW7 2AZ, UK
| | - Ranan Dasgupta
- Department of Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, UK
| | - Zoltan Takats
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London SW7 2AZ, UK
- The Rosalind Franklin Institute, Didcot OX11 0QS, UK
| | - Eric Yeatman
- Department of Electrical and Electronic Engineering, Faculty of Engineering, Imperial College London, London SW7 2AZ, UK
| | - Guang-Zhong Yang
- Institute of Medical Robots, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Burak Temelkuran
- The Hamlyn Centre for Robotic Surgery, Imperial College London, London SW7 2AZ, UK
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London SW7 2AZ, UK
- The Rosalind Franklin Institute, Didcot OX11 0QS, UK
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Machan L, Churilov L, Hu R, Peyton P, Tan C, Pillai P, Ellard L, Harley I, Story D, Hayward P, Matalanis G, Roubos N, Seevanayagam S, Weinberg L. Apneic Oxygenation Versus Low-Tidal-Volume Ventilation in Anesthetized Cardiac Surgical Patients: A Prospective, Single-Center, Randomized Controlled Trial. J Cardiothorac Vasc Anesth 2016; 31:2000-2009. [PMID: 28284927 DOI: 10.1053/j.jvca.2016.12.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To compare the physiology of apneic oxygenation with low-tidal-volume (VT) ventilation during harvesting of the left internal mammary artery. DESIGN Prospective, single-center, randomized trial. SETTING Single-center teaching hospital. PARTICIPANTS The study comprised 24 patients who underwent elective coronary artery bypass grafting surgery. INTERVENTIONS Apneic oxygenation (apneic group: 12 participants) and low-VT ventilation (low-VT group: 12 participants) (2.5 mL/kg ideal body weight) for 15 minutes during harvesting of the left internal mammary artery. MEASUREMENT AND MAIN RESULTS The primary endpoint was an absolute change in partial pressure of arterial carbon dioxide (PaCO2). Secondary endpoints were changes in arterial pH, pulmonary artery pressures (PAP), cardiac index, and pulmonary artery acceleration time and ease of surgical access. The mean (standard deviation) absolute increase in PaCO2 was 31.8 mmHg (7.6) in the apneic group and 17.6 mmHg (8.2) in the low-VT group (baseline-adjusted difference 14.2 mmHg [95% confidence interval 21.0-7.3], p<0.001). The mean (standard deviation) absolute decrease in pH was 0.15 (0.03) in the apneic group and 0.09 (0.03) in the low-VT group baseline-adjusted difference 0.06 [95% confidence interval 0.03-0.09], p<0.001. Differences in the rate of change over time between groups (time-by-treatment interaction) were observed for PaCO2 (p<0.001), pH (p<0.001), systolic PAP (p = 0.002), diastolic PAP (p = 0.023), and mean PAP (p = 0.034). Both techniques provided adequate ease of surgical access; however, apneic oxygenation was preferred predominantly. CONCLUSIONS Apneic oxygenation caused a greater degree of hypercarbia and respiratory acidemia compared with low-VT ventilation. Neither technique had deleterious effects on PAP or cardiac function. Both techniques provided adequate ease of surgical access.
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Affiliation(s)
| | - Leonid Churilov
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Victoria, Australia
| | - Raymond Hu
- Department of Anesthesia, Austin Hospital, Heidelberg, Victoria, Australia
| | - Philip Peyton
- Department of Anesthesia, Austin Hospital, Heidelberg, Victoria, Australia
| | - Chong Tan
- Department of Anesthesia, Austin Hospital, Heidelberg, Victoria, Australia
| | - Param Pillai
- Department of Anesthesia, Austin Hospital, Heidelberg, Victoria, Australia
| | - Louise Ellard
- Department of Anesthesia, Austin Hospital, Heidelberg, Victoria, Australia
| | - Ian Harley
- Department of Anesthesia, Austin Hospital, Heidelberg, Victoria, Australia
| | - David Story
- Department of Anesthesia, University of Melbourne, Victoria, Australia; Department of Surgery and Centre for Anesthesia, Perioperative and Pain Medicine, University of Melbourne, Victoria, Australia
| | - Philip Hayward
- Department of Cardiac Surgery, Austin Hospital, Heidelberg, Victoria, Australia
| | - George Matalanis
- Department of Cardiac Surgery, Austin Hospital, Heidelberg, Victoria, Australia
| | - Nicholas Roubos
- Department of Cardiac Surgery, Austin Hospital, Heidelberg, Victoria, Australia
| | | | - Laurence Weinberg
- Department of Anesthesia, University of Melbourne, Victoria, Australia; Department of Surgery and Centre for Anesthesia, Perioperative and Pain Medicine, University of Melbourne, Victoria, Australia.
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11
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Kolettas A, Grosomanidis V, Kolettas V, Zarogoulidis P, Tsakiridis K, Katsikogiannis N, Tsiouda T, Kiougioumtzi I, Machairiotis N, Drylis G, Kesisis G, Beleveslis T, Zarogoulidis K. Influence of apnoeic oxygenation in respiratory and circulatory system under general anaesthesia. J Thorac Dis 2014; 6 Suppl 1:S116-45. [PMID: 24672687 DOI: 10.3978/j.issn.2072-1439.2014.01.17] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Accepted: 01/12/2014] [Indexed: 12/15/2022]
Abstract
Apnoeic oxygenation is an alternative technique of oxygenation which is recommended in the consecutive oxygen administration with varying flows (2-10 lt/min) through a catheter which is positioned over the keel of the trachea. Apnoeic oxygenation maintains for a significant period of time the oxygenation of blood in breathless conditions. This technique was first applied in 1947 by Draper, Whitehead, and Spencer and it was studied sporadically by other inventors too. However, the international literature shows few studies that have examined closely apnoeic oxygenation and its effects on Hemodynamic image and the respiratory system of the human body. Recently they have begun to arise some studies which deal with the application of this technique in several conditions such as difficult tracheal intubation, ventilation of guinea pigs in campaign conditions where the oxygen supply is limited and calculable, the application of this technique in combination with the use of extracorporeal removal of carbon dioxide (CO2). All the above indicate, the clinical use of this technique.
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Affiliation(s)
- Alexander Kolettas
- 1 Anaesthesiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 2 Anaesthesiology Department, 3 Cardiology Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 8 Internal Medicine Department, Regional Hospital of Samos, Samos, Greece ; 9 Onocology Department, 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Vasilis Grosomanidis
- 1 Anaesthesiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 2 Anaesthesiology Department, 3 Cardiology Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 8 Internal Medicine Department, Regional Hospital of Samos, Samos, Greece ; 9 Onocology Department, 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Vasilis Kolettas
- 1 Anaesthesiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 2 Anaesthesiology Department, 3 Cardiology Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 8 Internal Medicine Department, Regional Hospital of Samos, Samos, Greece ; 9 Onocology Department, 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Paul Zarogoulidis
- 1 Anaesthesiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 2 Anaesthesiology Department, 3 Cardiology Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 8 Internal Medicine Department, Regional Hospital of Samos, Samos, Greece ; 9 Onocology Department, 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Kosmas Tsakiridis
- 1 Anaesthesiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 2 Anaesthesiology Department, 3 Cardiology Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 8 Internal Medicine Department, Regional Hospital of Samos, Samos, Greece ; 9 Onocology Department, 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Nikolaos Katsikogiannis
- 1 Anaesthesiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 2 Anaesthesiology Department, 3 Cardiology Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 8 Internal Medicine Department, Regional Hospital of Samos, Samos, Greece ; 9 Onocology Department, 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Theodora Tsiouda
- 1 Anaesthesiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 2 Anaesthesiology Department, 3 Cardiology Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 8 Internal Medicine Department, Regional Hospital of Samos, Samos, Greece ; 9 Onocology Department, 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Ioanna Kiougioumtzi
- 1 Anaesthesiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 2 Anaesthesiology Department, 3 Cardiology Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 8 Internal Medicine Department, Regional Hospital of Samos, Samos, Greece ; 9 Onocology Department, 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Nikolaos Machairiotis
- 1 Anaesthesiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 2 Anaesthesiology Department, 3 Cardiology Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 8 Internal Medicine Department, Regional Hospital of Samos, Samos, Greece ; 9 Onocology Department, 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Georgios Drylis
- 1 Anaesthesiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 2 Anaesthesiology Department, 3 Cardiology Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 8 Internal Medicine Department, Regional Hospital of Samos, Samos, Greece ; 9 Onocology Department, 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Georgios Kesisis
- 1 Anaesthesiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 2 Anaesthesiology Department, 3 Cardiology Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 8 Internal Medicine Department, Regional Hospital of Samos, Samos, Greece ; 9 Onocology Department, 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Thomas Beleveslis
- 1 Anaesthesiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 2 Anaesthesiology Department, 3 Cardiology Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 8 Internal Medicine Department, Regional Hospital of Samos, Samos, Greece ; 9 Onocology Department, 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
| | - Konstantinos Zarogoulidis
- 1 Anaesthesiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 2 Anaesthesiology Department, 3 Cardiology Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece ; 6 Surgery Department (NHS), University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 7 Internal Medicine Department, "Theageneio" Cancer Hospital, Thessaloniki, Greece ; 8 Internal Medicine Department, Regional Hospital of Samos, Samos, Greece ; 9 Onocology Department, 10 Cardiology Department, "Saint Luke" Private Clinic, Thessaloniki, Panorama, Greece
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