1
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Kok SD, Schaap PMR, van Dommelen L, van Huizen LMG, Dickhoff C, Dijkum EMNV, Engelsman AF, van der Valk P, Groot ML. Compact portable higher harmonic generation microscopy for the real time assessment of unprocessed thyroid tissue. J Biophotonics 2024; 17:e202300079. [PMID: 37725434 DOI: 10.1002/jbio.202300079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 09/12/2023] [Accepted: 09/15/2023] [Indexed: 09/21/2023]
Abstract
During thyroid surgery fast and reliable intra-operative pathological feedback has the potential to avoid a two-stage procedure and significantly reduce health care costs in patients undergoing a diagnostic hemithyroidectomy (HT). We explored higher harmonic generation (HHG) microscopy, which combines second harmonic generation (SHG), third harmonic generation (THG), and multiphoton excited autofluorescence (MPEF) for this purpose. With a compact, portable HHG microscope, images of freshly excised healthy tissue, benign nodules (follicular adenoma) and malignant tissue (papillary carcinoma, follicular carcinoma and spindle cell carcinoma) were recorded. The images were generated on unprocessed tissue within minutes and show relevant morphological thyroid structures in good accordance with the histology images. The thyroid follicle architecture, cells, cell nuclei (THG), collagen organization (SHG) and the distribution of thyroglobulin and/or thyroid hormones T3 or T4 (MPEF) could be visualized. We conclude that SHG/THG/MPEF imaging is a promising tool for clinical intraoperative assessment of thyroid tissue.
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Affiliation(s)
- S D Kok
- Vrije Universiteit Amsterdam, Faculty of Science, Department of Physics, LaserLab, Amsterdam, The Netherlands
| | - P M Rodriguez Schaap
- Department of Surgery, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - L van Dommelen
- Department of Surgery, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - L M G van Huizen
- Vrije Universiteit Amsterdam, Faculty of Science, Department of Physics, LaserLab, Amsterdam, The Netherlands
| | - C Dickhoff
- Department of Surgery, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Cardiothoracic Surgery, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - E M Nieveen-van Dijkum
- Department of Surgery, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - A F Engelsman
- Department of Surgery, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - P van der Valk
- Department of Pathology, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - M L Groot
- Vrije Universiteit Amsterdam, Faculty of Science, Department of Physics, LaserLab, Amsterdam, The Netherlands
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2
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van Doesburg JR, Voeten DM, Kalff MC, van Berge Henegouwen MI, Jol S, van den Bergh JE, Engelsman AF, Gisbertz SS, Daams F. Incidence and oncological implication of adrenal incidentalomas in esophageal cancer patients. Dis Esophagus 2023; 36:doad003. [PMID: 36722353 PMCID: PMC10473449 DOI: 10.1093/dote/doad003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 12/15/2022] [Accepted: 01/01/2023] [Indexed: 02/02/2023]
Abstract
Adrenal incidentalomas are regularly encountered during imaging for esophageal cancer patients, but their oncological significance remains unknown. This study aimed to describe the incidence and etiology of adrenal incidentalomas observed throughout the diagnostic workup. This retrospective cohort study included all esophageal cancer patients referred to or diagnosed in the Amsterdam UMC between January 2012 and December 2016. Radiology and multidisciplinary team meeting reports were reviewed for adrenal incidentalomas. In case of adrenal incidentaloma, the 18FDG-PET/CT was reassessed by a radiologist blinded for the original report. In case of a metachronous incidentaloma during follow-up, visibility on previous imaging was reassessed. Primary outcome was the incidence, etiology and oncological consequence of synchronous adrenal incidentalomas. This study included 1,164 esophageal cancer patients, with a median age of 66 years. Patients were predominantly male (76.1%) and the majority had an adenocarcinoma (69.0%). Adrenal incidentalomas were documented in 138 patients (11.9%) during the diagnostic workup. At primary esophageal cancer workup, 22 incidentalomas proved malignant. However, follow-up showed that four incidentalomas were inaccurately diagnosed as benign and three malignant incidentalomas were visible on staging imaging but initially missed. Stage migration occurred in 15 of 22 (68.2%), but this would have been higher if none were missed or inaccurately diagnosed. The oncological impact of adrenal incidentalomas in patients with esophageal cancer is significant as a considerable part of incidentalomas changed treatment intent from curative to palliative. As stage migration is likely, pathological examination of a synchronous adrenal incidentaloma should be weighted in mind.
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Affiliation(s)
- J R van Doesburg
- Department of Surgery, Amsterdam UMC location Vrije Universiteit, Amsterdam, The Netherlands
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - D M Voeten
- Department of Surgery, Amsterdam UMC location Vrije Universiteit, Amsterdam, The Netherlands
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - M C Kalff
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - M I van Berge Henegouwen
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - S Jol
- Department of Radiology, Amsterdam UMC Location Vrije Universiteit, Amsterdam, The Netherlands
| | - J E van den Bergh
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Radiology, Amsterdam UMC Location Vrije Universiteit, Amsterdam, The Netherlands
| | - A F Engelsman
- Department of Surgery, Amsterdam UMC location Vrije Universiteit, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - S S Gisbertz
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - F Daams
- Department of Surgery, Amsterdam UMC location Vrije Universiteit, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
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3
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Lin JF, Rodriguez Schaap PM, Metman MJH, Nieveen van Dijkum EJM, Dickhoff C, Links TP, Kruijff S, Engelsman AF. Thyroid Lobectomy for Low-Risk 1-4 CM Papillary Thyroid Cancer is not Associated with Increased Recurrence Rates in the Dutch Population with a Restricted Diagnostic Work-Up. World J Surg 2023; 47:1211-1218. [PMID: 36303039 PMCID: PMC10070212 DOI: 10.1007/s00268-022-06813-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The 2015 American Thyroid Association guidelines recommend to de-escalate treatment such as Thyroid lobectomy instead of total thyroidectomy for 1-4 cm papillary thyroid cancer (PTC). Dutch guidelines endorse restricted work-up for thyroid incidentalomas recommending only fine needle aspiration in case of a 'palpable thyroid nodule'. This diagnostic work-up algorithm may result in the identification of less indolent PTCs and may lead to a patient population with relatively more aggressive PTCs. This study aims to retrospectively analyze recurrence rates of low-risk 1-4 cm PTC in the Netherlands. METHODS From the national cancer registry, patients with low-risk 1-4 cm PTC between 2005 and 2015 were included for analysis. Disease free survival (DFS) and overall survival were compared between patients who underwent TT ± RAI and TL without RAI. Post-hoc propensity score analysis was performed correcting for age, sex, T-stage, and N-stage. RESULTS In total 901 patients were included, of which 711 (78.9%) were females, with a median follow-up of 7.7 years. TT was performed in 893 (94.8%) patients. Recurrence occurred in 23 (2.6%) patients. Multivariable analysis showed no significant correlation between extent of surgery and DFS (p = 0.978), or overall survival (p = 0.590). After propensity score matching, multivariable analysis showed no significant difference on extent of surgery and recurrence. CONCLUSION Low-risk PTC patients with 1-4 cm tumor who underwent TL showed similar recurrence rates as those who underwent TT ± adjuvant RAI, which suggests that TL can be sufficient in treating low-risk 1-4 cm PTC, possibly reducing morbidity of these patients in the Netherlands.
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Affiliation(s)
- J F Lin
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, P.O. 30.001, 9700, RB, Groningen, The Netherlands
| | - P M Rodriguez Schaap
- Department of Surgery, Location VUmc Cancer Centre Amsterdam, Amsterdam University Medical Centre, Postbus 7057, 1007, MB, Amsterdam, The Netherlands
| | - M J H Metman
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, P.O. 30.001, 9700, RB, Groningen, The Netherlands
| | - E J M Nieveen van Dijkum
- Department of Surgery, Location VUmc Cancer Centre Amsterdam, Amsterdam University Medical Centre, Postbus 7057, 1007, MB, Amsterdam, The Netherlands
| | - C Dickhoff
- Department of Surgery, Location VUmc Cancer Centre Amsterdam, Amsterdam University Medical Centre, Postbus 7057, 1007, MB, Amsterdam, The Netherlands
| | - T P Links
- Division of Endocrinology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - S Kruijff
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, P.O. 30.001, 9700, RB, Groningen, The Netherlands
| | - A F Engelsman
- Department of Surgery, Location VUmc Cancer Centre Amsterdam, Amsterdam University Medical Centre, Postbus 7057, 1007, MB, Amsterdam, The Netherlands.
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4
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Heidsma CM, Engelsman AF, van Dieren S, Stommel MWJ, de Hingh I, Vriens M, Hol L, Festen S, Mekenkamp L, Hoogwater FJH, Daams F, Klümpen HJ, Besselink MG, van Eijck CH, Nieveen van Dijkum EJ. Watchful waiting for small non-functional pancreatic neuroendocrine tumours: nationwide prospective cohort study (PANDORA). Br J Surg 2021; 108:888-891. [PMID: 33783475 PMCID: PMC10364894 DOI: 10.1093/bjs/znab088] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/21/2021] [Accepted: 02/15/2021] [Indexed: 12/12/2022]
Abstract
This prospective nationwide cohort study examined the feasibility of a watchful-waiting protocol for non-functional pancreatic neuroendocrine tumours (NF-pNET) of 2 cm or smaller. In total, 8 of 76 patients (11 per cent) with a NF-pNET no larger than 2 cm showed significant tumour progression (more than 0.5 cm/year) during 17 months of follow-up, of whom two opted for resection. No patient developed metastases. Quality of life was poorer than in the reference population. Watchful waiting seems a safe alternative to upfront surgery in patients with a NF-pNET no larger than 2 cm, although longer follow-up is necessary.
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Affiliation(s)
- C M Heidsma
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - A F Engelsman
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - S van Dieren
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - M W J Stommel
- Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - I de Hingh
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - M Vriens
- Department of Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - L Hol
- Department of Gastroenterology and Metabolism, Maasstad Hospital, Rotterdam, the Netherlands
| | - S Festen
- Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - L Mekenkamp
- Department of Medical Oncology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - F J H Hoogwater
- Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands
| | - F Daams
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - H-J Klümpen
- Department of Medical Oncology, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - M G Besselink
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - C H van Eijck
- Department of Surgery, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - E J Nieveen van Dijkum
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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5
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Kaçmaz E, Slooter MD, Nieveen van Dijkum EJM, Tanis PJ, Engelsman AF. Fluorescence angiography guided resection of small bowel neuroendocrine neoplasms with mesenteric lymph node metastases. Eur J Surg Oncol 2021; 47:1611-1615. [PMID: 33353827 DOI: 10.1016/j.ejso.2020.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/24/2020] [Accepted: 12/13/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Surgery for small bowel neuroendocrine neoplasms (SB-NEN) might result in vascular compromise of the remaining bowel due to resection of lymph node metastases in close proximity to main mesenteric vessels. Fluorescence angiography (FA) has been described as a safe technique to assess perfusion during gastro-intestinal surgery. This study aimed to evaluate the potential value of intraoperative FA during surgery for SB-NEN. METHODS This study included patients undergoing surgery for SB-NEN of any stage. The planned level of transection was marked by the surgeon, after which FA using indocyanine green (ICG) was performed. The primary study outcome was change in management due to FA. RESULTS Ten consecutive patients with SB-NEN were included, all with metastatic lymph nodes close to main mesenteric vessels. FA use led to management changes in eight patients (80%); four patients had less bowel resected with a preserved length of 5-35 cm. The other four patients had more extended bowel resections with an additional length varying from 3 to 25 cm. The median postoperative stay was 4 days (interquartile range 4-6). No anastomotic leakage occurred. CONCLUSION This is the first known series describing preliminary results of FA during SB-NEN surgery. FA led to a management change in 80% of patients with better tailoring the extent of resection of small bowel. Structural implementation of FA to assess small bowel perfusion after dissection for small bowel NET results in change of management, either by preserving small bowel or resecting ill-perfused small bowel.
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Affiliation(s)
- E Kaçmaz
- Department of Surgery, Amsterdam UMC, University of Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - M D Slooter
- Department of Surgery, Amsterdam UMC, University of Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - E J M Nieveen van Dijkum
- Department of Surgery, Amsterdam UMC, University of Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands; ENETS Center of Excellence, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - P J Tanis
- Department of Surgery, Amsterdam UMC, University of Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - A F Engelsman
- Cancer Center Amsterdam, Amsterdam, the Netherlands; ENETS Center of Excellence, Amsterdam UMC, University of Amsterdam, the Netherlands; Department of Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands.
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6
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van der Plas WY, Kruijff S, Engelsman AF. A lack of international consensus on definitions of hyperparathyroidism related to end-stage renal disease leads to heterogeneity in treatment: In response to the letter to the editor by Sharanappa et al. Surgery 2021; 169:1262-1263. [PMID: 33468336 DOI: 10.1016/j.surg.2020.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 11/29/2022]
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7
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Rodriguez Schaap PM, Botti M, Otten RHJ, Dreijerink KMA, Nieveen van Dijkum EJM, Bonjer HJ, Engelsman AF, Dickhoff C. Hemithyroidectomy versus total thyroidectomy for well differentiated T1-2 N0 thyroid cancer: systematic review and meta-analysis. BJS Open 2020; 4:987-994. [PMID: 33022150 PMCID: PMC7709359 DOI: 10.1002/bjs5.50359] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 08/21/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Evidence for limiting the extent of surgery in patients with low-risk thyroid cancer is lacking. METHODS A systematic search was performed according to the PRISMA and MOOSE guidelines to assess the effect of total thyroidectomy (TT) with or without radioactive iodine (RAI) treatment versus hemithyroidectomy (HT) on recurrence and overall mortality in patients with differentiated (papillary or follicular) T1-2 N0 thyroid cancer. PubMed, Embase and Cochrane databases were searched, and two authors independently assessed the articles. RESULTS A total of ten eligible articles were identified. All were observational cohort series, representing a total of 23 134 patients, of which 17 699 were available for meta-analysis. Six studies included patients who had TT followed by RAI treatment. The pooled recurrence rate after TT ± RAI and HT was 2·3 and 2·8 per cent respectively (odds ratio (OR) 1·12, 95 per cent c.i. 0·82 to 1·53; P = 0·48). The pooled 20-year overall survival rate after TT ± RAI was 96·8 per cent, compared with 97·4 per cent for HT (OR 1·30, 0·71 to 2·37; P = 0·40). Overall, higher complication rates were found in the TT ± RAI group. CONCLUSION Recurrence rates after HT for treatment of well differentiated T1-2 N0 thyroid cancer were similar to those after TT ± RAI, with a lower incidence of treatment-related complications.
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Affiliation(s)
| | - M. Botti
- Department of General SurgeryUniversity of Pavia, IRCSS Fondazione Policlinico San MatteoPaviaItaly
| | - R. H. J. Otten
- Medical Library, Amsterdam University Medical Centre, location VUmc, Cancer Centre AmsterdamAmsterdamthe Netherlands
| | | | | | | | | | - C. Dickhoff
- Department of SurgeryAmsterdamthe Netherlands
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8
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Kaçmaz E, Zwart MJW, Engelsman AF, Busch OR, Nieveen van Dijkum EJM, Besselink MG. Robotic Enucleation of an Intra-Pancreatic Insulinoma in the Pancreatic Head. J Vis Exp 2020. [PMID: 31957744 DOI: 10.3791/60290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Pancreatic parenchyma sparing surgery for insulinomas avoids the risk of endocrine and exocrine insufficiency, and potential high-risk anastomoses associated with pancreatic resection. Robotic surgery may be used as an alternative for open pancreatic enucleation without compromising dexterity and 3D-vision. We present the case of a 42-year old woman who presented with sweating, tremor and episodes of hypoglycemia. A fasting test confirmed endogenic insulin overproduction. After inconclusive CT- and MRI imaging, endoscopic ultrasonography showed a hypoechoic lesion, which was fully within the pancreatic head. Although consent was obtained for pancreatoduodenectomy, robotic enucleation seemed feasible. After mobilization, intraoperative ultrasonography was used to identify the lesion and its relation with the pancreatic duct. Dissection was performed using a traction suture, hot shears and bipolar diathermia. A sealant patch was applied for hemostasis and a drain placed. The patient developed a grade B pancreatic fistula for which endoscopic sphincterotomy was performed; the surgical drain could be removed in the outpatient clinic after 20 days. Prospective studies should confirm the short- and long-term benefits of robotic enucleation of insulinomas.
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Affiliation(s)
- E Kaçmaz
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam
| | - M J W Zwart
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam
| | - A F Engelsman
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam; ENETS Center of Excellence, Amsterdam UMC, University of Amsterdam
| | - O R Busch
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam
| | - E J M Nieveen van Dijkum
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam; ENETS Center of Excellence, Amsterdam UMC, University of Amsterdam
| | - M G Besselink
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam;
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9
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Metman MJH, Lončar I, Kruijff S, Engelsman AF, van Ginhoven TM. Is less always more in a national well-differentiated thyroid cancer population? Eur J Surg Oncol 2019; 46:709-711. [PMID: 31607415 DOI: 10.1016/j.ejso.2019.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 09/27/2019] [Accepted: 10/05/2019] [Indexed: 10/25/2022] Open
Affiliation(s)
- M J H Metman
- Department of Surgical Oncology, University Medical Center Groningen, P.O. 30.001, 9700, RB, Groningen, the Netherlands.
| | - I Lončar
- Department of Surgery, Erasmus Medical Center Rotterdam, P.O. 2040, 3000, CA, Rotterdam, the Netherlands.
| | - S Kruijff
- Department of Surgical Oncology, University Medical Center Groningen, P.O. 30.001, 9700, RB, Groningen, the Netherlands.
| | - A F Engelsman
- Department of Surgery, Amsterdam UMC, location VUmc, Postbus 7057, 1007, MB, Amsterdam, the Netherlands.
| | - T M van Ginhoven
- Department of Surgery, Erasmus Medical Center Rotterdam, P.O. 2040, 3000, CA, Rotterdam, the Netherlands.
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10
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Kaçmaz E, Slooter MD, Nieveen van Dijkum EJM, Tanis PJ, Engelsman AF. Laparoscopic assisted central mesenteric lymph node dissection with bowel sparing resection of small bowel neuroendocrine tumours using fluorescence angiography - a video vignette. Colorectal Dis 2019; 21:724-725. [PMID: 30895686 DOI: 10.1111/codi.14616] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 03/05/2019] [Indexed: 02/08/2023]
Affiliation(s)
- E Kaçmaz
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - M D Slooter
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - E J M Nieveen van Dijkum
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,ENETS Center of Excellence, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - P J Tanis
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - A F Engelsman
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,ENETS Center of Excellence, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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11
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Engelsman AF, Warhurst S, Fraser S, Novakovic D, Sidhu SB. Influence of neural monitoring during thyroid surgery on nerve integrity and postoperative vocal function. BJS Open 2018; 2:135-141. [PMID: 29951637 PMCID: PMC5989980 DOI: 10.1002/bjs5.50] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 01/04/2018] [Indexed: 11/06/2022] Open
Abstract
Background Integrity of the recurrent laryngeal nerve (RLN) and the external branch of the superior laryngeal nerve (EBSLN) can be checked by intraoperative nerve monitoring (IONM) after visualization. The aim of this study was to determine the prevalence and nature of voice dysfunction following thyroid surgery with routine IONM. Methods Thyroidectomies were performed with routine division of strap muscles and nerve monitoring to confirm integrity of the RLN and EBSLN following dissection. Patients were assessed for vocal function before surgery and at 1 and 3 months after operation. Assessment included use of the Voice Handicap Index (VHI) 10, maximum phonation time, fundamental frequency, pitch range, harmonic to noise ratio, cepstral peak prominence and smoothed cepstral peak prominence. Results A total of 172 nerves at risk were analysed in 102 consecutive patients undergoing elective thyroid surgery. In 23·3 per cent of EBSLNs and 0·6 per cent of RLNs nerve identification required the assistance of IONM in addition to visualization. Nerve integrity was confirmed during surgery for 98·8 per cent of EBSLNs and 98·3 per cent of RLNs. There were no differences between preoperative and postoperative VHI-10 scores. Acoustic voice assessment showed small changes in maximum phonation time at 1 and 3 months after surgery. Conclusion Where there is routine division of strap muscles, thyroidectomy using nerve monitoring confirmation of RLN and EBSLN function following dissection results in no clinically significant voice change.
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Affiliation(s)
- A F Engelsman
- Endocrine Surgery Unit University of Sydney Sydney New South Wales Australia
| | - S Warhurst
- Voice Research Laboratory, Faculty of Health Sciences University of Sydney Sydney New South Wales Australia
| | - S Fraser
- Endocrine Surgery Unit University of Sydney Sydney New South Wales Australia
| | - D Novakovic
- Voice Research Laboratory, Faculty of Health Sciences University of Sydney Sydney New South Wales Australia
| | - S B Sidhu
- Endocrine Surgery Unit University of Sydney Sydney New South Wales Australia
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12
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Vrielink OM, Engelsman AF, Hemmer PHJ, de Vries J, Vorselaars WMCM, Vriens MR, Karakatsanis A, Hellman P, Sywak MS, van Leeuwen BL, El Moumni M, Kruijff S. Multicentre study evaluating the surgical learning curve for posterior retroperitoneoscopic adrenalectomy. Br J Surg 2018; 105:544-551. [PMID: 29493779 DOI: 10.1002/bjs.10740] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 06/20/2017] [Accepted: 09/30/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Posterior retroperitoneoscopic adrenalectomy has gained international popularity in the past decade. Despite major advantages, including shorter duration of operation, minimal blood loss and decreased postoperative pain, many surgeons still prefer laparoscopic transperitoneal adrenalectomy. It is likely that the unfamiliar anatomical environment, smaller working space and long learning curve impede implementation. The present study assessed the number of procedures required to fulfil the surgical learning curve for posterior retroperitoneoscopic adrenalectomy. METHODS The first consecutive posterior retroperitoneoscopic adrenalectomies performed by four surgical teams from university centres in three different countries were analysed. The primary outcome measure was duration of operation. Secondary outcomes were conversion to an open or laparoscopic transperitoneal approach, complications and recovery time. The learning curve cumulative sum (LC-CUSUM) was used to assess the learning curves for each surgical team. RESULTS A total of 181 surgical procedures performed by four surgical teams were analysed. The median age of the patients was 57 (range 15-84) years and 61·3 per cent were female. Median tumour size was 25 (range 4-85) mm. There were no significant differences in patient characteristics and tumour size between the teams. The median duration of operation was 89 (range 29-265) min. There were 35 perioperative and postoperative complications among the 181 patients (18·8 per cent); 17 of 27 postoperative complications were grade 1. A total of nine conversions to open procedures (5·0 per cent) were observed. The LC-CUSUM analysis showed that competency was achieved after a range of 24-42 procedures. CONCLUSION In specialized endocrine surgical centres between 24 and 42 procedures are required to fulfil the entire surgical learning curve for the posterior retroperitoneoscopic adrenalectomy.
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Affiliation(s)
- O M Vrielink
- Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - A F Engelsman
- Department of Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - P H J Hemmer
- Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - J de Vries
- Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - W M C M Vorselaars
- Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - M R Vriens
- Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - A Karakatsanis
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - P Hellman
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - M S Sywak
- Department of Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - B L van Leeuwen
- Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - M El Moumni
- Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - S Kruijff
- Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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13
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Engelsman AF, Nieveen van Dijkum EJM. [Intraoperative neuromonitoring in endocrine surgery: when is it appropriate?]. Ned Tijdschr Geneeskd 2018; 162:D2320. [PMID: 29676711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The use of intraoperative neuromonitoring (IONM) in thyroid surgery has steadily increased in recent years. This technique helps to identify different nerves in and around the operation site, such as the recurrent laryngeal nerve (RLN) and the external branch of the superior laryngeal nerve. Particularly in patients who undergo a second operation or a complex procedure for malignancy, the technique's value has been demonstrated. However, in non-complex thyroid operations the risk of vocal cord paresis due to iatrogenic injury of the RLN is 0.1%. Therefore, high quality research with sufficient power to assess the effect of IONM on prevention of vocal cord paresis is scarce, and the routine use of IONM in thyroid surgery is currently not indicated.
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Affiliation(s)
- A F Engelsman
- Academisch Medisch Centrum, afd. Chirurgie, Amsterdam
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Chin KWTK, Engelsman AF, Chin PTK, Meijer SL, Strackee SD, Oostra RJ, van Gulik TM. Evaluation of collimated polarized light imaging for real-time intraoperative selective nerve identification in the human hand. Biomed Opt Express 2017; 8:4122-4134. [PMID: 28966851 PMCID: PMC5611927 DOI: 10.1364/boe.8.004122] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 07/18/2017] [Accepted: 07/18/2017] [Indexed: 05/22/2023]
Abstract
Intraoperative peripheral nerve lesions are common complications due to misidentification and limitations of surgical nerve identification. This study validates a real-time non-invasive intraoperative method of nerve identification. Long working distance collimated polarized light imaging (CPLi) was used to identify peripheral radial nerve branches in a human cadaver hand by their nerve specific anisotropic optical reflection. Seven ex situ and six in situ samples were examined for nerves, resulting after histological validation, in a 100% positive correct score (CPLi) versus 77% (surgeon). Nerves were visible during a clinical in vivo observation using CPLi. Therefore CPLi is a promising technique for intraoperative nerve identification.
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Affiliation(s)
- K. W. T. K Chin
- Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - A. F. Engelsman
- Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - P. T. K. Chin
- Condensed Matter and Interfaces, Debye Institute for Nanomaterials Science, Utrecht University, Princetonplein 5, 3584 CC Utrecht, the Netherlands
| | - S. L. Meijer
- Department of Pathology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - S. D. Strackee
- Department of Plastic and Reconstructive Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - R. J. Oostra
- Department of Anatomy, Embryology and Physiology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - T. M. van Gulik
- Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
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Nejadnik MR, Engelsman AF, Saldarriaga Fernandez IC, Busscher HJ, Norde W, van der Mei HC. Bacterial colonization of polymer brush-coated and pristine silicone rubber implanted in infected pockets in mice. J Antimicrob Chemother 2008; 62:1323-5. [DOI: 10.1093/jac/dkn395] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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Engelsman AF, van der Mei HC, Busscher HJ, Ploeg RJ. Morphological aspects of surgical meshes as a risk factor for bacterial colonization. Br J Surg 2008; 95:1051-9. [PMID: 18618841 DOI: 10.1002/bjs.6154] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
Background
Prosthetic meshes are increasingly popular in abdominal wall reconstructive surgery owing to a reduction in hernia recurrence rate. Individual meshes have been evaluated with respect to the formation of infectious biofilms, but no comprehensive comparison yet exists. The aim of this study was to evaluate the effect of the material and morphology of surgical meshes on biofilm growth.
Methods
Biofilms of a coagulase-negative staphylococcus, Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa were grown in vitro on different meshes. Intact biofilms were stained fluorescently and evaluated with confocal laser scanning microscopy to distinguish dead from live bacteria and slime.
Results
Numbers of adhering bacteria and the amount of slime in the biofilm were dependent on the morphology of the mesh. Hydrophobicity and the presence of niches in multifilament meshes contributed most to increased biofilm growth.
Conclusion
The morphological properties of surgical meshes as well as their hydrophobicity influence bacterial growth and slime production. Differences in slime production may explain why the effectiveness of antibiotic treatment varies for different types of mesh.
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Affiliation(s)
- A F Engelsman
- Department of Biomedical Engineering, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
- Department of Surgery, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
| | - H C van der Mei
- Department of Biomedical Engineering, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
| | - H J Busscher
- Department of Biomedical Engineering, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
| | - R J Ploeg
- Department of Surgery, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
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