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Akhtar W, Baston VR, Berman M, Bhagra S, Chue C, Deakin CD, Dalzell JR, Dunning J, Dunning J, Gardner RS, Kiff K, Kore S, Lim S, MacGowan G, Naldrett I, Ostermann M, Pinto S, Pettit S, Gil FR, Rosenberg A, Rubino A, Sayeed R, Sequeira J, Swanson N, Tsui S, Walker C, Webb S, Woods A, Ventkateswaran R, Bowles CT. British societies guideline on the management of emergencies in implantable left ventricular assist device recipients in transplant centres. Intensive Care Med 2024; 50:493-501. [PMID: 38526578 PMCID: PMC11018667 DOI: 10.1007/s00134-024-07382-y] [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] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 02/29/2024] [Indexed: 03/26/2024]
Abstract
An implantable left ventricular assist device (LVAD) is indicated as a bridge to transplantation or recovery in the United Kingdom (UK). The mechanism of action of the LVAD results in a unique state of haemodynamic stability with diminished arterial pulsatility. The clinical assessment of an LVAD recipient can be challenging because non-invasive blood pressure, pulse and oxygen saturation measurements may be hard to obtain. As a result of this unusual situation and complex interplay between the device and the native circulation, resuscitation of LVAD recipients requires bespoke guidelines. Through collaboration with key UK stakeholders, we assessed the current evidence base and developed guidelines for the recognition of clinical deterioration, inadequate circulation and time-critical interventions. Such guidelines, intended for use in transplant centres, are designed to be deployed by those providing immediate care of LVAD patients under conditions of precipitous clinical deterioration. In summary, the Joint British Societies and Transplant Centres LVAD Working Group present the UK guideline on management of emergencies in implantable LVAD recipients for use in advanced heart failure centres. These recommendations have been made with a UK resuscitation focus but are widely applicable to professionals regularly managing patients with implantable LVADs.
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Affiliation(s)
- Waqas Akhtar
- Harefield Hospital, London, UK.
- Faculty of Intensive Care Medicine, London, UK.
| | | | | | | | - Colin Chue
- University Hospitals Birmingham, Birmingham, UK
| | | | | | - Joel Dunning
- Cardiac Advanced Resuscitation Education, Festus, MO, USA
| | | | - Roy S Gardner
- Golden Jubilee National Hospital, Glasgow, UK
- British Society of Heart Failure, London, UK
| | | | | | - Sern Lim
- University Hospitals Birmingham, Birmingham, UK
| | | | - Ian Naldrett
- British Association of Critical Care Nurses, Newcastle, UK
| | | | | | | | | | | | | | - Rana Sayeed
- Society for Cardiothoracic Surgery in Great Britain & Ireland, London, UK
| | | | | | - Steven Tsui
- Society for Cardiothoracic Surgery in Great Britain & Ireland, London, UK
| | | | | | | | - Rajamiyer Ventkateswaran
- Wythenshawe Hospital, Manchester, UK
- Society for Cardiothoracic Surgery in Great Britain & Ireland, London, UK
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Gandhi S, Novoa Valentin NM, Brunelli A, Schmitt-Opitz I, Lugaresi M, Daddi N, Decaluwe H, Batirel H, Veronesi G, Baste JM, Lyberis P, Dunning J. Results of an exploratory survey within ESTS membership in 2022 on current trend of robotic-assisted thoracic surgery and its training perspectives. Interdiscip Cardiovasc Thorac Surg 2024; 38:ivae031. [PMID: 38441251 PMCID: PMC11014782 DOI: 10.1093/icvts/ivae031] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 02/05/2024] [Accepted: 03/02/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVES Robotic-assisted thoracic surgery (RATS) is increasingly used in our specialty. We surveyed European Society of Thoracic Surgeons membership with the objective to determine current status of robotic thoracic surgery practice including training perspectives. METHODS A survey of 17 questions was rolled out with 1 surgeon per unit responses considered as acceptable. RESULTS A total of 174 responses were obtained; 56% (97) were board-certified thoracic surgeons; 28% (49) were unit heads. Most responses came from Italy (20); 22% (38) had no robot in their institutions, 31% (54) had limited access and only 17% (30) had full access including proctoring. Da Vinci Xi was the commonest system in 56% (96) centres, 25% (41) of them had dual console in all systems, whereas RATS simulator was available only in half (51.18% or 87). Video-assisted thoracic surgery (VATS) was the most commonly adopted surgical approach in 81% of centres (139), followed by thoracotomy in 67% (115) and RATS in 36% (62); 39% spent their training time on robotic simulator for training, 51% on robotic wet/dry lab, which being no significantly different to 46-59% who had training on VATS platform. There was indeed huge overlap between simulator models or varieties usage; 52% (90) reported of robotic surgery not a part of training curriculum with no plans to introduce it in future. Overall, 51.5% (89) responded of VATS experience being helpful in robotic training in view of familiarity with minimally invasive surgery anatomical views and dissection; 71% (124) reported that future thoracic surgeons should be proficient in both VATS and RATS. Half of the respondents found no difference in earlier chest drain removal with either approach (90), 35% (60) reported no difference in postoperative pain and 49% (84) found no difference in hospital stay; 52% (90) observed better lymph node harvest by RATS. CONCLUSIONS Survey concluded on a positive response with at least 71% (123) surgeons recommending to adopt robotics in future.
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Affiliation(s)
- Shilpa Gandhi
- Cardiac surgery unit, Department of Cardiothoracic Surgery, St Georges’ University Hospital NHS Foundation Trust, London, UK
| | | | | | | | - Marialuisa Lugaresi
- Department of Medical and Surgical Sciences, University of Bologna Medical School, Bologna, Italy
| | - Niccolò Daddi
- Division of Thoracic Surgery unit, IRCCS Azienda Ospedaliero-Universitaria, University of Bologna Medical School, Bologna, Italy
| | - Herbert Decaluwe
- Division of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium
| | - Hasan Batirel
- Division of Thoracic Surgery, Biruni University School of Medicine, Istanbul, Turkey
| | - Giulia Veronesi
- Division of Thoracic Surgery, Universita Vita e Salute San Raffaele, Milan, Italy
| | - Jean-Marc Baste
- Cardiothoracic Department, Rouen University Hospital, Inserm U1096, UNIVRouen, Normandy, France
| | | | - Joel Dunning
- Division of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK
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Cardillo G, Petersen RH, Ricciardi S, Patel A, Lodhia JV, Gooseman MR, Brunelli A, Dunning J, Fang W, Gossot D, Licht PB, Lim E, Roessner ED, Scarci M, Milojevic M. European guidelines for the surgical management of pure ground-glass opacities and part-solid nodules: Task Force of the European Association of Cardio-Thoracic Surgery and the European Society of Thoracic Surgeons. Eur J Cardiothorac Surg 2023; 64:ezad222. [PMID: 37243746 DOI: 10.1093/ejcts/ezad222] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/10/2023] [Accepted: 05/26/2023] [Indexed: 05/29/2023] Open
Affiliation(s)
- Giuseppe Cardillo
- Unit of Thoracic Surgery, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
- Unicamillus-Saint Camillus University of Health Sciences, Rome, Italy
| | - René Horsleben Petersen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Sara Ricciardi
- Unit of Thoracic Surgery, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
- Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Akshay Patel
- Department of Thoracic Surgery, University Hospitals Birmingham, England, United Kingdom
- Institute of Immunology and Immunotherapy, University of Birmingham, United Kingdom
| | - Joshil V Lodhia
- Department of Thoracic Surgery, St James University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Michael R Gooseman
- Department of Thoracic Surgery, Hull University Teaching Hospitals NHS Trust, and Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Alessandro Brunelli
- Department of Thoracic Surgery, St James University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Joel Dunning
- James Cook University Hospital Middlesbrough, United Kingdom
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Jiaotong University Medical School, Shangai, China
| | - Dominique Gossot
- Department of Thoracic Surgery, Curie-Montsouris Thoracic Institute, Paris, France
| | - Peter B Licht
- Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark
| | - Eric Lim
- Academic Division of Thoracic Surgery, The Royal Brompton Hospital and Imperial College London, United Kingdom
| | - Eric Dominic Roessner
- Department of Thoracic Surgery, Center for Thoracic Diseases, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Marco Scarci
- Division of Thoracic Surgery, Imperial College NHS Healthcare Trust and National Heart and Lung Institute, Hammersmith Hospital, London, United Kingdom
| | - Milan Milojevic
- Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
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Soumpasis I, Nashef S, Dunning J, Moran P, Slack M. Safe Implementation of a Next-Generation Surgical Robot: First Analysis of 2,083 Cases in the Versius Surgical Registry. Ann Surg 2023; 278:e903-e910. [PMID: 37036097 PMCID: PMC10481922 DOI: 10.1097/sla.0000000000005871] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
OBJECTIVE To present the first report of data from the Versius Surgical Registry, a prospective, multicenter data registry with ongoing collection across numerous surgical indications, developed to accompany the Versius Robotic Surgical System into clinical practice. BACKGROUND A data registry can be utilized to minimize risk to patients by establishing the safety and effectiveness of innovative medical devices and generating a thorough evidence base of real-world data. METHODS Surgical outcome data were collected and inputted through a secure online platform. Preoperative data included patient age, sex, body mass index, surgical history, and planned procedures. Intraoperative data included operative time, complications during surgery, conversion from robot-assisted surgery to an alternative surgical technique, and blood loss. Postoperative outcome data included length of hospital stay, complications following surgery, serious adverse events, return to the operating room, readmission to the hospital, and mortality within 90 days of surgery. RESULTS This registry analysis included 2083 cases spanning general, colorectal, hernia, gynecologic, urological, and thoracic indications. A considerable number of cases were recorded for cholecystectomy (n=539), anterior resection (n=162), and total laparoscopic hysterocolpectomy (n=324) procedures. The rates of conversion to an alternative technique, serious adverse events, and 90-day mortality were low for all procedures across all surgical indications. CONCLUSIONS We report the large-scale analysis of the first 2083 cases recorded in this surgical registry, with substantial data collected for cholecystectomies, anterior resections, and total laparoscopic hysterectomies. The extensive surgical outcome data reported here provide real-world evidence for the safe implementation of the surgical robot into clinical practice.
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Affiliation(s)
| | - Samer Nashef
- Royal Papworth Hospital, Cardiac Surgery Department, Cambridge Biomedical Campus, Cambridge, UK
| | - Joel Dunning
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK
| | - Paul Moran
- Department of Obstetrics and Gynaecology, Worcestershire Royal Hospital, Worcestershire Acute Hospitals NHS Trust, Worcester, UK
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Spencer A, Nicholls I, Onianwa O, Furneaux J, Grieves J, Pottage T, Gould S, Fletcher T, Dunning J, Bennett AM, Atkinson B. Mpox virus DNA contamination can still be detected by qPCR analysis after autoclaving. J Hosp Infect 2023; 139:217-219. [PMID: 37459916 DOI: 10.1016/j.jhin.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 07/13/2023] [Indexed: 08/13/2023]
Affiliation(s)
- A Spencer
- Diagnostics and Pathogen Characterisation, UK Health Security Agency, Porton Down, Salisbury, UK.
| | - I Nicholls
- Diagnostics and Pathogen Characterisation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - O Onianwa
- Diagnostics and Pathogen Characterisation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - J Furneaux
- Rare and Imported Pathogens Laboratory, UK Health Security Agency, Porton Down, Salisbury, UK
| | - J Grieves
- Diagnostics and Pathogen Characterisation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - T Pottage
- Diagnostics and Pathogen Characterisation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - S Gould
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - T Fletcher
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - J Dunning
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - A M Bennett
- Diagnostics and Pathogen Characterisation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - B Atkinson
- Diagnostics and Pathogen Characterisation, UK Health Security Agency, Porton Down, Salisbury, UK
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6
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Abbas AAM, McPherson I, Dunning J. Is vacuum-assisted closure therapy the main culprit in right ventricular rupture after deep sternal wound infection? J Wound Care 2023; 32:520-526. [PMID: 37572337 DOI: 10.12968/jowc.2023.32.8.520] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/14/2023]
Abstract
Right ventricular rupture after deep sternal wound infection (DSWI) is a rare but fatal complication, and can occur with or without vacuum assisted closure (VAC) therapy. There is currently no strong evidence to suggest whether or not VAC therapy is a contributing factor to this complication. In total, 30 articles were retrieved and assessed through a systematic review strategy from 1953 to 2022. The keywords: 'vacuum assisted closure'; 'VAC'; 'negative pressure wound therapy'; 'deep sternal wound infection'; 'DSWI'; 'right ventricular rupture'; and 'cardiac rupture' were used in the search. Overall, 15 of the included articles satisfied the predefined eligibility criteria. Fatal right ventricular ruptures were reported in 18 (36%) out of 50 cases. In this article, the risk factors, mechanisms and management of right ventricular rupture are discussed. A novel view of the mechanism of VAC-associated right ventricular rupture is highlighted, with a focus on both pre- and intraoperative management.
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Affiliation(s)
| | | | - Joel Dunning
- James Cook University Hospital, Middlesbrough, UK
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7
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Riesgo Gil F, Gallone G, Morley-Smith A, Dar O, Ibero Valencia J, Monteagudo Vela M, Fiorelli F, Konicoff M, Edwards G, Raj B, Shanmuganathan M, Frea S, De Ferrari G, Panoulas V, Stock U, Bowles C, Dunning J. Assessment of the Optimal Echocardiographic Profile on Left Ventricular Assist Device Support: Consider the Right Parameters. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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8
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Gallone G, Valencia JI, Morley-Smith A, Dar O, Vela MM, Fiorelli F, Konicoff M, Edwards G, Raj B, Shanmuganathan M, Frea S, De Ferrari G, Panoulas V, Stock U, Bowles C, Dunning J, Gil FR. Association of Neurohormonal Blockade with Clinical Outcomes Among Patients with Advanced Heart Failure on Left Ventricular Assist Device Support. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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9
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Peterzan M, Lyster H, Grover A, Imam F, Kwinta J, Hall A, Murthy S, Dar O, Rial Baston V, Morley-Smith A, Dunning J, Riesgo Gil F. Cumulative Incidence and Risk Factors for Early Post-Transplant Lymphoproliferative Disorder in Adult Heart Transplant Recipients: Single-Centre Experience. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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10
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Peterzan M, Price S, Trimlett R, Lees N, Khoshbin E, Hill J, Heng E, Smith R, Barron A, Dar O, Riesgo Gil F, Morley-Smith A, Dunning J. Rescue of Cardiogenic Shock with Multiple Staged Interventions Each Bridging to the Next. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Ahmed H, Saez DG, Zych B, Dunning J, Khoshbin E. Moderately Prolonged Cold Ischemic Time. Does It Impact Outcome of Lung Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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12
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Peterzan M, Danskine A, Brookes P, Olwell B, Khoshbin E, Dunning J, Riesgo Gil F, Dar O, Morley-Smith A. Successful Heart Transplantation in Severe Pulmonary Hypertension with Reversibility. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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13
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Konicoff M, Dunning J, Riesgo Gil F, Dar O, Morley-Smith A. Paraganglioma as a Cause of Acute Heart Failure Causing Cardiogenic Shock. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Ismail M, Waterhouse BR, Colman A, Gonzalez-Rivas D, Bosinceanu M, Dunning J. The transition to uniportal robotic surgery in the second decade of uniportal surgery. Ann Cardiothorac Surg 2023; 12:96-101. [PMID: 37035643 PMCID: PMC10080332 DOI: 10.21037/acs-2022-urats-34] [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] [Received: 12/27/2022] [Accepted: 03/08/2023] [Indexed: 03/30/2023]
Abstract
Uniportal robotic surgery was created by Dr. Diego Gonzalez-Rivas as a fusion of his decade of experience with uniportal video-assisted thoracoscopic surgery (VATS) and his recent experience with the Intuitive Robotic System. It represents, in his view, the natural evolution of the uniportal technique in the era of robotic surgery. In this article, we discuss some of the novel issues that this raises, including capacitive coupling, and we describe the technique in detail to help surgeons who may be interested in starting uniportal robotic surgery. We go through case selection, which should start with wedge resections and lymphadenectomy. We look at port placement, which is more posterior and lower than the usual uniportal VATS approach, and we discuss the optimal instruments and ports for the technique. We discuss the role of the assistant in uniportal robotic surgery, which is a key part of the operation as we regard this as a two-surgeon technique. We then discuss the future and other possible robotic platforms that might be suitable for uniportal robotic surgery. It is an exciting new development for robotic surgery, and we recommend that this technique is suitable for advanced surgeons who are experienced in uniportal VATS lobectomy and in multiportal robotic surgery.
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Affiliation(s)
| | | | - Alyx Colman
- Department of Thoracic Surgery, James Cook University Hospital, Middlesbrough, UK
| | - Diego Gonzalez-Rivas
- Department of Thoracic Surgery and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña University Hospital, A Coruña, Spain
| | - Mugurel Bosinceanu
- Department of Thoracic Surgery, Monza Oncological Hospital, Bucharest, Bulgaria
| | - Joel Dunning
- Department of Thoracic Surgery, James Cook University Hospital, Middlesbrough, UK
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Manolache V, Motas N, Bosinceanu ML, de la Torre M, Gallego-Poveda J, Dunning J, Ismail M, Turna A, Paradela M, Decker G, Ramos R, Bodner J, Espinosa Jimenez D, Zardo P, Garcia-Perez A, Ureña Lluveras A, Pantile D, Gonzalez-Rivas D. Comparison of uniportal robotic-assisted thoracic surgery pulmonary anatomic resections with multiport robotic-assisted thoracic surgery: a multicenter study of the European experience. Ann Cardiothorac Surg 2023; 12:102-109. [PMID: 37035654 PMCID: PMC10080339 DOI: 10.21037/acs-2022-urats-27] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/17/2023] [Indexed: 03/12/2023]
Abstract
Background Robotic-assisted thoracic surgery (RATS) has seen increasing interest in the last few years, with most procedures primarily being performed in the conventional multiport manner. Our team has developed a new approach that has the potential to convert surgeons from uniportal video-assisted thoracic surgery (VATS) or open surgery to robotic-assisted surgery, uniportal-RATS (U-RATS). We aimed to evaluate the outcomes of one single incision, uniportal robotic-assisted thoracic surgery (U-RATS) against standard multiport RATS (M-RATS) with regards to safety, feasibility, surgical technique, immediate oncological result, postoperative recovery, and 30-day follow-up morbidity and mortality. Methods We performed a large retrospective multi-institutional review of our prospectively curated database, including 101 consecutive U-RATS procedures performed from September 2021 to October 2022, in the European centers that our main surgeon operates in. We compared these cases to 101 consecutive M-RATS cases done by our colleagues in Barcelona between 2019 to 2022. Results Both patient groups were similar with respect to demographics, smoking status and tumor size, but were significantly younger in the U-RATS group [M-RATS =69 (range, 39-81) years; U-RATS =63 years (range, 19-82) years; P<0.0001]. Most patients in both operative groups underwent resection of a primary non-small cell lung cancer (NSCLC) [M-RATS 96/101 (95%); U-RATS =60/101 (59%); P<0.0001]. The main type of anatomic resection was lobectomy for the multiport group, and segmentectomy for the U-RATS group. In the M-RATS group, only one anatomical segmentectomy was performed, while the U-RATS group had twenty-four (24%) segmentectomies (P=0.0006). All M-RATS and U-RATS surgical specimens had negative resection margins (R0) and contained an equivalent median number of lymph nodes available for pathologic analysis [M-RATS =11 (range, 5-54); U-RATS =15 (range, 0-41); P=0.87]. Conversion rate to thoracotomy was zero in the U-RATS group and low in M-RATS [M-RATS =2/101 (2%); U-RATS =0/101; P=0.19]. Median operative time was also statistically different [M-RATS =150 (range, 60-300) minutes; U-RATS =136 (range, 30-308) minutes; P=0.0001]. Median length of stay was significantly lower in U-RATS group at four days [M-RATS =5 (range, 2-31) days; U-RATS =4 (range, 1-18) days; P<0.0001]. Rate of complications and 30-day mortality was low in both groups. Conclusions U-RATS is feasible and safe for anatomic lung resections and comparable to the multiport conventional approach regarding surgical outcomes. Given the similarity of the technique to uniportal VATS, it presents the potential to convert minimally invasive thoracic surgeons to a robotic-assisted approach.
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Affiliation(s)
- Veronica Manolache
- Department of Thoracic Surgery, Memorial Oncology Hospital, Bucharest, Romania
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Natalia Motas
- Department of Thoracic Surgery, Memorial Oncology Hospital, Bucharest, Romania
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
- Department of Thoracic Surgery, Institute of Oncology “Prof. Dr. Al. Trestioreanu”, Bucharest, Romania
| | | | | | | | - Joel Dunning
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK
| | - Mahmoud Ismail
- Department of Thoracic Surgery, Klinikum Ernst von Bergmann Potsdam, Academic Hospital of the Charité-Universitätsmedizin Humboldt University Berlin, Potsdam, Germany
| | - Akif Turna
- Department of Thoracic Surgery, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, İstanbul, Turkey
| | - Marina Paradela
- Department of Thoracic Surgery, Coruña University Hospital, A Coruña, Spain
| | - Georges Decker
- Department of Thoracic Surgery, Hôpitaux Robert Schuman-ZithaKlinik, Luxembourg, Luxembourg
| | - Ricard Ramos
- Thoracic Surgery Service, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Johanes Bodner
- Department of Thoracic Surgery, Klinikum Bogenhausen, Englschalkinger Strasse 77, Munchen, Germany
| | | | - Patrick Zardo
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | | | - Anna Ureña Lluveras
- Thoracic Surgery Service, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Daniel Pantile
- Department of Thoracic Surgery, Central Military Emergency University Hospital Bucharest, Bucharest, Romania
| | - Diego Gonzalez-Rivas
- Department of Thoracic Surgery, Memorial Oncology Hospital, Bucharest, Romania
- Department of Thoracic Surgery, Coruña University Hospital, A Coruña, Spain
- Department of Cardio-Thoracic Surgery, Lusiadas Hospital, Lisbon, Portugal
- Department of Thoracic Surgery, Klinikum Ernst von Bergmann Potsdam, Academic Hospital of the Charité-Universitätsmedizin Humboldt University Berlin, Potsdam, Germany
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16
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Ismail M, Waterhouse BR, Colman A, Gonzalez-Rivas D, Dunning J. Video atlas of each uniportal robotic-assisted thoracic surgery lobectomy and lymphadenectomy. Ann Cardiothorac Surg 2023; 12:91-95. [PMID: 37035651 PMCID: PMC10080340 DOI: 10.21037/acs-2022-urats-33] [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] [Received: 02/20/2023] [Accepted: 03/10/2023] [Indexed: 03/31/2023]
Abstract
It is important when evaluating new techniques that a surgeon can see and assess all the differences and similarities between their usual technique and the novel technique. Thus, we have collated a comprehensive atlas of videos of uniportal robotic lobectomies for every lobe. Surgeons who are considering embarking on a program of uniportal robotic lobectomies can accordingly see the different views and techniques that will be required for when they perform their first procedure. We have fully narrated the videos, so that you will be taken through each procedure. Whilst these five videos are fifty-five minutes in total, our intention is not necessarily for you to watch them all from start to finish, but rather, come to this video, select the lobe that you will shortly embark on, and watch it prior to your case so that you can visualise, as closely as possible, the procedure that you will be performing. We recommend that you watch the videos with your bedside assistant as the uniportal robotic lobectomy is a joint procedure between two surgeons, rather than a single surgeon's operation with an assistant. Though we have not provided videos on segmentectomies, the uniportal robotic lobectomy is an advanced technique and we are confident that advanced surgeons will be able to gain key insights with what has been included, even if they are proceeding to a segmentectomy for their first cases. We feel for an advanced surgeon, a segmentectomy will be just as suitable an operation as a lobectomy in the initial learning phase.
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Affiliation(s)
| | | | - Alyx Colman
- Department of Thoracic Surgery, James Cook University Hospital, Middlesbrough, UK
| | - Diego Gonzalez-Rivas
- Department of Thoracic Surgery and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña University Hospital, A Coruña, Spain
| | - Joel Dunning
- Department of Thoracic Surgery, James Cook University Hospital, Middlesbrough, UK
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Soumpasis I, Nashef S, Dunning J, Moran P, Slack M. Safe implementation of surgical innovation: a prospective registry of the Versius Robotic Surgical System. BMJ Surg Interv Health Technol 2023; 5:e000144. [PMID: 36865989 PMCID: PMC9972451 DOI: 10.1136/bmjsit-2022-000144] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 02/05/2023] [Indexed: 03/03/2023] Open
Abstract
Objectives To describe a new, international, prospective surgical registry developed to accompany the clinical implementation of the Versius Robotic Surgical System by accumulating real-world evidence of its safety and effectiveness. Interventions This robotic surgical system was introduced in 2019 for its first live-human case. With its introduction, cumulative database enrollment was initiated across several surgical specialties, with systematic data collection via a secure online platform. Main outcome measures Pre-operative data include diagnosis, planned procedure(s), characteristics (age, sex, body mass index and disease status) and surgical history. Peri-operative data include operative time, intra-operative blood loss and use of blood transfusion products, intra-operative complications, conversion to an alternative technique, return to the operating room prior to discharge and length of hospital stay. Complications and mortality within 90 days of surgery are also recorded. Results The data collected in the registry are analyzed as comparative performance metrics, by meta-analyses or by individual surgeon performance using control method analysis. Continual monitoring of key performance indicators, using various types of analyses and outputs within the registry, have provided meaningful insights that help institutions, teams and individual surgeons to perform most effectively and ensure optimal patient safety. Conclusions Harnessing the power of large-scale, real-world registry data for routine surveillance of device performance in live-human surgery from first use will enhance the safety and efficacy outcomes of innovative surgical techniques. Data are crucial to driving the evolution of robot-assisted minimal access surgery while minimizing risk to patients. Trial registration number CTRI/2019/02/017872.
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Affiliation(s)
| | | | - Joel Dunning
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK
| | - Paul Moran
- Department of Obstetrics and Gynaecology, Worcestershire Royal Hospital, Worcester, UK
| | - Mark Slack
- Cambridge Medical Robotics Surgical Ltd, Cambridge, UK
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18
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Atkinson B, Spencer A, Onianwa O, Furneaux J, Grieves J, Nicholls I, Gould S, Fletcher T, Dunning J, Bennett AM, Patel S, Asboe D, Whitlock G. Longitudinal mpox virus surface sampling in an outpatient setting. J Hosp Infect 2023; 135:196-198. [PMID: 36842538 DOI: 10.1016/j.jhin.2023.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 02/19/2023] [Indexed: 02/26/2023]
Affiliation(s)
- B Atkinson
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury, UK.
| | - A Spencer
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - O Onianwa
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - J Furneaux
- Rare and Imported Pathogens Laboratory, UK Health Security Agency, Porton Down, Salisbury, UK
| | - J Grieves
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - I Nicholls
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - S Gould
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - T Fletcher
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - J Dunning
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - A M Bennett
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - S Patel
- Chelsea & Westminster Hospital NHS Trust, London, UK
| | - D Asboe
- Chelsea & Westminster Hospital NHS Trust, London, UK
| | - G Whitlock
- Chelsea & Westminster Hospital NHS Trust, London, UK
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19
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Gonzalez-Rivas D, Bosinceanu M, Manolache V, Gallego-Poveda J, Garcia A, Paradela M, Dunning J, Bale M, Motas N. Uniportal fully robotic-assisted major pulmonary resections. Ann Cardiothorac Surg 2023; 12:52-61. [PMID: 36793991 PMCID: PMC9922773 DOI: 10.21037/acs-2022-urats-29] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 12/29/2022] [Indexed: 01/31/2023]
Abstract
Robotic-assisted thoracoscopic surgery (RATS) has proven advantages over that of conventional thoracic surgery, primarily by offering a three-dimensional view and excellent maneuverability, and by providing great ergonomic comfort to the surgeon. The instrumentation specifically offers seven degrees of freedom, allowing for safe, yet complex dissections and radical lymphadenectomies. However, the robotic platform was initially designed with four robotic arms in mind, and therefore four to five incisions were needed for most thoracic approaches. The uniportal video-assisted thoracoscopic surgery (UVATS) approach, the philosophical predecessor to the uniportal robotic-assisted thoracoscopic surgery (URATS) approach, evolved very quickly with the help of the latest technologies during the last decade. Since the first cases of UVATS in 2010, we have improved upon the technique, such that we are now able to do increasingly more complex cases. This is due to the acquired experience, specifically designed instruments, better high-definition cameras and more angulated staplers. In our efforts to improve and adapt robotic surgery to the uniportal approach, we utilized the initial available platforms (Davinci Si and X) to test the feasibility of this approach, in terms of safety and possibilities. The latest platform, the Da Vinci Xi, due to the configuration of its arms, did indeed allow for us to reduce the number of incisions to two initially and finally to one. We hence decided to fully adapt the Da Vinci Xi® to allow for the URATS approach routinely, and performed the first fully robotic anatomic resections in the world in September 2021, in Coruña, Spain. We define pure or fully robotic URATS as robotic thoracic surgery performed by a single intercostal incision, without rib spreading, using the robotic camera, robotic dissecting instruments and robotic staplers.
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Affiliation(s)
- Diego Gonzalez-Rivas
- Department of Thoracic Surgery and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña University Hospital, Coruña, Spain;,Department of Thoracic Surgery, Memorial Hospital, Bucharest, Romania;,Department of Cardio-Thoracic Surgery, Lusiadas Hospital, Lisbon, Portugal;,Department of Thoracic Surgery, Yashoda Hospital, Hyderabad, India
| | | | - Veronica Manolache
- Department of Thoracic Surgery, Memorial Hospital, Bucharest, Romania;,University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
| | | | - Alejandro Garcia
- Department of Thoracic Surgery and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña University Hospital, Coruña, Spain
| | - Marina Paradela
- Department of Thoracic Surgery and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña University Hospital, Coruña, Spain
| | - Joel Dunning
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK
| | - Manjunath Bale
- Department of Thoracic Surgery, Yashoda Hospital, Hyderabad, India
| | - Natalia Motas
- University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania;,Department of Thoracic Surgery, Institute of Oncology “Prof.Dr. Al.Trestioreanu” Bucharest, Romania
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20
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Lim E, Harris RA, McKeon HE, Batchelor TJ, Dunning J, Shackcloth M, Anikin V, Naidu B, Belcher E, Loubani M, Zamvar V, Dabner L, Brush T, Stokes EA, Wordsworth S, Paramasivan S, Realpe A, Elliott D, Blazeby J, Rogers CA. Impact of video-assisted thoracoscopic lobectomy versus open lobectomy for lung cancer on recovery assessed using self-reported physical function: VIOLET RCT. Health Technol Assess 2022; 26:1-162. [PMID: 36524582 PMCID: PMC9791462 DOI: 10.3310/thbq1793] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Lung cancer is the leading cause of cancer death. Surgery remains the main method of managing early-stage disease. Minimal-access video-assisted thoracoscopic surgery results in less tissue trauma than open surgery; however, it is not known if it improves patient outcomes. OBJECTIVE To compare the clinical effectiveness and cost-effectiveness of video-assisted thoracoscopic surgery lobectomy with open surgery for the treatment of lung cancer. DESIGN, SETTING AND PARTICIPANTS A multicentre, superiority, parallel-group, randomised controlled trial with blinding of participants (until hospital discharge) and outcome assessors conducted in nine NHS hospitals. Adults referred for lung resection for known or suspected lung cancer, with disease suitable for both surgeries, were eligible. Participants were followed up for 1 year. INTERVENTIONS Participants were randomised 1 : 1 to video-assisted thoracoscopic surgery lobectomy or open surgery. Video-assisted thoracoscopic surgery used one to four keyhole incisions without rib spreading. Open surgery used a single incision with rib spreading, with or without rib resection. MAIN OUTCOME MEASURES The primary outcome was self-reported physical function (using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30) at 5 weeks. Secondary outcomes included upstaging to pathologic node stage 2 disease, time from surgery to hospital discharge, pain in the first 2 days, prolonged pain requiring analgesia at > 5 weeks, adverse health events, uptake of adjuvant treatment, overall and disease-free survival, quality of life (Quality of Life Questionnaire Core 30, Quality of Life Questionnaire Lung Cancer 13 and EQ-5D) at 2 and 5 weeks and 3, 6 and 12 months, and cost-effectiveness. RESULTS A total of 503 patients were randomised between July 2015 and February 2019 (video-assisted thoracoscopic surgery, n = 247; open surgery, n = 256). One participant withdrew before surgery. The mean age of patients was 69 years; 249 (49.5%) patients were men and 242 (48.1%) did not have a confirmed diagnosis. Lobectomy was performed in 453 of 502 (90.2%) participants and complete resection was achieved in 429 of 439 (97.7%) participants. Quality of Life Questionnaire Core 30 physical function was better in the video-assisted thoracoscopic surgery group than in the open-surgery group at 5 weeks (video-assisted thoracoscopic surgery, n = 247; open surgery, n = 255; mean difference 4.65, 95% confidence interval 1.69 to 7.61; p = 0.0089). Upstaging from clinical node stage 0 to pathologic node stage 1 and from clinical node stage 0 or 1 to pathologic node stage 2 was similar (p ≥ 0.50). Pain scores were similar on day 1, but lower in the video-assisted thoracoscopic surgery group on day 2 (mean difference -0.54, 95% confidence interval -0.99 to -0.09; p = 0.018). Analgesic consumption was 10% lower (95% CI -20% to 1%) and the median hospital stay was less (4 vs. 5 days, hazard ratio 1.34, 95% confidence interval 1.09, 1.65; p = 0.006) in the video-assisted thoracoscopic surgery group than in the open-surgery group. Prolonged pain was also less (relative risk 0.82, 95% confidence interval 0.72 to 0.94; p = 0.003). Time to uptake of adjuvant treatment, overall survival and progression-free survival were similar (p ≥ 0.28). Fewer participants in the video-assisted thoracoscopic surgery group than in the open-surgery group experienced complications before and after discharge from hospital (relative risk 0.74, 95% confidence interval 0.66 to 0.84; p < 0.001 and relative risk 0.81, 95% confidence interval 0.66 to 1.00; p = 0.053, respectively). Quality of life to 1 year was better across several domains in the video-assisted thoracoscopic surgery group than in the open-surgery group. The probability that video-assisted thoracoscopic surgery is cost-effective at a willingness-to-pay threshold of £20,000 per quality-adjusted life-year is 1. LIMITATIONS Ethnic minorities were under-represented compared with the UK population (< 5%), but the cohort reflected the lung cancer population. CONCLUSIONS Video-assisted thoracoscopic surgery lobectomy was associated with less pain, fewer complications and better quality of life without any compromise to oncologic outcome. Use of video-assisted thoracoscopic surgery is highly likely to be cost-effective for the NHS. FUTURE WORK Evaluation of the efficacy of video-assisted thoracoscopic surgery with robotic assistance, which is being offered in many hospitals. TRIAL REGISTRATION This trial is registered as ISRCTN13472721. FUNDING This project was funded by the National Institute for Health and Care Research ( NIHR ) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 48. See the NIHR Journals Library website for further project information.
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21
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Stokes EA, Harris RA, Dabner L, McKeon HE, Kaur S, Paramasivan S, Realpe A, Elliott D, Batchelor TJ, Dunning J, Shackcloth M, Anikin V, Naidu B, Belcher E, Loubani M, Zamvar V, De Sousa P, Blazeby JM, Rogers CA, Lim E, Wordsworth S. Cost-Effectiveness of Video-Assisted Thoracoscopic Surgery Compared to Open Lobectomy in Patients with Early-Stage Lung Cancer: Findings from the VIOLET Randomised Controlled Trial. Lung Cancer 2022. [DOI: 10.1016/j.lungcan.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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22
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Atkinson B, Gould S, Spencer A, Onianwa O, Furneaux J, Grieves J, Summers S, Crocker-Buqué T, Fletcher T, Bennett A, Dunning J. Monkeypox virus contamination in an office-based workplace environment. J Hosp Infect 2022; 130:141-143. [PMID: 36055524 PMCID: PMC9428113 DOI: 10.1016/j.jhin.2022.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 10/25/2022]
Affiliation(s)
- B. Atkinson
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury, UK,Corresponding author. Address: Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury SP4 0JG, UK
| | - S. Gould
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - A. Spencer
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - O. Onianwa
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - J. Furneaux
- Rare and Imported Pathogens Laboratory, UK Health Security Agency, Porton Down, Salisbury, UK
| | - J. Grieves
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - S. Summers
- High Containment Microbiology, UK Health Security Agency, Porton Down, Salisbury, UK
| | - T. Crocker-Buqué
- Faculty of Public Health and Policy, London School Hygiene and Tropical Medicine, London, UK
| | - T. Fletcher
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - A.M. Bennett
- Research and Evaluation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - J. Dunning
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Pandemic Sciences Institute, University of Oxford, Oxford, UK
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23
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Karcher C, Jurisevic C, Southwood T, McCormack D, Rogers A, Levine A, Dunning J. The Australasian ANZSCTS/ANZICS guidelines on cardiothoracic advanced life support (CALS-ANZ). CRIT CARE RESUSC 2022; 24:218-223. [PMID: 38046213 PMCID: PMC10692601 DOI: 10.51893/2022.3.sa3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Christian Karcher
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
- University of Melbourne, Melbourne, VIC, Australia
| | - Craig Jurisevic
- Department of Cardiothoracic Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Tim Southwood
- Department of Intensive Care, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | | | - Amy Rogers
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Adrian Levine
- Department of Cardiothoracic Surgery and Anaesthesia, University of North Staffordshire, Stoke-on-Trent, UK
| | - Joel Dunning
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK
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24
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Luc JGY, Pizano A, Udwadia F, Gupta S, Dairywala M, Joyce C, Robinson E, Rush G, Dunning J, Myers PO, Antonoff MB, Nguyen TC. Early effect of the COVID-19 pandemic on the North American cardiothoracic surgery job market. J Thorac Dis 2022; 14:3304-3313. [PMID: 36245601 PMCID: PMC9562543 DOI: 10.21037/jtd-22-320] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 07/28/2022] [Indexed: 11/12/2022]
Abstract
Background The present study aims to report the early effect of the coronavirus disease 2019 (COVID-19) pandemic on the cardiothoracic surgery job market in North America. Methods The Cardiothoracic Surgery Network (CTSNet) job market database was queried, and patterns from January to May for 2019 versus January to May 2020 were compared for trends in job postings and job seekers. Results Our study is comprised of 395 cardiothoracic surgery job postings, of which 98% were positions located in North America and 63% were academic. The negative impact of the pandemic on the cardiothoracic surgery job market was greatest in the cardiothoracic/cardiovascular combined subspecialty, followed by congenital and adult cardiac surgery, whereas general thoracic surgery experienced an increase in proportion of jobs available. Despite an increase in views per job posted in 2020 vs. 2019 (532 vs. 290), employer views of job seeker curriculum vitae declined over the same time period in 2020 (January, 380 views/month to May, 3 views/month) compared to 2019 (January, 100 views/month to May, 54 views/month). Conclusions An analysis of job postings from CTSNet suggests a decline in job availability in the North American cardiothoracic surgical job market following declaration of the pandemic with acknowledgement that there is month to month variability and a supply-demand mismatch. The COVID-19 pandemic has had an unprecedented impact on our field, and the ultimate consequences remain unknown.
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Affiliation(s)
- Jessica G. Y. Luc
- Division of Cardiovascular Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alejandro Pizano
- Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center Houston, McGovern Medical School, Houston, TX, USA
| | - Farhad Udwadia
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Saurabh Gupta
- Division of Cardiac Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Mohammed Dairywala
- Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center Houston, McGovern Medical School, Houston, TX, USA
| | | | | | - Grahame Rush
- The Cardiothoracic Surgery Network, Chicago, IL, USA
| | - Joel Dunning
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK
| | - Patrick O. Myers
- Department of Cardiac Surgery, CHUV-Center Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Mara B. Antonoff
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tom C. Nguyen
- Division of Cardiothoracic Surgery, Department of Surgery, University of California San Francisco, CA, USA
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25
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Dunning J, Archbold A, de Bono JP, Butterfield L, Curzen N, Deakin CD, Gudde E, Keeble TR, Keys A, Lewis M, O'Keeffe N, Sarma J, Stout M, Swindell P, Ray S. Joint British Societies' guideline on management of cardiac arrest in the cardiac catheter laboratory. Heart 2022; 108:e3. [PMID: 35470236 DOI: 10.1136/heartjnl-2021-320588] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
More than 300 000 procedures are performed in cardiac catheter laboratories in the UK each year. The variety and complexity of percutaneous cardiovascular procedures have both increased substantially since the early days of invasive cardiology, when it was largely focused on elective coronary angiography and single chamber (right ventricular) permanent pacemaker implantation. Modern-day invasive cardiology encompasses primary percutaneous coronary intervention, cardiac resynchronisation therapy, complex arrhythmia ablation and structural heart interventions. These procedures all carry the risk of cardiac arrest.We have developed evidence-based guidelines for the management of cardiac arrest in adult patients in the catheter laboratory. The guidelines include recommendations which were developed by collaboration between nine professional and patient societies that are involved in promoting high-quality care for patients with cardiovascular conditions. We present a set of protocols which use the skills of the whole catheter laboratory team and which are aimed at achieving the best possible outcomes for patients who suffer a cardiac arrest in this setting. We identified six roles and developed a treatment algorithm which should be adopted during cardiac arrest in the catheter laboratory. We recommend that all catheter laboratory staff undergo regular training for these emergency situations which they will inevitably face.
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Affiliation(s)
- Joel Dunning
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, Middlesbrough, UK
| | - Andrew Archbold
- Department of General & Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Joseph Paul de Bono
- Department of Cardiology, Queen Elizabeth Hospital, University of Birmingham, Birmingham, West Midlands, UK
| | - Liz Butterfield
- School of Nursing, Midwifery and Social Work, Faculty of Health and Wellbeing, Canterbury Christ Church University, Canterbury, UK
| | - Nick Curzen
- Faculty of Medicine, University of Southampton and Department of Cardiology, Southampton, UK
| | - Charles D Deakin
- Anaesthesia and Intensive Care, Southampton University Hospitals NHS Trust, Southampton, Southampton, UK
| | - Ellie Gudde
- Essex Cardiothoracic Centre, Mid and South Essex NHS Trust, Basildon, Essex, UK.,Medical Technology Research Centre, Anglia Ruskin School of Medicine, Chelmsford, UK
| | - Thomas R Keeble
- Essex Cardiothoracic Centre, Mid and South Essex NHS Trust, Basildon, Essex, UK.,Medical Technology Research Centre, Anglia Ruskin School of Medicine, Chelmsford, UK
| | - Alan Keys
- Cardiovascular Care Partnership (UK), British Cardiovascular Society, London, London, UK
| | - Mike Lewis
- Department of Cardiac Surgery, Royal Sussex County Hospital, Brighton, UK
| | - Niall O'Keeffe
- Department of Cardiothoracic Anaesthesia and Critical Care, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
| | - Jaydeep Sarma
- Department of Cardiology, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
| | - Martin Stout
- School of Healthcare Science, Manchester Metropolitan University, Manchester, UK
| | | | - Simon Ray
- Department of Cardiology, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
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26
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Lim E, Batchelor TJP, Dunning J, Shackcloth M, Anikin V, Naidu B, Belcher E, Loubani M, Zamvar V, Harris RA, Dabner L, McKeon HE, Paramasivan S, Realpe A, Elliott D, De Sousa P, Stokes EA, Wordsworth S, Blazeby JM, Rogers CA. Video-Assisted Thoracoscopic or Open Lobectomy in Early-Stage Lung Cancer. NEJM Evid 2022; 1:EVIDoa2100016. [PMID: 38319202 DOI: 10.1056/evidoa2100016] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Video-Assisted Thoracoscopic Surgery or Open Lobectomy in Early-Stage Lung CancerIn a patient with early-stage lung cancer, is resection by video-assisted thoracoscopic surgery (VATS) versus open resection superior with respect to the postoperative recovery? This question was addressed in a multicenter randomized trial in more than 500 patients. At 5 weeks after surgery, the physical function mean score was 73 in the VATS group and 67 in the open surgery group (function scores range from 0 to 100, with higher scores indicating better function). Of the participants allocated to VATS, 30.7% had serious adverse events after discharge compared with 37.8% of those allocated to open surgery. At 52 weeks, there were no differences in cancer progression-free survival.
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Affiliation(s)
- Eric Lim
- Academic Division of Thoracic Surgery, Royal Brompton and Harefield Hospitals, London
- Imperial College London, London
| | - Tim J P Batchelor
- Thoracic Surgery, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Joel Dunning
- Department of Cardiothoracic Surgery, The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom
| | - Michael Shackcloth
- Department of Thoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Vladimir Anikin
- Academic Division of Thoracic Surgery, Royal Brompton and Harefield Hospitals, London
- Department of Oncology and Reconstructive Surgery, I.M. Sechenov First Moscow State Medical University, Moscow
| | - Babu Naidu
- Department of Thoracic Surgery, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Elizabeth Belcher
- Cardiothoracic Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Mahmoud Loubani
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Hull University Teaching Hospitals, Cottingham, United Kingdom
| | - Vipin Zamvar
- Department of Cardiothoracic Surgery, Edinburgh Royal Infirmary, NHS Lothian, Edinburgh
| | - Rosie A Harris
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Lucy Dabner
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Holly E McKeon
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Sangeetha Paramasivan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Alba Realpe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Daisy Elliott
- National Institute for Health Research Bristol Biomedical Research Centre, Surgical Innovation Theme, Centre for Surgical Research, University of Bristol, Bristol, United Kingdom
| | - Paulo De Sousa
- Academic Division of Thoracic Surgery, Royal Brompton and Harefield Hospitals, London
| | - Elizabeth A Stokes
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- National Institute for Health Research Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Sarah Wordsworth
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- National Institute for Health Research Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Jane M Blazeby
- National Institute for Health Research Bristol Biomedical Research Centre, Surgical Innovation Theme, Centre for Surgical Research, University of Bristol, Bristol, United Kingdom
| | - Chris A Rogers
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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Mahon B, Reynolds M, Russell K, Dunning J. Using Epidemic Intelligence to Inform UK Public Health Response to Infectious Disease Threats, such as Ebola Virus Disease. Int J Infect Dis 2022. [DOI: 10.1016/j.ijid.2021.12.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Tan G, Dunning J. 11 Robotic Left Lower Sleeve Lobectomy with Bronchoplasty for the Removal of a Carcinoid Tumour. Br J Surg 2022. [DOI: 10.1093/bjs/znac039.006] [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: 11/12/2022]
Abstract
Abstract
Lung carcinoid tumours constitute approximately 1–2% of all pulmonary tumours. They are derived from enterochromaffin cells, which are also known as ‘Kulchitsky cells' and generally have indolent growth and development patterns. Carcinoid tumours are categorized as typical or atypical, depending on the number of mitoses per high power field and the presence of necrosis. In terms of management, surgical resection has been recognized to be the standard treatment for pulmonary carcinoid tumours. To our knowledge, the da Vinci system and robotic surgery have not been applied in sleeve lobectomies and bronchoplasty for the removal of carcinoid tumours in the United Kingdom. Therefore, we present a case of a sleeve lobectomy with bronchoplasty procedure for the removal of a carcinoid tumour located in the left lower lobe of the patient. The bronchus was repaired using a V-lock suture & Prolene sutures with the surgery performed using the da Vinci robotic surgical system.
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Affiliation(s)
- G. Tan
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - J. Dunning
- James Cook University Hospital, Middlesbrough, United Kingdom
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Treasure T, Dunning J, Williams NR, Macbeth F. Lung metastasectomy for colorectal cancer: The impression of benefit from uncontrolled studies was not supported in a randomized controlled trial. J Thorac Cardiovasc Surg 2022; 163:486-490. [PMID: 33840470 DOI: 10.1016/j.jtcvs.2021.01.142] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 11/19/2020] [Accepted: 01/02/2021] [Indexed: 01/19/2023]
Affiliation(s)
- Tom Treasure
- Clinical Operational Research Unit, University College London, London, United Kingdom.
| | - Joel Dunning
- James Cook University Hospital, Middlesbrough, United Kingdom
| | - Norman R Williams
- Surgical and Interventional Trials Unit, University College London, London, United Kingdom
| | - Fergus Macbeth
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
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Affiliation(s)
- Giuseppe Aresu
- Cardiothoracic Surgical Department, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Joel Dunning
- Department of Thoracic Surgery, James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Tom Routledge
- Department of Thoracic Surgery, Guy’s and St Thomas' NHS Foundation Trust, London, UK
| | - Patrick Bagan
- Department of Thoracic and Vascular Surgery, Centre Hospitalier Victor Dupouy, Argenteuil, France
| | - Mark Slack
- CMR Surgical, Cambridge, UK
- Corresponding author. CMR Surgical Ltd, 1 Evolution Business Park, Milton Road, Cambridge CB24 9NG. Tel: +44 (0)1223 755300; e-mail: (M. Slack)
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Macbeth F, Dunning J, Treasure T. Pulmonary metastasectomy in colorectal cancer: A letter in response to Antonoff and colleagues. JTCVS Open 2021; 8:612-613. [PMID: 36004202 PMCID: PMC9390400 DOI: 10.1016/j.xjon.2021.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Tough D, Dunning J, Robinson J, Dixon J, Ferguson J, Paul I, Harrison SL. Investigating balance, gait, and physical function in people who have undergone thoracic surgery for a diagnosis of lung cancer: A mixed-methods study. Chron Respir Dis 2021; 18:14799731211052299. [PMID: 34715760 PMCID: PMC8558594 DOI: 10.1177/14799731211052299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objectives Symptoms associated with lung cancer and thoracic surgery might increase fall risk. We aimed to investigate: 1) balance, gait and functional status in people post-thoracic surgery compared to healthy controls; 2) perceptions of balance, gait and functional status. Methods Recruitment targeted older adults (≥50 years) who had undergone thoracic surgery for a diagnosis of lung cancer in the previous 3 months, and healthy age-matched controls. Dynamic and static balance, gait velocity, knee-extension strength and physical activity levels were assessed using the BESTest, Kistler force plate, GAITRite system, Biodex System 3 and CHAMPS questionnaire, respectively. Two-part semi-structured interviews were conducted post-surgery. Results Individuals post-surgery (n = 15) had worse dynamic balance and gait, and lower levels of moderate/vigorous physical activity (MVPA) (all p<0.05) versus healthy controls (n = 15). Strength did not differ between groups (p > 0.05). No associations between BESTest and strength or physical activity existed post-surgery (p > 0.05). Three themes were identified: 1) Symptoms affect daily activities; 2) Functional assessments alter perceptions of balance ability and 3) Open to supervised rehabilitation. Conclusion Balance, gait and MVPA are impaired post-thoracic surgery, yet balance was not viewed to be important in enabling activities of daily living. However, supervised rehabilitation was considered acceptable.
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Affiliation(s)
- Daniel Tough
- School of Health and Life Sciences, 5462Teesside University, Middlesbrough, UK
| | - Joel Dunning
- Department of Cardiothoracic Surgery, 156705James Cook University Hospital, Middlesbrough, UK
| | - Jonathan Robinson
- School of Health and Life Sciences, 5462Teesside University, Middlesbrough, UK
| | - John Dixon
- School of Health and Life Sciences, 5462Teesside University, Middlesbrough, UK
| | - Jonathan Ferguson
- Department of Cardiothoracic Surgery, 156705James Cook University Hospital, Middlesbrough, UK
| | - Ian Paul
- Department of Cardiothoracic Surgery, 156705James Cook University Hospital, Middlesbrough, UK
| | - Samantha L Harrison
- School of Health and Life Sciences, 5462Teesside University, Middlesbrough, UK
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Hayanga JWA, Likosky DS, van Diepen S, Holst K, Whitson BA, Whitman G, Arkley J, Dunning J, Arora RC. 2020 in review. J Thorac Cardiovasc Surg 2021; 162:628-632. [PMID: 34024612 DOI: 10.1016/j.jtcvs.2021.04.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/07/2021] [Accepted: 04/07/2021] [Indexed: 11/20/2022]
Affiliation(s)
- J W Awori Hayanga
- Department of Cardiovascular and Thoracic Surgery, Heart and Vascular Institute, West Virginia University, Morgantown, WVa.
| | - Donald S Likosky
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | - Sean van Diepen
- Division of Cardiology and Department of Critical Care, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Kimberly Holst
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Bryan A Whitson
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University, Columbus, Ohio
| | - Glenn Whitman
- Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James Arkley
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, United Kingdom
| | - Joel Dunning
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, United Kingdom
| | - Rakesh C Arora
- Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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Nardini M, Jayakumar S, Migliore M, Nosotti M, Paul I, Dunning J. Minimally Invasive Plication of the Diaphragm: A Single-Center Prospective Study. Innovations (Phila) 2021; 16:343-349. [PMID: 34130535 DOI: 10.1177/15569845211011583] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Plication of the diaphragm is a life-changing procedure for patients affected by diaphragm paralysis. Traditionally, this procedure is performed through a thoracotomy. Access to the diaphragm via this incision is poor and the indications for surgery are limited to patients who can actually sustain such an invasive approach and associated morbidities. A minimally invasive approach was developed to improve the surgical management of diaphragm paralysis. METHODS Patients underwent minimally invasive diaphragm plication either by video-assisted or robotic surgery through a 3-port technique with CO2 insufflation. Patients were followed at the routine 6-week clinic and also by telephone consultation 6 to 12 months postoperatively. Data were collected on postoperative complications, postoperative pain or numbness, symptomatic improvement, and change to quality of life following surgery. RESULTS Forty-eight patients underwent 49 minimally invasive diaphragm plication. Median postoperative length of hospital stay was 4 days (range: 2 to 34 days) and there were no cases of mortality. Mean reduction in Medical Research Council dyspnea score per patient was 2.2 points (mode: 3 points). Twenty-eight patients (77.8%) reported a significant symptomatic improvement enabling improvements in quality of life, and 97.2% (n = 35) were satisfied with the surgical outcome. CONCLUSIONS Minimally invasive diaphragm plication is a safe procedure associated with prompt postoperative recovery. It is effective at reducing debilitating dyspnea and improving quality of life.
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Affiliation(s)
- Marco Nardini
- 9304 Department of Thoracic Surgery and Lung Transplantation, University of Milan, Italy.,4964 Department of Cardiothoracic Surgery, Royal Brompton and Harefield Hospitals, London, UK
| | - Shruti Jayakumar
- 156705 Department of Thoracic Surgery, James Cook University Hospital, Middlesbrough, UK
| | - Marcello Migliore
- 8903 Department of Thoracic Surgery, University Hospital of Wales, Cardiff, UK
| | - Mario Nosotti
- 9304 Department of Thoracic Surgery and Lung Transplantation, University of Milan, Italy
| | - Ian Paul
- 156705 Department of Thoracic Surgery, James Cook University Hospital, Middlesbrough, UK
| | - Joel Dunning
- 156705 Department of Thoracic Surgery, James Cook University Hospital, Middlesbrough, UK
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35
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Lim EKS, Batchelor TJ, Dunning J, Shackcloth M, Anikin V, Naidu B, Belcher E, Loubani M, Zamvar V, Harris RA, Dabner L, Mckeon HE, Paramasivan S, Realpe A, Elliot D, De Sousa P, Blazeby JM, Rogers CA. Video-assisted thoracoscopic versus open lobectomy in patients with early-stage lung cancer: One-year results from a randomized controlled trial (VIOLET). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.8504] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8504 Background: Video assisted thoracoscopic surgery (VATS) is a popular access for lung cancer resection. However, there is limited information from RCTs from in-hospital to one-year clinical efficacy, safety and oncologic outcomes of a minimal access approach. Methods: VIOLET is a parallel group multi-center RCT conducted in 9 centers in the United Kingdom that recruited participants with known or suspected (cT1-3, N0-1 and M0) lung cancer (ISRCTN13472721). Trial protocol: https://bmjopen.bmj.com/content/9/10/e029507.info. Results: From July 2015 to February 2019, 503 participants were randomized to VATS (n=247) or open (n=256) lobectomy. Patients allocated to VATS had less pain with a mean difference (MD) in visual analogue score of -0.54 (95%CI -0.99 to -0.10) despite less analgesic consumption (mean ratio 0.90, 95%CI 0.80 to 1.01). After discharge pain was consistent on multiple sub-scales including overall pain (MD -7.19, -10.59 to -3.80), chest pain (MD -4.66, -7.96 to -1.36) and an 18% relative risk (RR) reduction in incision pain (RR 0.82; 0.72 to 0.94) up to one-year. Better functional recovery continued in VATS arm after discharge with better physical function (primary outcome) with MD of 4.65 (1.69 to 7.61; P=0.002) at 5 weeks and overall improvement in global health status with a MD of 4.21 (1.62 to 6.79; P=0.001). In hospital, VATS arm had fewer complications (RR 0.74, 0.66 to 0.84; P<0.001) with no difference in serious adverse events (RR 0.98, 0.59 to 1.63; P=0.948). Median hospital stay was one day shorter in the VATS arm (4 vs 5 days) corresponding to hazard ratio (HR) for discharge of 1.34, 95%CI 1.09 to 1.65; P=0.006). After discharge VATS arm had 19% less serious adverse events (RR 0.81, 0.66 to 1.00; p=0.053) and lower readmission rates (29.0% vs. 35.9% respectively) to one-year. Of those with lymph node disease, 50.9% in the VATS and 45.9% in open arms received adjuvant treatment. There was no difference in the time to uptake of adjuvant chemotherapy (HR 1.12, 0.62 to 2.02; p=0.716). Recurrence with clinical follow up and CT at one-year was similar with 7.7% versus 8.1% in the VATS and open groups respectively. Progression-free survival (HR 0.74, 0.43 to 1.27; p=0.27) and overall survival HR 0.67, 0.32 to 1.40; p=0.282) was not significantly different. Conclusions: VATS lobectomy for lung cancer is associated with less pain, fewer in-hospital complications and shorter hospital stay, achieved without any compromise to early oncologic outcomes nor serious adverse events. Superior functional recovery continues in the post-operative period with improved physical function, lower re-admission rates and no difference in disease-free and overall survival up to one-year. Clinical trial information: ISRCTN13472721.
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Affiliation(s)
| | - Tim J.P. Batchelor
- Thoracic Surgery, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Joel Dunning
- The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom
| | - Michael Shackcloth
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Vladimir Anikin
- Royal Brompton and Harefield Hospitals, London, United Kingdom
| | - Babu Naidu
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Elizabeth Belcher
- John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | | | - Vipin Zamvar
- Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, United Kingdom
| | - Rosie A. Harris
- Bristol Trials Centre (CTEU), Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Lucy Dabner
- Bristol Trials Centre (CTEU), Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Holly E. Mckeon
- Bristol Trials Centre (CTEU), Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Sangeetha Paramasivan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Alba Realpe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Daisy Elliot
- National Institute for Health Research Bristol Biomedical Research Centre, Surgical Innovation Theme, Centre for Surgical Research, Bristol, United Kingdom
| | - Paulo De Sousa
- Royal Brompton and Harefield Hospitals, London, United Kingdom
| | - Jane M. Blazeby
- National Institute for Health Research Bristol Biomedical Research Centre, Surgical Innovation Theme, Centre for Surgical Research, University of Bristol, Bristol, United Kingdom
| | - Chris A. Rogers
- Bristol Trials Centre (CTEU), Bristol Medical School, University of Bristol, Bristol, United Kingdom
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Freystaetter K, Waterhouse BR, Chilvers N, Trevis J, Ferguson J, Paul I, Dunning J. The Importance of Culture Change Associated With Novel Surgical Approaches and Innovation: Does Perioperative Care Transcend Technical Considerations for Pulmonary Lobectomy? Front Surg 2021; 8:597410. [PMID: 34017851 PMCID: PMC8129019 DOI: 10.3389/fsurg.2021.597410] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 04/06/2021] [Indexed: 11/13/2022] Open
Abstract
Robotic thoracic surgery for pulmonary lobectomy was introduced at our unit in 2015, along with enhanced perioperative patient care pathways. We evaluated the effect of this practice change on short-term outcomes. Data on all adult patients who underwent a lobectomy in our unit between 2015 and 2019 were obtained retrospectively from our surgical database. Patients fell into three groups: conventional open surgery via thoracotomy, video-assisted thoracoscopic surgery (VATS), and robot-assisted thoracoscopic surgery (RATS). Survival was defined as survival to discharge. Our cohort included 722 patients. Three hundred and ninety-two patients (54.3%) underwent an open operation, 259 patients (35.9%) underwent VATS surgery, and 71 patients (9.8%) underwent a robotic procedure. Comparing these surgical approaches, there was no statistically significant difference in the overall incidence of post-operative complications (p = 0.15) as well as the incidence of wound infections, arrhythmias, prolonged air leaks, respiratory failure, or ICU readmissions. Additionally, there was no statistically significant difference in survival to discharge (p = 0.66). However, patients who had a VATS procedure were less likely to develop a post-operative chest infection (p = 0.01). Evaluating our practice over time, we found a decrease in the overall incidence of post-operative complications (p = 0.01) with an improvement in survival to discharge (p = 0.02). In our experience, VATS lobectomy was associated with a lower incidence of post-operative chest infections. However, the limitations of our study must be considered; factors such as patient selection that may have had a substantial impact. The culture change associated with adoption of a VATS and robotic surgical programme appears to have corresponded with an improved survival to discharge for all lobectomy patients, irrespective of surgical approach. Perioperative care may therefore have a more significant impact on outcomes than technical considerations.
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Affiliation(s)
- Kathrin Freystaetter
- Department of Cardiothoracic Surgery, The James Cook University Hospital, Middlesbrough, United Kingdom
| | - Benjamin R Waterhouse
- Department of Cardiothoracic Surgery, The James Cook University Hospital, Middlesbrough, United Kingdom
| | - Nicholas Chilvers
- Department of Cardiothoracic Surgery, The James Cook University Hospital, Middlesbrough, United Kingdom
| | - Jason Trevis
- Department of Cardiothoracic Surgery, The James Cook University Hospital, Middlesbrough, United Kingdom
| | - Jonathan Ferguson
- Department of Cardiothoracic Surgery, The James Cook University Hospital, Middlesbrough, United Kingdom
| | - Ian Paul
- Department of Cardiothoracic Surgery, The James Cook University Hospital, Middlesbrough, United Kingdom
| | - Joel Dunning
- Department of Cardiothoracic Surgery, The James Cook University Hospital, Middlesbrough, United Kingdom
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Pompili C, Trevis J, Patella M, Brunelli A, Libretti L, Novoa N, Scarci M, Tenconi S, Dunning J, Cafarotti S, Koller M, Velikova G, Shargall Y, Raveglia F. European Society of Thoracic Surgeons electronic quality of life application after lung resection: field testing in a clinical setting. Interact Cardiovasc Thorac Surg 2021; 32:911-920. [PMID: 33909903 DOI: 10.1093/icvts/ivab030] [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: 09/18/2020] [Revised: 11/30/2020] [Accepted: 12/12/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Technology has the potential to assist healthcare professionals in improving patient-doctor communication during the surgical journey. Our aims were to assess the acceptability of a quality of life (QoL) application (App) in a cohort of cancer patients undergoing lung resections and to depict the early perioperative trajectory of QoL. METHODS This multicentre (Italy, UK, Spain, Canada and Switzerland) prospective longitudinal study with repeated measures used 12 lung surgery-related validated questions from the European Organisation for Research and Treatment of Cancer Item Bank. Patients filled out the questionnaire preoperatively and 1, 7, 14, 21 and 28 days after surgery using an App preinstalled in a tablet. A one-way repeated measures analysis of variance was run to determine if there were differences in QoL over time. RESULTS A total of 103 patients consented to participate in the study (83 who had lobectomies, 17 who had segmentectomies and 3 who had pneumonectomies). Eighty-three operations were performed by video-assisted thoracoscopic surgery (VATS). Compliance rates were 88%, 90%, 88%, 82%, 71% and 56% at each time point, respectively. The results showed that the operation elicited statistically significant worsening in the following symptoms: shortness of breath (SOB) rest (P = 0.018), SOB walk (P < 0.001), SOB stairs (P = 0.015), worry (P = 0.003), wound sensitivity (P < 0.001), use of arm and shoulder (P < 0.001), pain in the chest (P < 0.001), decrease in physical capability (P < 0.001) and scar interference on daily activity (P < 0.001) during the first postoperative month. SOB worsened immediately after the operation and remained low at the different time points. Worry improved following surgery. Surgical access and forced expiratory volume in 1 s (FEV1) are the factors that most strongly affected the evolution of the symptoms in the perioperative period. CONCLUSIONS We observed good early compliance of patients operated on for lung cancer with the European Society of Thoracic Surgeons QoL App. We determined the evolution of surgery-related QoL in the immediate postoperative period. Monitoring these symptoms remotely may reduce hospital appointments and help to establish early patient-support programmes.
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Affiliation(s)
- Cecilia Pompili
- Section of Patient Centred Outcomes Research, Leeds Institute for Medical Research at St James's, University of Leeds, Leeds, UK
| | - Jason Trevis
- Department of Thoracic Surgery, James Cook University Hospital, Middlesbrough, UK
| | - Miriam Patella
- Department of Thoracic Surgery, San Giovanni Hospital, Bellinzona, Switzerland
| | - Alessandro Brunelli
- Department of Thoracic Surgery, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - Lidia Libretti
- Department of Thoracic Surgery, San Gerardo Hospital, Monza, Italy
| | - Nuria Novoa
- Department of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain
| | - Marco Scarci
- Department of Thoracic Surgery, San Gerardo Hospital, Monza, Italy
| | - Sara Tenconi
- Department of Thoracic Surgery, Sheffield Teaching Hospital NHS Trust, Sheffield, UK
| | - Joel Dunning
- Department of Thoracic Surgery, James Cook University Hospital, Middlesbrough, UK
| | - Stefano Cafarotti
- Department of Thoracic Surgery, San Giovanni Hospital, Bellinzona, Switzerland
| | - Michael Koller
- University Hospital of Regensburg, Centre for Clinical Studies Regensburg, Germany
| | - Galina Velikova
- Section of Patient Centred Outcomes Research, Leeds Institute for Medical Research at St James's, University of Leeds, Leeds, UK
| | - Yaron Shargall
- Department of Thoracic Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada
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Moore G, Rickard H, Stevenson D, Aranega-Bou P, Pitman J, Crook A, Davies K, Spencer A, Burton C, Easterbrook L, Love HE, Summers S, Welch SR, Wand N, Thompson KA, Pottage T, Richards KS, Dunning J, Bennett A. Detection of SARS-CoV-2 within the healthcare environment: a multi-centre study conducted during the first wave of the COVID-19 outbreak in England. J Hosp Infect 2021; 108:189-196. [PMID: 33259882 PMCID: PMC7831847 DOI: 10.1016/j.jhin.2020.11.024] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/25/2020] [Accepted: 11/25/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Understanding how severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is spread within the hospital setting is essential in order to protect staff, implement effective infection control measures, and prevent nosocomial transmission. METHODS The presence of SARS-CoV-2 in the air and on environmental surfaces around hospitalized patients, with and without respiratory symptoms, was investigated. Environmental sampling was undertaken within eight hospitals in England during the first wave of the coronavirus disease 2019 outbreak. Samples were analysed using reverse transcription polymerase chain reaction (PCR) and virus isolation assays. FINDINGS SARS-CoV-2 RNA was detected on 30 (8.9%) of 336 environmental surfaces. Cycle threshold values ranged from 28.8 to 39.1, equating to 2.2 x 105 to 59 genomic copies/swab. Concomitant bacterial counts were low, suggesting that the cleaning performed by nursing and domestic staff across all eight hospitals was effective. SARS-CoV-2 RNA was detected in four of 55 air samples taken <1 m from four different patients. In all cases, the concentration of viral RNA was low and ranged from <10 to 460 genomic copies/m3 air. Infectious virus was not recovered from any of the PCR-positive samples analysed. CONCLUSIONS Effective cleaning can reduce the risk of fomite (contact) transmission, but some surface types may facilitate the survival, persistence and/or dispersal of SARS-CoV-2. The presence of low or undetectable concentrations of viral RNA in the air supports current guidance on the use of specific personal protective equipment for aerosol-generating and non-aerosol-generating procedures.
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Affiliation(s)
- G Moore
- National Infection Service, Public Health England, Porton Down, Salisbury, UK.
| | - H Rickard
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - D Stevenson
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - P Aranega-Bou
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - J Pitman
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - A Crook
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - K Davies
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - A Spencer
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - C Burton
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - L Easterbrook
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - H E Love
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - S Summers
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - S R Welch
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - N Wand
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - K-A Thompson
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - T Pottage
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - K S Richards
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - J Dunning
- Emerging Infections and Zoonoses Unit, National Infection Service, Public Health England, Colindale, London, UK; NIHR Health Protection Research Unit in Emerging Infections and Zoonoses, Liverpool, UK
| | - A Bennett
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
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Trevis J, Chilvers N, Freystaetter K, Dunning J. Surgeon-Powered Robotics in Thoracic Surgery; An Era of Surgical Innovation and Its Benefits for the Patient and Beyond. Front Surg 2020; 7:589565. [PMID: 33330607 PMCID: PMC7731580 DOI: 10.3389/fsurg.2020.589565] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/12/2020] [Indexed: 12/02/2022] Open
Abstract
Following its introduction in 1992, the growth of minimally invasive thoracic surgery was initially hampered by the lack of specialized instruments, impeded visualization and stapling. However, in subsequent years these challenges were somewhat overcome and video-assisted thoracoscopic surgery (VATS) became the preferred modality of many centers. More recently, robotic surgery has come to the fore. Whilst it offers outstanding precision via robotic wristed instruments, robotic surgery is expensive and has safety implications as the surgeon is away from the patient's side. Wristed VATS instruments offer a new, exciting alternative. By placing the robotic-like wristed instruments in the hands of the surgeon, a concept we call surgeon-powered robotics, the benefits of robotic surgery can be achieved by the patient's side. We describe our experience of the ArtiSential® wristed instruments and discuss the benefits and challenges of this technology. By combining wristed instruments with the latest surgeon-controlled 3D camera technology, surgeon-powered robotics is an affordable reality.
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Zhao H, ParryFord F, Dabrera G, Sinnathamby M, Ellis J, Dunning J, Osman H, Machin N, Pebody R. Six-year experience of detection and investigation of possible Middle East Respiratory Syndrome coronavirus cases, England, 2012-2018. Public Health 2020; 189:141-143. [PMID: 33227597 PMCID: PMC7574929 DOI: 10.1016/j.puhe.2020.10.007] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Surveillance for Middle East Respiratory Syndrome (MERS) has been undertaken in the UK since September 2012. This study describes the surveillance outcomes in England from 2012 to 2018. STUDY DESIGN This was a descriptive study using surveillance data. METHODS Local health protection teams in England report possible MERS cases to the National Infection Service with clinical and laboratory data. RESULTS A total of 1301 possible MERS cases were identified in the study period. Five cases were laboratory-confirmed MERS. The majority of cases had travelled to Saudi Arabia (56.7%) and United Arab Emirates (25.9%). Fifty-four percent of cases were men and 43.7% were women. The majority of cases (65.1%) were aged 45 years or older. The number of tests increased in the period after Hajj each year. Laboratory-confirmed alternative diagnoses were available for 513 (39.4%) cases; influenza was the most common virus detected (n = 255, 52.4%). CONCLUSIONS Our study highlights the importance of differential diagnosis of influenza and other respiratory pathogens and early influenza antiviral treatment.
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Affiliation(s)
- H Zhao
- National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK.
| | - F ParryFord
- National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - G Dabrera
- National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - M Sinnathamby
- National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - J Ellis
- National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - J Dunning
- National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - H Osman
- Birmingham Public Health Laboratory, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham, B9 5SS, UK
| | - N Machin
- Public Health Laboratory, Manchester, UK
| | - R Pebody
- National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK
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Milosevic M, Edwards J, Tsang D, Dunning J, Shackcloth M, Batchelor T, Coonar A, Hasan J, Davidson B, Marchbank A, Grumett S, Williams N, Macbeth F, Farewell V, Treasure T. Pulmonary Metastasectomy in Colorectal Cancer: updated analysis of 93 randomized patients - control survival is much better than previously assumed. Colorectal Dis 2020; 22:1314-1324. [PMID: 32388895 PMCID: PMC7611567 DOI: 10.1111/codi.15113] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 04/24/2020] [Indexed: 12/23/2022]
Abstract
AIM Lung metastases from colorectal cancer are resected in selected patients in the belief that this confers a significant survival advantage. It is generally assumed that the 5-year survival of these patients would be near zero without metastasectomy. We tested the clinical effectiveness of this practice in Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC), a randomized, controlled noninferiority trial. METHOD Multidisciplinary teams in 14 hospitals recruited patients with resectable lung metastases into a two-arm trial. Randomization was remote and stratified according to site, with minimization for age, sex, primary cancer stage, interval since primary resection, prior liver involvement, number of metastases and carcinoembryonic antigen level. The trial management group was blind to patient allocation until after intention-to-treat analysis. RESULTS From 2010 to 2016, 93 participants were randomized. These patients were 35-86 years of age and had between one and six lung metastases at a median of 2.7 years after colorectal cancer resection; 29% had prior liver metastasectomy. The patient groups were well matched and the characteristics of these groups were similar to those of observational studies. The median survival after metastasectomy was 3.5 (95% CI: 3.1-6.6) years compared with 3.8 (95% CI: 3.1-4.6) years for controls. The estimated unadjusted hazard ratio for death within 5 years, comparing the metastasectomy group with the control group, was 0.93 (95% CI: 0.56-1.56). Use of chemotherapy or local ablation was infrequent and similar in each group. CONCLUSION Patients in the control group (who did not undergo lung metastasectomy) have better survival than is assumed. Survival in the metastasectomy group is comparable with the many single-arm follow-up studies. The groups were well matched with features similar to those reported in case series.
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Affiliation(s)
- M. Milosevic
- Institute for Lung Diseases of VojvodinaThoracic Surgery ClinicSremska KamenicaSerbia
| | - J. Edwards
- Sheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | - D. Tsang
- Basildon and Thurrock University Hospitals NHS Foundation TrustBasildonUK
| | - J. Dunning
- South Tees Hospitals NHS Foundation TrustThe James Cook University HospitalMiddlesbroughUK
| | - M. Shackcloth
- Liverpool Heart And Chest Hospital NHS Foundation TrustLiverpoolUK
| | - T. Batchelor
- Bristol Royal InfirmaryUniversity Hospitals Bristol NHS Foundation TrustBristolUK
| | - A. Coonar
- Royal Papworth Hospital NHS Foundation TrustCambridgeUK
| | - J. Hasan
- The Christie NHS Foundation TrustManchesterUK
| | - B. Davidson
- Division of SurgeryRoyal Free London NHS Foundation TrustUCLLondonUK
| | - A. Marchbank
- Derriford HospitalUniversity Hospitals Plymouth NHS TrustPlymouthUK
| | - S. Grumett
- The Royal Wolverhampton NHS TrustNew Cross HospitalWolverhamptonUK
| | - N.R. Williams
- Surgical & Interventional Trials Unit (SITU)University College LondonLondonUK
| | - F. Macbeth
- Centre for Trials ResearchCardiff UniversityCardiffUK
| | | | - T. Treasure
- Clinical Operational Research UnitUniversity College LondonLondonUK
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Abstract
The advent of helical high-resolution CT scanners, the application of screening programs and the follow-up of patient with oncological history, led to an increasing number of diagnosis of small pulmonary nodule (less than 10 mm in maximum diameter), partially solid nodule or completely ground glass ones. Their management is controversial. Excisional biopsy by mean of video-assisted thoracic surgery is often a viable choice but to locate these lesions intraoperatively can be impossible without the aid of preoperative or intraoperative localization techniques. In this brief review we will analyze the benefit of adopting localization techniques prior to pulmonary resection for small pulmonary lesions and face the advantages and problems with the main techniques described in the literatures.
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Affiliation(s)
- Marco Nardini
- Department of Thoracic Surgery, University Hospital of Catania, Catania, Italy
| | - Joel Dunning
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, United Kingdom
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Milosevic M, Edwards J, Dunning J, Shackcloth M, Treasure T. Five-year survival of patients in control groups of randomized controlled trials is much higher than that assumed in observational study reports. Int J Colorectal Dis 2020; 35:941-942. [PMID: 32067060 DOI: 10.1007/s00384-020-03540-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2020] [Indexed: 02/04/2023]
Affiliation(s)
- Misel Milosevic
- Thoracic Surgery Clinic, Institute for Lung Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - John Edwards
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Joel Dunning
- The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | | | - Tom Treasure
- Clinical Operational Research Unit, University College, London, UK.
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Bowe F, Paul I, Ferguson J, Dunning J, Harrison S. High intensity inspiratory muscle training (HI-IMT) in individuals referred for lung resection surgery. Physiotherapy 2020. [DOI: 10.1016/j.physio.2020.03.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Page A, Messer S, Berman M, Kaul P, Pavlushkov E, Parameshwar J, Abu-Omar Y, Goddard M, Dunning J, Pettit S, Lewis C, Kydd A, Bhagra S, Ali A, Sudarshan C, Jenkins D, Tsui S, Catarino P, Large S. Heart Transplantation from Donation after Circulatory Determined Death: The Royal Papworth Experience. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Liu L, Mei J, He J, Demmy TL, Gao S, Li S, He J, Liu Y, Huang Y, Xu S, Hu J, Chen L, Zhu Y, Luo Q, Mao W, Tan Q, Chen C, Li X, Zhang Z, Jiang G, Xu L, Zhang L, Fu J, Li H, Wang Q, Liu D, Tan L, Zhou Q, Fu X, Jiang Z, Chen H, Fang W, Zhang X, Li Y, Tong T, Yu Z, Liu Y, Zhi X, Yan T, Zhang X, Pu Q, Che G, Lin Y, Ma L, Embun R, Aragón J, Evman S, Kocher GJ, Bertolaccini L, Brunelli A, Gonzalez-Rivas D, Dunning J, Liu HP, Swanson SJ, Borisovich RA, Sarkaria IS, Sihoe ADL, Nagayasu T, Miyazaki T, Chida M, Kohno T, Thirugnanam A, Soukiasian HJ, Onaitis MW, Liu CC. International expert consensus on the management of bleeding during VATS lung surgery. Ann Transl Med 2019; 7:712. [PMID: 32042728 DOI: 10.21037/atm.2019.11.142] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Intraoperative bleeding is the most crucial safety concern of video-assisted thoracic surgery (VATS) for a major pulmonary resection. Despite the advances in surgical techniques and devices, intraoperative bleeding is still not rare and remains the most common and potentially fatal cause of conversion from VATS to open thoracotomy. Therefore, to guide the clinical practice of VATS lung surgery, we proposed the International Interest Group on Bleeding during VATS Lung Surgery with 65 experts from 10 countries in the field to develop this consensus document. The consensus was developed based on the literature reports and expert experience from different countries. The causes and incidence of intraoperative bleeding were summarised first. Seven situations of intraoperative bleeding were collected based on clinical practice, including the bleeding from massive vessel injuries, bronchial arteries, vessel stumps, and bronchial stumps, lung parenchyma, lymph nodes, incisions, and the chest wall. The technical consensus for the management of intraoperative bleeding was achieved on these seven surgical situations by six rounds of repeated revision. Following expert consensus statements were achieved: (I) Bleeding from major vascular injuries: direct compression with suction, retracted lung, or rolled gauze is useful for bleeding control. The size and location of the vascular laceration are evaluated to decide whether the bleeding can be stopped by direct compression or by ligation. If suturing is needed, the suction-compressing angiorrhaphy technique (SCAT) is recommended. Timely conversion to thoracotomy with direct compression is required if the operator lacks experience in thoracoscopic angiorrhaphy. (II) Bronchial artery bleeding: pre-emptive clipping of bronchial artery before bronchial dissection or lymph node dissection can reduce the incidence of bleeding. Bronchial artery bleeding can be stopped by compression with the suction tip, followed by the handling of the vascular stump with energy devices or clips. (III) Bleeding from large vessel stumps and bronchial stumps: bronchial stump bleeding mostly comes from accompanying bronchial artery, which can be clipped for hemostasis. Compression for hemostasis is usually effective for bleeding at the vascular stump. Otherwise, additional use of hemostatic materials, re-staple or a suture may be necessary. (IV) Bleeding from the lung parenchyma: coagulation hemostasis is the first choice. For wounds with visible air leakage or an insufficient hemostatic effect of coagulation, suturing may be necessary. (V) Bleeding during lymph node dissection: non-grasping en-bloc lymph node dissection is recommended for the nourishing vessels of the lymph node are addressed first with this technique. If bleeding occurs at the site of lymph node dissection, energy devices can be used for hemostasis, sometimes in combination with hemostatic materials. (VI) Bleeding from chest wall incisions: the chest wall incision(s) should always be made along the upper edge of the rib(s), with good hemostasis layer by layer. Recheck the incision for hemostasis before closing the chest is recommended. (VII) Internal chest wall bleeding: it can usually be managed with electrocoagulation. For diffuse capillary bleeding with the undefined bleeding site, compression of the wound with gauze may be helpful.
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Affiliation(s)
- Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jiandong Mei
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jie He
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Todd L Demmy
- Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Shugeng Gao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Shanqing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medicine, Beijing 100032, China
| | - Jianxing He
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Yang Liu
- Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Yunchao Huang
- Department of Thoracic and Cardiovascular Surgery, The Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital), Kunming 650106, China
| | - Shidong Xu
- Department of Thoracic Surgery, Harbin Medical University Cancer Hospital, Harbin 150086, China
| | - Jian Hu
- Department of Thoracic Surgery, First Hospital Affiliated to Medical College of Zhejiang University, Hangzhou 310003, China
| | - Liang Chen
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yuming Zhu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200003, China
| | - Qingquan Luo
- Shanghai Lung Tumor Clinical Medical Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Weimin Mao
- Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Qunyou Tan
- Department of Thoracic Surgery, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing 400042, China
| | - Chun Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Xiaofei Li
- Department of Thoracic Surgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an 710038, China
| | - Zhu Zhang
- Department of Thoracic Surgery, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200003, China
| | - Lin Xu
- Department of Thoracic Surgery, Nanjing Medical University Affiliated Cancer Hospital, Jiangsu Key Laboratory of Molecular and Translational Cancer Research, Cancer Institute of Jiangsu Province, Nanjing 210009, China
| | - Lanjun Zhang
- Department of Thoracic Surgery, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China
| | - Jianhua Fu
- Department of Thoracic Surgery, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China
| | - Hui Li
- Department of Thoracic Surgery, Beijing Chao-Yang Hospital, Beijing 100043, China
| | - Qun Wang
- Department of Thoracic Surgery, Shanghai Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Deruo Liu
- Department of Thoracic Surgery, China and Japan Friendship Hospital, Beijing 100029, China
| | - Lijie Tan
- Department of Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Qinghua Zhou
- Department of Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xiangning Fu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Zhongmin Jiang
- Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan 250014, China
| | - Haiquan Chen
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Jiao Tong University, Shanghai 200032, China
| | - Xun Zhang
- Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin 300051, China
| | - Yin Li
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Ti Tong
- Department of Thoracic Surgery, Second Hospital of Jilin University, Changchun 130041, China
| | - Zhentao Yu
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - Yongyu Liu
- Department of Thoracic Surgery, Liaoning Cancer Hospital and Institute, Shenyang 110042, China
| | - Xiuyi Zhi
- Department of Thoracic Surgery, Xuanwu Hospital of Capital Medical University, Beijing 100053, China
| | - Tiansheng Yan
- Department of Thoracic Surgery, Peking University Third Hospital, Beijing 100191, China
| | - Xingyi Zhang
- Department of Thoracic Surgery, The Second Hospital of Jilin University, Changchun 130041, China
| | - Qiang Pu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yidan Lin
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Lin Ma
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Raul Embun
- Thoracic Surgery Department, Hospital Universitario Miguel Servet, IIS Aragón, Zaragoza, Spain
| | - Javier Aragón
- Department of Thoracic Surgery, Asturias University Central Hospital, Oviedo, Spain
| | - Serdar Evman
- Department of Thoracic Surgery, University of Health Sciences, Sureyyapasa Training and Research Hospital, Istanbul, Turkey
| | - Gregor J Kocher
- Division of Thoracic Surgery, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Luca Bertolaccini
- Department of Thoracic Surgery, Maggiore Teaching Hospital, Bologna, Italy
| | | | - Diego Gonzalez-Rivas
- Department of Thoracic Surgery, Coruña University Hospital and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain
| | - Joel Dunning
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK
| | - Hui-Ping Liu
- Department of Thoracic Surgery, Chang Gung Memorial Hospital (Linkou), Taiwan, China
| | - Scott J Swanson
- Department of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Inderpal S Sarkaria
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Alan Dart Loon Sihoe
- Honorary Consultant in Cardio-Thoracic Surgery, Gleneagles Hong Kong Hospital, Hong Kong, China
| | - Takeshi Nagayasu
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takuro Miyazaki
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Masayuki Chida
- Department of General Thoracic Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Tadasu Kohno
- Department of Thoracic Surgery, Thoracoscopic Surgery Center, New Tokyo Hospital, Chiba, Japan
| | - Agasthian Thirugnanam
- Agasthian Thoracic Surgery Pte Ltd. 3 Mount Elizabeth #14-12 Mount Elizabeth Medical Centre, Singapore
| | - Harmic J Soukiasian
- Division of Thoracic Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Mark W Onaitis
- Moores Cancer Center, UC San Diego Health - La Jolla, Moores Cancer Center, La Jolla, USA
| | - Chia-Chuan Liu
- Division of Thoracic Surgery, Sun Yat-Sen Cancer Center, Taipei, Taiwan, China
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Lim E, Batchelor T, Shackcloth M, Dunning J, McGonigle N, Brush T, Dabner L, Harris R, Mckeon HE, Paramasivan S, Elliott D, Stokes EA, Wordsworth S, Blazeby J, Rogers CA. Study protocol for VIdeo assisted thoracoscopic lobectomy versus conventional Open LobEcTomy for lung cancer, a UK multicentre randomised controlled trial with an internal pilot (the VIOLET study). BMJ Open 2019; 9:e029507. [PMID: 31615795 PMCID: PMC6797374 DOI: 10.1136/bmjopen-2019-029507] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Lung cancer is a leading cause of cancer deaths worldwide and surgery remains the main treatment for early stage disease. Prior to the introduction of video-assisted thoracoscopic surgery (VATS), lung resection for cancer was undertaken through an open thoracotomy. To date, the evidence base supporting the different surgical approaches is based on non-randomised studies, small randomised trials and is focused mainly on short-term in-hospital outcomes. METHODS AND ANALYSIS The VIdeo assisted thoracoscopic lobectomy versus conventional Open LobEcTomy for lung cancer study is a UK multicentre parallel group randomised controlled trial (RCT) with blinding of outcome assessors and participants (to hospital discharge) comparing the effectiveness, cost-effectiveness and acceptability of VATS lobectomy versus open lobectomy for treatment of lung cancer. We will test the hypothesis that VATS lobectomy is superior to open lobectomy with respect to self-reported physical function 5 weeks after randomisation (approximately 1 month after surgery). Secondary outcomes include assessment of efficacy (hospital stay, pain, proportion and time to uptake of chemotherapy), measures of safety (adverse health events), oncological outcomes (proportion of patients upstaged to pathologic N2 (pN2) disease and disease-free survival), overall survival and health related quality of life to 1 year. The QuinteT Recruitment Intervention is integrated into the trial to optimise recruitment. ETHICS AND DISSEMINATION This trial has been approved by the UK (Dulwich) National Research Ethics Service Committee London. Findings will be written-up as methodology papers for conference presentation, and publication in peer-reviewed journals. Many aspects of the feasibility work will inform surgical RCTs in general and these will be reported at methodology meetings. We will also link with lung cancer clinical studies groups. The patient and public involvement group that works with the Respiratory Biomedical Research Unit at the Brompton Hospital will help identify how we can best publicise the findings. TRIAL REGISTRATION NUMBER ISRCTN13472721.
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Affiliation(s)
- Eric Lim
- Academic Division of Thoracic Surgery, The Royal Brompton and Harefield NHS foundation Trust, London, UK
| | - Tim Batchelor
- Thoracic Surgery, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Michael Shackcloth
- Department of Thoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Joel Dunning
- Department of Thoracic Surgery, The James Cook University Hospital, Middlesbrough, UK
| | - Niall McGonigle
- Department of Thoracic Surgery, Royal Brompton and Harefield, Harefield Hospital, London, UK
| | - Tim Brush
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - Lucy Dabner
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - Rosie Harris
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - Holly E Mckeon
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sangeetha Paramasivan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Daisy Elliott
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Elizabeth A Stokes
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Sarah Wordsworth
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jane Blazeby
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Chris A Rogers
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK
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Zanetto L, Da Dalt L, Daverio M, Dunning J, Frigo AC, Nigrovic LE, Bressan S. Systematic review and meta-analysis found significant risk of brain injury and neurosurgery in alert children after a post-traumatic seizure. Acta Paediatr 2019; 108:1841-1849. [PMID: 30951221 DOI: 10.1111/apa.14810] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 03/19/2019] [Accepted: 04/02/2019] [Indexed: 10/27/2022]
Abstract
AIM This study aimed to determine the frequency of traumatic brain injury (TBI) on neuroimaging and the need for emergency neurosurgery in children with normal mental status following a post-traumatic seizure (PTS). METHODS We searched six electronic databases from inception to October 15, 2018, to identify studies including children under 18 years with head injury and a Glasgow Coma Score of 15 after an immediate PTS. Relevant non-English articles were translated to determine eligibility. RESULTS We performed random effect meta-analyses and assessed heterogeneity with I2 . The pooled estimate of the frequency of TBI, from seven studies, was 13.0% (95% CI: 4.0-26.1; I2 = 81%). Data on the need of emergency neurosurgery were reported in four studies and the pooled estimate of its frequency was 2.3% (95% CI: 0.0-9.9; I2 = 86%). Two studies reported on children with isolated PTS without any other signs of head injury, representing 0.1% of patients in both studies, for a total of 76 children. Of these, only three had TBI and one underwent neurosurgery. CONCLUSION Children with immediate PTS and normal mental status frequently have TBI with a substantial need for neurosurgery. Clinicians should strongly consider neuroimaging for these children, although prolonged observation may be considered for those with isolated PTS.
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Affiliation(s)
- Lorenzo Zanetto
- Division of Emergency Medicine Department of Women's and Children's Health University of Padova Padova Italy
| | - Liviana Da Dalt
- Division of Emergency Medicine Department of Women's and Children's Health University of Padova Padova Italy
| | - Marco Daverio
- Division of Emergency Medicine Department of Women's and Children's Health University of Padova Padova Italy
| | - Joel Dunning
- Department of Cardiothoracic Surgery James Cook University Hospital Middlesbrough UK
| | - Anna Chiara Frigo
- Unit of Biostatistics, Epidemiology and Public Health Department of Cardiac, Thoracic and Vascular Sciences University of Padova Padova Italy
| | - Lise E. Nigrovic
- Division of Emergency Medicine Harvard Medical School Boston Children's Hospital Boston MA USA
| | - Silvia Bressan
- Division of Emergency Medicine Department of Women's and Children's Health University of Padova Padova Italy
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Naruka V, Nardini M, McVie J, Dunning J. The Reamer-Irrigator-Aspirator technique for manubriosternal non-union repair†. Interact Cardiovasc Thorac Surg 2019; 29:327–328. [PMID: 30848816 DOI: 10.1093/icvts/ivz001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 09/17/2018] [Revised: 12/12/2018] [Accepted: 01/06/2019] [Indexed: 11/13/2022] Open
Abstract
Autologous bone graft is used in the treatment of fracture non-unions. A novel approach to treat painful manubriosternal non-unions is described with bone graft harvested from the femur and plating.
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Affiliation(s)
- Vinci Naruka
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK
| | - Marco Nardini
- Department of Thoracic Surgery, University Hospital Policlinico of Catania, Catania, Italy
| | - James McVie
- Department of Trauma and Orthopaedic Surgery, James Cook University Hospital, Middlesbrough, UK
| | - Joel Dunning
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK
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