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Li YR, Ji R, Ren HB. Endoscopic management of post-cholecystectomy clip migration in biliary and gastrointestinal tract: A multicenter retrospective case series study. Asian J Surg 2024:S1015-9584(24)00459-7. [PMID: 38494352 DOI: 10.1016/j.asjsur.2024.03.032] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 03/01/2024] [Indexed: 03/19/2024] Open
Affiliation(s)
- Ying-Rui Li
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shan。dong Province, China
| | - Rui Ji
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shan。dong Province, China; Laboratory of Translational Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong Province, China; Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI Tumor, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, China.
| | - Hong-Bo Ren
- Department of Gastroenterology, Qilu Hospital of Shandong University Dezhou Hospital, Dezhou, 253000, Shandong, China.
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2
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Rinaldo L, Meyer FB, Van Gompel JJ. Use of Sundt Clip Graft for the Treatment of Intracranial Aneurysms: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 20:E362. [PMID: 33646307 DOI: 10.1093/ons/opab056] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 10/23/2020] [Indexed: 11/13/2022] Open
Abstract
Dr Thoralf Sundt III joined the department of neurosurgery at Mayo Clinic in 1969 and served as chairman from 1980 until his death in 1992. Dr Sundt was a pioneer in the field of cerebrovascular neurosurgery and among his many contributions to neurosurgical technology was the introduction of the Sundt clip graft (Codman, Raynham, Massachusetts), which was developed in partnership with Dr George Kees. This device is a vessel-encircling Teflon or Dacron graft loaded on a circular metallic spring initially designed to repair injuries to vessel walls during intracranial aneurysm surgery,1 which was not an uncommon complication resulting from the use of contemporary aneurysm clips.2 When used for this purpose, the clip graft has demonstrated both safety and efficacy in a modern series of surgical treatment of intracranial aneurysm.3 An additional application of the clip graft is the direct clipping of aneurysms, particularly side-wall aneurysms, though Dr Sundt recognized that the potential to occlude perforating arteries adjacent to the aneurysm neck would limit the general use of the clip graft for aneurysm clipping.2 In the following video, we present archival footage of Dr Sundt utilizing the Sundt clip graft during intracranial aneurysm surgery. The 3 cases are of the treatment of posterior communicating, middle cerebral, and anterior communicating artery aneurysms and depict the potential applications of the clip graft during aneurysm surgery. We also present footage of animal experiments Dr Sundt performed to validate the use of the clip graft. This footage likely represents some of the first microscopic neurosurgical recordings ever made. The patients consented to the procedure and to presentation of video recordings at the time of initial surgery. Image of Sundt at 0:11, Reproduced with permission from the American Association of Neurological Surgeons, 5550 Meadowbrook Dr, Rolling Meadows, IL 60008. Figures at 2:26 and 2:28, from Park PJ, Meyer FB, The Sundt clip graft, Neurosurgery, 2010;66(6 suppl operative):300-305, by permission of the Congress of Neurological Surgeons. Figure at 2:35, ©2009 Mayo, Clingman. Used with permission.
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Affiliation(s)
- Lorenzo Rinaldo
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Fredric B Meyer
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jamie J Van Gompel
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
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Aldosary G, Caudrelier JM, Arnaout A, Chang L, Tse T, Foottit C, Song J, Belec J, Vandervoort E. Can we rely on surgical clips placed during oncoplastic breast surgery to accurately delineate the tumor bed for targeted breast radiotherapy? Breast Cancer Res Treat 2021; 186:343-352. [PMID: 33484375 DOI: 10.1007/s10549-020-06086-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 12/29/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Oncoplastic breast surgery (OBS) is gaining popularity among surgeons for breast-conserving surgery treatments. OBS relies on complex relocation and deformation of breast tissue involving the tumor bed (TB). In this study, we investigate the validity of using surgical clips with OBS for accurate TB delineation in adjuvant, targeted breast radiotherapy. METHODS Different OBS techniques were simulated on realistic breast phantoms. Surgical clips were used to demarcate the TB. Following tumor resection and closure, the true TB (TBTrue) was extracted. Each phantom was CT imaged at several phases of surgery in order to record pre- and post-OBS closure surgical clip displacements. Two senior radiation oncologists (ROs) were asked to delineate TBs on CTs by relying on surgical clips placed as per standard protocol, and by referring to operative notes. Their original contours, as well as those expanded using 5-15 mm margins, were compared with the accurate TBTrue using the dice similarity coefficient (DSC), Hausdorff Distance (HD), and over- and under-contoured volumes. Inter- and intra-RO contour agreements were also evaluated. RESULTS Post-OBS surgical clips were significantly displaced outside the original breast quadrant. Inter- and Intra-RO TB contours were consistent, yet systematically differed from TBTrue (DSC values range = 0.38 to 0.69, and maximum HD range = 17.8 mm to 38.0 mm). Using expansion margins did not improve contour congruence and caused significant over-contoured volumes. CONCLUSION Following OBS, surgical clips alone are not reliable radiographic surrogates of TB locations and accurate TB delineation is challenging. For complex OBS cases, indication of any type of partial breast irradiation is very questionable.
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Affiliation(s)
- Ghada Aldosary
- Department of Physics, Carleton University, Ottawa, ON, Canada. .,Radiation Oncology Section, Department of Oncology, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia.
| | - Jean-Michel Caudrelier
- Department of Radiation Medicine, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada.,Department of Radiology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Angel Arnaout
- Department of Surgery, The University of Ottawa, Ottawa, ON, Canada.,Department of General Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Lynn Chang
- Department of Radiation Medicine, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada.,Department of Radiology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Tabitha Tse
- Department of Surgery, The University of Ottawa, Ottawa, ON, Canada
| | - Claire Foottit
- Department of Radiology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Department of Medical Physics, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | - Jiheon Song
- Department of Radiation Medicine, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | - Jason Belec
- Department of Radiology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Department of Medical Physics, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | - Eric Vandervoort
- Department of Radiology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Department of Medical Physics, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
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Liebl M, Schulze-Hagen M, Zimmermann M, Pedersoli F, Kuhl C, Bruners P, Isfort P. Microwave Ablation in the Proximity of Surgical Clips: Is there a Safety Issue? Cardiovasc Intervent Radiol 2020; 43:918-923. [PMID: 32236668 PMCID: PMC7225190 DOI: 10.1007/s00270-020-02453-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/25/2019] [Accepted: 03/12/2020] [Indexed: 12/22/2022]
Abstract
Purpose The purpose of this study was to evaluate the heat generation of surgical clips within the target area of MWA and the influences on the ablation volume. Materials and Methods In bovine liver tissue, 42 ex vivo microwave ablations (60 W; 180 s) were performed. During ablation, the temperature was measured continuously at 4 points of interest (POI), in a distance of 7.5 and 15 mm on each side of the microwave antenna, with a titanium surgical placed at one 7.5-mm POI. Ablation volumes containing large vessels (n = 10) were excluded. For every POI, the mean temperature of 32 ablations was calculated. The mean temperatures were compared between the 4 POI and statistically analyzed using the Student’s t test. Results The mean maximum temperatures at the side of the clip were 88.76 °C/ 195 s and 52.97 °C/ 195 s and at the side without clip 78.75 °C/ 195 s and 43.16 °C/ 195 s, respectively, at POI 7.5 mm and POI 15 mm. The maximum difference of mean temperatures for POI 7.5 mm was 12.91 °C at 84 s (p = 0.022) and for POI 15 mm 9.77 °C at 195 s (p = 0.009). No significant changes in size and shape of the ablation zone could be determined. Conclusions Our study demonstrated significantly higher temperatures adjacent to surgical clips. Also, the temperatures distal to the titanium clip were higher compared to the control location without clip. These findings suggest an increased risk of thermal damage to surrounding tissues during MWA, especially in case of immediate contact to surgical clips.
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Affiliation(s)
- Martin Liebl
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.,Hôpital Kirchberg (Hôpitaux Robert Schuman), 9, Rue Edward Steichen, 2540, Luxembourg, Luxembourg
| | - Maximilian Schulze-Hagen
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Markus Zimmermann
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Federico Pedersoli
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Christiane Kuhl
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Philipp Bruners
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Peter Isfort
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
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Demircioglu O, Aribal E, Uluer M, Ozgen Z, Demircioglu F. Surgical Clips in Breast-conserving Surgery: Do they Represent the Tumour Bed Accurately? Curr Med Imaging 2020; 15:573-577. [PMID: 32008565 DOI: 10.2174/1573405614666180821121254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 08/05/2018] [Accepted: 08/10/2018] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Radiotherapy after Breast-Conserving Surgery (BCS) is a standard treatment for breast cancer. Currently, surgical clips are used to determine the tumour bed before radiotherapy planning. This study aimed to evaluate the migration of these clips on mammograms. METHODS The study was conducted on 121 females who were treated with radiotherapy after BCS at their first radiologic control examination 6 months after the end of treatment. MLO and CC views of all cases were evaluated regarding the clips. The distance between the surgical scar centre and the centre of the area covered by the clips was measured on both MLO and CC projections and recorded separately. This distance was determined as the clip displacement. A displacement ≤10 mm was recorded as no displacement. RESULTS The clips were out of the images and were not evaluated in 45 cases (37.2%) on CC and in 9 cases (7.4%) on MLO projections. There were no clip displacements in 37 (30.6%) cases on CC and in 43 (35.5%) cases on MLO views. The amount of displacement ranged from 11 to 56 mm with a mean of 24.38 mm on CC views, while on MLO projections, displacement ranged from 11 to 66 mm with a mean of 24.42 mm. CONCLUSION A clip displacement of greater than 10 mm was found in 64.5% of cases on MLO views. Therefore, we believe that the reliability of these clips for accurate delineation of the tumour bed in radiotherapy planning is controversial and other methods must be added.
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Affiliation(s)
| | - Erkin Aribal
- Department of Radiology, Marmara University, Istanbul, Turkey
| | - Meral Uluer
- Department of Radiology, Marmara University, Istanbul, Turkey
| | - Zerrin Ozgen
- Department of Radiation Oncology, Marmara University, Istanbul, Turkey
| | - Fatih Demircioglu
- Department of Radiation Oncology, Kartal Dr. Lutfi Kırdar Education and Research Hospital, Istanbul, Turkey
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Corrao G, Rojas DP, Ciardo D, Fanetti G, Dicuonzo S, Mantovani M, Gerardi MA, Dell'Acqua V, Morra A, Fodor C, Galimberti VE, Veronesi P, Cattani F, Orecchia R, Jereczek-Fossa BA, Leonardi MC. Intra- and inter-observer variability in breast tumour bed contouring and the controversial role of surgical clips. Med Oncol 2019; 36:51. [PMID: 31037520 DOI: 10.1007/s12032-019-1273-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 03/11/2019] [Accepted: 04/17/2019] [Indexed: 10/26/2022]
Abstract
The purpose of this study was to evaluate whether the visualization of surgical clips (SCs) on the same set of planning computed tomography (CT) of breast cancer (BC) patients influences agreement on tumour bed (TB) delineation. Planning CT (CTorig) of 47 BC patients with SCs to visualize the TB was processed in order to blur SCs and create a virtual CT (CTmod). Four radiation oncologists (ROs, 2 juniors and 2 seniors) contoured TB on both the CT sets. Centre of mass distance (CMD), percentage overlap as Dice similarity coefficient (DSC), surface distance as average Hausdorff distance (AHD) and TB volume size were analysed. The intra-observer variability when contouring TB with and without SCs was statistically significant (p-values = 0.016, 0.0002 and ≪ 0.001 for CMD, AHD and DSC, respectively). Junior ROs showed worse reproducibility compared to seniors. The median DSC was < 0.7. The inter-observer variability with and without SCs was statistically significant (p < 0.001) for all metrics, with an increase of 48.7% in DSC and decrease of 50.7% and 57.1% in CMD and AHD, respectively, as relative median values, when SCs were visible. Regarding TB volumes, when SCs were visible, the intra-observer analysis revealed that 3/4 ROs delineated larger volumes, especially juniors. The inter-observer analysis showed that, in presence of visible SCs, the difference in TB volume among all the ROs fell from statistically significant to borderline significance (p = 0.052). TB contouring is confirmed to be an observer-dependent task. SCs decreased the intra and inter-observer variability but the overall agreement between ROs remained low.
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Affiliation(s)
- Giulia Corrao
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Damaris Patricia Rojas
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Delia Ciardo
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Giuseppe Fanetti
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Samantha Dicuonzo
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy.
| | - Marinella Mantovani
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Marianna Alessandra Gerardi
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Veronica Dell'Acqua
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Anna Morra
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Cristiana Fodor
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | | | - Paolo Veronesi
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Federica Cattani
- Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Roberto Orecchia
- Scientific Direction, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Maria Cristina Leonardi
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
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de Freitas TB, Lopes de Barros Lima KM, de Andrade Carvalho H, de Azevedo Marques P, Belfort Mattos FT, Franco Fonseca AS, Munhoz AM, Filassi JR, Stuart SR, Marta GN. What a difference a clip makes! Analysis of boost volume definition in radiation therapy for conservative breast surgery. Eur J Surg Oncol 2018; 44:1312-1317. [PMID: 30041975 DOI: 10.1016/j.ejso.2018.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 01/24/2018] [Revised: 05/04/2018] [Accepted: 06/11/2018] [Indexed: 12/25/2022] Open
Abstract
PURPOSE/OBJECTIVE(S) To evaluate the role of surgical clips placement in the definition of boost treatment volume. MATERIALS/METHODS Clinical Target Volumes (CTV) were defined as: CTV Breast, CTV Quadrant (based on physical exam and pre-surgical images), CTV Boost, defined by clip plus margin (1 cm for 2 or more clips and 2 cm for 1 clip only) plus radiological changes, CTV NT (normal tissue), defined by CTV Quadrant minus CTV Boost and CTV MISS (CTV that would be outside the treatment volume), defined by CTV Boost minus CTV Quadrant. RESULTS A total of 247 patients were included. Upper lateral quadrant was the most common clinical location (47.3%). The median number of clips used was three. The mean volumes were: CTV Breast:982.52 cc, CTV Boost:36.59 cc, CTV Quadrant:285.07 cc, CTV NT:210.1 cc and CTV MISS:13.57 cc. Only 50.6% (125) of the patients presented the CTV Boost completely inside the CTV Quadrant and in 47.3% (117), partially inside. Among patients with any CTV MISS, 80.3% (98) had 10% or more of CTV Boost outside the treatment volume. Regarding CTV MISS, there were no statistically significant differences between the groups with 1 clip versus 2 or more clips, nor between patients with or without reconstructive surgery. In average, the CTV Boost was 87% smaller than the CTV Quadrant. The whole quadrant irradiation would lead to unnecessary irradiation of 26% of normal breast tissue. CONCLUSION Surgical bed clipping is up most important in the definition of the boost volume irradiation to ensure precision minimizing geographical miss and optimizing surrounding normal tissue sparing.
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Affiliation(s)
- Thiago Brasileiro de Freitas
- Department of Radiology and Oncology, Division of Radiation Oncology, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil.
| | | | - Heloísa de Andrade Carvalho
- Department of Radiology and Oncology, Division of Radiation Oncology, Instituto de Radiologia (INRAD), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Department of Radiation Oncology, Hospital Sírio-Libanês, Sao Paulo, Brazil.
| | - Patricia de Azevedo Marques
- Department of Plastic Surgery, Division of Breast Reconstruction, Cancer Institute of São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | - Fabio Teixeira Belfort Mattos
- Department of Plastic Surgery, Division of Breast Reconstruction, Cancer Institute of São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | - Alexandre Siqueira Franco Fonseca
- Department of Plastic Surgery, Division of Breast Reconstruction, Cancer Institute of São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | - Alexandre Mendonça Munhoz
- Department of Plastic Surgery, Division of Breast Reconstruction, Cancer Institute of São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Division of Plastic Surgery, Hospital Sírio-Libanês, São Paulo, Brazil.
| | - José Roberto Filassi
- Department of Obstetrics and Gynecology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | - Silvia R Stuart
- Department of Radiology and Oncology, Division of Radiation Oncology, Instituto de Radiologia (INRAD), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | - Gustavo Nader Marta
- Department of Radiology and Oncology, Division of Radiation Oncology, Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil; Department of Radiation Oncology, Hospital Sírio-Libanês, Sao Paulo, Brazil.
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