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Wu W, Luo Z, Fang Y, Yu L, Lin N, Yang J, Zhao H, Xiao C, Wang Y. Preoperative ultrasound-guided dual localization with titanium clips and carbon nanoparticles for predicting the surgical approach and guiding the resection of Siewert type II esophagogastric junction adenocarcinoma. J Cancer Res Clin Oncol 2024; 150:145. [PMID: 38507110 PMCID: PMC10954912 DOI: 10.1007/s00432-024-05689-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/05/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE To investigate the superiority of preoperative ultrasound-guided titanium clip and nanocarbon dual localization over traditional methods for determining the surgical approach and guiding resection of Siewert type II adenocarcinoma of the esophagogastric junction (AEG). METHOD This study included 66 patients with Siewert type II AEG who were treated at the PLA Joint Logistics Support Force 900th Hospital between September 1, 2021, and September 1, 2023. They were randomly divided into an experimental group (n = 33), in which resection was guided by the dual localization technique, and the routine group (n = 33), in which the localization technique was not used. Surgical approach predictions, proximal esophageal resection lengths, pathological features, and the occurrence of complications were compared between the groups. RESULT The use of the dual localization technique resulted in higher accuracy in predicting the surgical approach (96.8% vs. 75.9%, P = 0.02) and shorter proximal esophageal resection lengths (2.39 ± 0.28 cm vs. 2.86 ± 0.39 cm, P < 0.001) in the experimental group as compared to the routine group, while there was no significant difference in the incidence of postoperative complications (22.59% vs. 24.14%, P = 0.88). CONCLUSION Preoperative dual localization with titanium clips and carbon nanoparticles is significantly superior to traditional methods and can reliably delineate the actual infiltration boundaries of Siewert type II AEG, guide the surgical approach, and avoid excessive esophageal resection.
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Affiliation(s)
- Weihang Wu
- Department of General Surgery, Fuzong Clinical Medical College of Fujian Medical University, 900th Hospital of Joint Logistics Support Force, PLA, Fuzhou, China
| | - Ziqiang Luo
- Department of General Surgery, Dongfang Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Yongchao Fang
- Department of General Surgery, Fuzong Clinical Medical College of Fujian Medical University, 900th Hospital of Joint Logistics Support Force, PLA, Fuzhou, China
| | - Li Yu
- Department of Gastroenterology, Fuzong Clinical Medical College of Fujian Medical University, 900th Hospital of Joint Logistics Support Force, PLA, Fuzhou, China
| | - Nan Lin
- Department of General Surgery, Fuzong Clinical Medical College of Fujian Medical University, 900th Hospital of Joint Logistics Support Force, PLA, Fuzhou, China
| | - Jin Yang
- Department of General Surgery, Fuzong Clinical Medical College of Fujian Medical University, 900th Hospital of Joint Logistics Support Force, PLA, Fuzhou, China
| | - Hu Zhao
- Department of General Surgery, Fuzong Clinical Medical College of Fujian Medical University, 900th Hospital of Joint Logistics Support Force, PLA, Fuzhou, China
| | - Chunhong Xiao
- Department of General Surgery, Fuzong Clinical Medical College of Fujian Medical University, 900th Hospital of Joint Logistics Support Force, PLA, Fuzhou, China
| | - Yu Wang
- Department of General Surgery, Fuzong Clinical Medical College of Fujian Medical University, 900th Hospital of Joint Logistics Support Force, PLA, Fuzhou, China.
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Faddoul A, de la Jonquière C. [Anaesthesia during COVID-19 epidemic]. ACTA ACUST UNITED AC 2020; 24:181-5. [PMID: 32843845 DOI: 10.1016/j.pratan.2020.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Au décours de la pandémie de COVID-19, la reprise de l’activité chirurgicale s’est traduite par une complexification des circuits de prise en charge des patients liée au risque de propagation de l’infection. La prise en charge des patients porteurs du virus SARScoV-2 impose plusieurs modifications contraignantes qui font également évoluer les pratiques. Il en est ainsi du développement de la télé-consultation mais aussi aux mesures de distanciation sociales pour les consultations présentielles. Les recommandations actuelles sont d’orienter le dépistage des patients opérés en fonction d’une pré-selection prenant en compte la possibilité de signes cliniques, de contact avec une personne infectée et la lourdeur du geste chirurgical. En fonction, l’intervention peut être reportée ou le patient peut être intégré dans un circuit individualisé et la conduite de l’anesthésie peut être modifiée.
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Abstract
Outpatient surgery has become a national policy priority set by health care authorities (targets for more than 70% of outpatient procedures by 2022), making ambulatory hospitalization the new standard of care. This practice introduces new risks along the patient's course. Even though these risks are low and although the literature and data from insurance databases is reassuring, the risks in outpatient surgery remain poorly understood. Risks can be organizational in view of the many stages of the patient journey that must be formalized-medical, anesthetic or surgical-in view of planned discharge the same evening as the procedure, and medico-legal because of the importance of the discharge authorization and the information provided to the patient. A risk management approach (a priori or a posteriori) has become a mandatory part of a policy of continuous quality improvement and safety of care. The coordination of all the team members (surgeon, anesthesiologist, nursing and administrative staff and the patient's accompanying person) as well as the patient's active participation are essential to minimize risks and prevent complications.
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Thomas A, Murtaza AN, Michael Spiers HV, Zargaran A, Turki M, Mathur J, Fukui A, Zargaran D, Khan O. Declining interest in general surgical training - Challenging misconceptions and improving access at undergraduate level. Ann Med Surg (Lond) 2018; 40:3-8. [PMID: 30962923 PMCID: PMC6423304 DOI: 10.1016/j.amsu.2018.11.002] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 10/30/2018] [Accepted: 11/01/2018] [Indexed: 11/29/2022] Open
Abstract
Background In recent years, general surgery has faced a decline in applicants for postgraduate training. The St. George's Surgical Society hosted a national surgical conference with an aim to explore the reasons for the decline and to investigate the effectiveness of a one-day intervention on students' perceptions of general surgery and surgical skills. Materials and methods The conference took place on 20th January 2018 at St. George's, University of London. During the conference, medical students received lectures on "careers in surgery" and small-group workshops introducing students to simulation-based laparoscopic machines. Delegates were invited to complete before and after questionnaires looking at various domains; (1) Perceptions of general surgery, (2) Simulation skills, and (3) Usefulness of the day. Results There were significant impacts on student perceptions of the speciality such as increases in the views that "general surgery contained the opportunities for personal and professional development" (26%, p = 0.04), and of "general surgery as a rewarding speciality" (26%, p = 0.05). There were also negative changes such as an increase in the perception that "general surgery is female unfriendly" (+32%, p = 0.01). There were positive findings in all aspects relating to the use of laparoscopic simulation. Discussion The challenges faced in improving access to general surgery has been highlighted. More importantly the benefits of a one day intervention in addressing misconceptions and improving knowledge was seen. This study also shows the benefits of simulation teaching in the undergraduate curriculum. Conclusion The intervention has improved the perceptions on general surgery, surgical skills and knowledge and provided a platform for engaging students and clinicians.
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Affiliation(s)
- Amal Thomas
- St. George's, University of London, London, UK
| | | | | | | | | | - Jai Mathur
- St. George's, University of London, London, UK
| | - Akiko Fukui
- St. George's, University of London, London, UK
| | - David Zargaran
- Academic Foundation Doctor, Imperial College Healthcare NHS Trust, London, UK
| | - Omar Khan
- St. George's University Hospital NHS Trust, London, UK
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Abstract
The case for radical pathway re-design before surgery is in part driven by healthcare system pressures which are in turn the result of continuously rising demand in the face of tightly constrained resources. Such circumstances tend to drive revolutionary, rather than incremental, change. The current approach to preoperative assessment, that typically occurs in the weeks leading up to surgery, but is all too often only a few days before surgery, results in a lost opportunity for perioperative physicians to improve patient care. Re-engineering this process based on a patient-focused, pathway-driven vision of perioperative medicine offers a means of exploiting this opportunity. This review explores drivers for change, the opportunity offered by pathway re-design, and suggests a variety of strategies to add value in the preoperative pathway, each of which is facilitated by early engagement between perioperative physician and patient: collaborative decision-making, collaborative behavioural change, targeted comorbidity management as well as expectation management and psychological preparation for surgery including surgery schools.
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Affiliation(s)
- Michael P W Grocott
- Anaesthesia and Critical Care Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Critical Care Research Area, NIHR Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,GICU, Mailpoint 27, D Level, Centre Block, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, Hampshire SO16 6YD UK
| | - James O M Plumb
- Anaesthesia and Critical Care Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Critical Care Research Area, NIHR Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,Department of Anaesthesia, E Level, Centre Block, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, Hampshire SO16 6YD UK
| | - Mark Edwards
- Anaesthesia and Critical Care Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Critical Care Research Area, NIHR Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,Department of Anaesthesia, E Level, Centre Block, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, Hampshire SO16 6YD UK
| | - Imogen Fecher-Jones
- Anaesthesia and Critical Care Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Critical Care Research Area, NIHR Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Department of Anaesthesia, E Level, Centre Block, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, Hampshire SO16 6YD UK
| | - Denny Z H Levett
- Anaesthesia and Critical Care Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Critical Care Research Area, NIHR Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,GICU, Mailpoint 27, D Level, Centre Block, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, Hampshire SO16 6YD UK
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