1,721,007 research outputs found
Validation of a Simulator Set Up Entirely in an Academic Setting: Low-Cost Surgical Trainer Rather than High-Cost Videogame
No full textLaparoscopic surgery is the standard approach for most surgical operations because of its benefits for the patients, although it requires a significant learning curve. For this reason, the FDA established the need for certified laparoscopic training programs, supported by validated surgical simulators. Our multidisciplinary team developed a virtual surgical simulator (eLap4D) based on: a low-cost and a realistic haptic feedback. This study presents the validation process of the eLap4D, performed through the construct and face validities.The authors preliminarily analyzed and excluded the possible impact of videogame experience on eLap4D users. The construct validity was used to objectively assess the surgical value of five basic skills by comparing the performances between two groups with different levels of laparoscopy experience. The presence of a learning curve was also evaluated by comparing the results of the first and second attempts. The difference among exercises was investigated in terms of the difficulty and kind of basic gestures, comparing the completion rates of every task in the three difficulty levels each. Face validation was performed using a specific questionnaire investigating the realism and accuracy of the simulator. This last survey was administered only to experienced surgeons. The validation process indicated that eLap4D can measure surgical ability and not just videogame experience. It also positively affects the learning curve and reproduces different basic gestures and levels of difficulty. Face validity confirmed that its structural features and ergonomics are satisfactory. In conclusion, eLap4D seems suitable and useful for learning basic laparoscopy skills
Postoperative follow up in patients showing no evident residual disease - Cut-offs for imaging/ intervention
No full textThe European Group generally agrees with the American guidelines on the issue of the indications for additional surgery in patients with recurrence of medullary thyroid cancer. The discussions have been focused mainly on the postoperative follow-up, where some European experts feel that a postoperative calcitonin-stimulating test is of some importance in assigning the patient to the "Cured" or "Non-cured" group immediately after surgery. A part of the European group feels that a negative calcitonin-stimulating test might lead to a less intensive follow-up in the late follow-up of these patients
Proteomics, and metabolomics: magnetic resonance spectroscopy for the presurgical screening of thyroid nodules.
No full textWe review the progress and state-of-the-art applications of studies in Magnetic Resonance Spectroscopy (MRS) and Imaging as an aid for diagnosis of thyroid lesions of different nature, especially focusing our attention to those lesions that are cytologically undetermined. It appears that the high-resolution of High-Resolution Magic-Angle-Spinning (HRMAS) MRS improves the overall accuracy of the analysis of thyroid lesions to a point that a significant improvement in the diagnosis of cytologically undetermined lesions can be expected. This analysis, in the meantime, allows a more precise comprehension of the alterations in the metabolic pathways induced by the development of the different tumors. Although these results are promising, at the moment, a clinical application of the method to the common workup of thyroid nodules cannot be used, due to both the limitation in the availability of this technology and the wide range of techniques, that are not uniformly used. The coming future will certainly see a wider application of these methods to the clinical practice in patients affected with thyroid nodules and various other neoplastic diseases
Thyroidectomy - Minimally Invasive Video-Assisted Thyroidectomy (MIVAT)
No full textThe more frequent early diagnosis of thyroid nodules and small thyroid cancers has made minimally invasive surgical techniques possible and such techniques are requested by many patients. Since the early 2000’s, several minimally invasive surgical techniques have been used to limit the length of the cervical incision, with questionable improvement in the cosmetic results. Several of the formerly recommended endoscopic approaches, have been abandoned, and remote access, surgery is currently only recommended by a few surgeons. It is generally agreed upon that many of these operative techniques use small incisions but require more extensive surgery and therefore cannot be considered “minimally invasive” for several reasons: (a) the considerably longer operative time required since all the endoscopic techniques, and the robotic transaxillary technique, require more time to reach the thyroid gland from a remote access. (b) the extensive dissection required to reach the neck (contradictory to the definition itself of what should be a “minimally invasive” surgical technique), and (c) the questionable cosmetic improvement when compared to the traditional thyroidectomy since the endoscopic techniques require three to five small incisions in the neck. Many of these minimally invasive techniques are only done by a few surgeons who initially proposed these techniques so that other surgeons may not achieve the same excellent results. Jean-Francois Henry, in 2006, proposed the main requirements that a surgical technique should follow to be considered “Minimally Invasive”: (a) the incision should be less than 3 cm, in the neck (direct approach), (b) the surgery should be assisted by an endoscope, to have the benefit of a magnified field, and thus, better vision. With these principles in mind, it is clear that not all of the new techniques described for thyroidectomy adhere to this definition: an operation can be “scarless” in the neck, robotic, or endoscopic, but these operations are not “minimally invasive” from our point of view. The two techniques that comply with this more strict definition are therefore the endoscopic lateral approach described by J.F. Henry, and the Minimally Invasive Video-Assisted Thyroidectomy (MIVAT), created by two separate Italian teams in the late ‘90s. This chapter explores the indications for MIVAT techniques and illustrates its surgical details. We believe that MIVAT is at present the most widely used minimally invasive technique for thyroid resections
Incidence of Morbidity Following Thyroid Surgery: Acceptable Morbidity Rates
No full textThyroid complications and power analysis. The issue of complications of thyroid surgery is extremely difficult to consider due to the relative rarity of the complications themselves, when thyroidectomy is performed by an experienced surgeon. Almost every study present in the literature reports the morbidity following thyroidectomy but there are only a few specifically addressing this issue, and the results are generally obtained from a statistical analysis that is not thorough: the rarity of the complication event would need studies performed on large numbers of patients. This chapter will focus on two main issues: analysing, from the results reported in the literature, what is a ‘reasonable’ incidence rate of complications for any surgeon performing thyroidectomies, and not necessarily operating in a large-volume thyroid surgery department, and briefly examining the most important statistical problems regarding the analysis of a rare event, such as the morbidity after thyroid surgery, when performing a reliable study on complications
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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