98 research outputs found
Risk factors and impact of conversion from VATS to open lobectomy: analysis from a national database.
No full textOBJECTIVE:
The objective of the study is to analyse the causes and impact of conversion from VATS to thoracotomy identifying any possible pre-operative risk factors and related consequences.
METHODS:
Data from patient who underwent VATS lobectomy (VATS-L) for NSCLC at VATS Group participating centres were retrospectively analysed and divided in two groups: patients treated with VATS-L and patients who suffered from conversion. Predictors of conversion were assessed with univariate and multivariable exact logistic regression. Complications were evaluated as dependent variables of conversion in a Cox multivariable logistic regression model.
RESULTS:
A total of 4629 patients underwent planned VATS-L for NSCLC and of these, 432 (9.3%) required conversion; the most frequent causes were bleeding (30.4%) and fibro-calcified hilar lymph nodes (23.9%). The independent risk factors at multivariable analysis model were sex male (OR 1.458, p < 0.01), age older than 70 years (OR 1.248, p = 0.036) and the clinically node-positive disease (OR 2.258, p < 0.01). The mortality rate was similar, but the percentage of patients who suffered from any complication (41.7% vs 24.4%, p < 0.01), the complication rate (65% vs 32.2%, p < 0.01), chest tube duration (p < 0.01) and the hospitalisation rate (p < 0.01) were higher for patients converted. Atrial fibrillation (OR 1.471, p = 0.019), prolonged air leak (OR 1.403, p = 0.043), blood transfusions (OR 4.820, p < 0.01), sputum retention (OR 1.80, p = 0.027) and acute kidney failure (OR 2.758, p = 0.03) were significantly associated with conversion at multivariable analysis.
CONCLUSIONS:
Conversion is associated with increased surgical morbidity, blood loss and hospital stay. Sex male, old age and the clinical involvement of lymph nodes were the strongest predictors of conversio
Surgeon-Powered Robotics: Left Upper Lobectomy With Fully Wristed VATS Instruments
No full textThis video demonstrates the first VATS Left upper lobectomy using ArtiSential® wristed instruments.For the first time in VATS, there are now instruments that are as versatile as robotic instruments. These instruments have the additional advantage of tactile feedback, the ability to do one’s own staple firings, and allow the surgeon to be with the patient in case of emergencies. It is also much cheaper than current robotic systems.The author calls this “surgeon-powered robotics” because they can now achieve robotic-style surgery without any automation, and it includes full range of movement coming from the surgeon. The author also endeavors to use an automated camera holder to further close the gap between robotics and VATS. More videos will come as they continue to use these exciting instruments.DisclosureJoel Dunning received these instruments for free from the company.</p
COLOR OF CREATORSHIP - Author\u27s Response
No full textThis essay is the author\u27s response to three reviews of The Color of Creatorship written by notable intellectual property scholars and published in the IP Law Book Review
Correction to: Predictors of nodal upstaging in patients with cT1-3N0 non-small cell lung cancer (NSCLC): results from the Italian VATS Group Registry (Surgery Today, (2020), 50, 7, (711-718), 10.1007/s00595-019-01939-x)
No full textIn the original publication, Carlo Curcio was not included in the author list. The correct author list is included in this Correction. Also an Appendix listing VATS author group is included in this correction
Optimization and standardization of computed tomography perfusion and development of low radiation exposure CT perfusion alternative for clinical applications in oncologic imaging
No full textThe pancreas located in abdominal cavity of the human body, plays essential role in digestion and blood sugar regulation. Various medical conditions such as pancreatic tumors or cystic lesions can disrupt its normal functioning. CT perfusion is the most commonly used functional imaging technique in diagnosing these tumors. However, its widespread adoption in clinical practice has been limited by several challenges. One significant obstacle is the absence of standardized protocols for image acquisition. Moreover, image noise can negatively impact perfusion measurements, resulting in inaccuracies when quantifying tissue perfusion, thereby compromising it’s clinical effectiveness. Efforts to mitigate image noise and improve image quality are essential to enhance the accuracy of CT perfusion measurements. Another critical limitation of CT perfusion is the associated radiation exposure, which poses risks to patients, particularly in vulnerable populations such as children and pregnant women.
The objective of this thesis was to conduct a comprehensive meta-analysis of CT perfusion within the context of pancreatic research articles. This involves collecting and analyzing a large number of published research articles related to pancreatic CT perfusion, with a focus on including studies that report quantitative perfusion parameters derived from CT perfusion. Furthermore, the aim was to identify acquisition parameters that influence quantitative measurements, facilitating standardization of those parameters. Additionally, noise correction algorithm was developed using digital perfusion phantoms to mitigate the negative impact of image noise on BF perfusion measurements. Further, for reducing radiation exposure and acquisition time of CT perfusion, a novel perfusion technique namely, FPA was implemented. FPA model was validated using the most commonly used CT perfusion model, MSM. In contrast to CT perfusion using multiple volume acquisitions, FPA uses only two volume acquisitions. The timing for these two volume acquisitions was estimated and optimized based on the information about contrast agent injection. The reduction in number of volume acquisitions reduces the radiation dose, hence, overcoming one of the critical limitations of CT perfusion.
The meta-analysis findings indicated an upward trend in number of CT perfusion studies and sample size since 2009. Furthermore, there was an increase in amount of contrast agent and iodine levels used over the years. The tube potential showed a slight decrease, while tube current-time product increased gradually. Anatomical coverage expanded, and slice thickness decreased over time. Most studies reported significant differences in BF and BV between normal pancreatic tissue and pathological conditions. However, the findings for permeability were less consistent, with only about half of the studies showing significant differences. Additionally, most research studies preferred vendor-supplied software for post-processing, and MSM is the most commonly used model to quantify pancreatic perfusion. It has been found that certain CT acquisition parameters had statistically significant effect on quantitative perfusion measurements, particularly when comparing normal versus pathological pancreatic tissue.
The findings from noise correction algorithm demonstrated a significant improvement in the accuracy of BF measurements. Detailed analysis of GTBF, noiseimpacted BF, and corrected BF values across various tissue regions showed the efficacy of noise correction in mitigating the adverse effects of noise on BF perfusion measurements, leading to more precise quantification of tissue perfusion. Moreover, the observed enhancements in CNR and agreement between GTBF and noise-corrected BF measurements further underscored the utility of noise-correction algorithms in refining BF measurements.
The results from FPA technique demonstrated a strong correlation in perfusion measurements when compared to the reference method, MSM. Small COV and box plot analysis revealed reduced BF variation over acquisition time, particularly in parenchyma tissue. Therefore, a high correlation to MSM could be achieved depending upon selection of acquisition time within the optimum time range. Variations across tissue types were statistically significant, emphasizing the discriminative capabilities of FPA. Moreover, FPA exhibited advantages in terms of reduced radiation exposure and acquisition times compared to conventional CT perfusion techniques.
For clinical application of FPA, the process begins with intravenous injection of a nonionic iodinated contrast agent, followed by a bolus of saline solution (NaCl). Specifically for pancreatic imaging, first volume scan is to be acquired after contrast agent bolus reaches a threshold of 120 HU in the abdominal aorta, which can be precisely achieved by bolus tracking. Subsequently, the second volume scan is planned after a delay ranging from 15.5 to 20.0 seconds, based on the findings of current thesis.
In conclusion, this thesis has addressed critical challenges of CT perfusion, emphasizing the need for standardization of protocols, the impact of image noise, and concerns related to radiation exposure. The development and application of the noise correction algorithm and FPA technique represent significant steps toward making CT perfusion scans more clinically acceptable
The impoverished representations of brains in vats
No full textIn this article, the notion that brains in vats with perceptual experiences of the same type as ours could perceptually represent other entities than shapes is challenged. Whereas it is often held that perceptual experiences with the same phenomenal character as ours could represent computational properties, the present author argues that this is not the case for shapes. His argument is in brief that the phenomenal character of a normal visual experience exemplifies shapes - phenomenal shapes - which functions as the vehicle for our perceptual representation of shapes. Due to the unique mereological structure of shapes, phenomenal shapes are unable to reliably track any property but shapes. In so far as reliable tracking is a necessary condition for perceptual representation, phenomenal shapes can consequently and contrary to received wisdom only represent shapes.</p
The differences in quality of life between open thoracotomy and video-assisted thoracoscopic surgery (VATS): a literature review
No full textAbstract
Introduction:Thoracotomy is considered one of the most common surgical procedures related to pain. Patients may consider postoperative complications (such as pain) in the hospital as an acceptable risk, but patients are not ready to accept long-term disability that can affect the patient’s daily life.Methods:This article was conducted by analysis and synthesis from various references. The author uses “video-assisted thoracoscopic surgery-VATS” AND “Open Thoracotomy” AND “Quality of Life” as keywords to explore the literature from PubMed, Google Scholar, ProQuest, and Clinical Key. The related papers published in the last fifteen years were included and non-full-text papers were excluded. These papers were analyzed subsequently to answer the aim of this study.Results:We obtained a total of four articles that met our review criteria. Up to six journals were extracted from PubMed, Google Scholar, ProQuest, and Clinical Key. According to our review method considerations, many articles excluded by the year of publication criteria are out of date.Conclusions:Most studies still show VATS’s superiority over thoracotomy. There is a difference in the quality-of-life scores of patients after VATS compared to thoracotomy. VATS shows an improvement in quality of life after the procedure. VATS revealed significantly better results in physical function, physical role, bodily pain, and general health than open thoracotom
Correction To: Predictors of Nodal Upstaging in Patients With cT1-3N0 Non-Small Cell Lung Cancer (NSCLC): Results From the Italian VATS Group Registry
No full textIn the original publication, Carlo Curcio was not included in the author list. The correct author list is included in this Correction
Switching from Thoracoscopic to Robotic Platform for Lobectomy: Report of Learning Curve and Outcome
No full text© The Author(s) 2020. Objective: The optimal minimally invasive surgical management for patients with non-small-cell lung cancer (NSCLC) is unclear. For experienced video-assisted thoracoscopic surgery (VATS) surgeons, the increased costs and learning curve are strong barriers for adoption of robotics. We examined the learning curve and outcome of an experienced VATS lobectomy surgeon switching to a robotic platform. Methods: We conducted a retrospective review to identify patients who underwent a robotic or VATS lobectomy for NSCLC from 2016 to 2018. Analysis of patient demographics, perioperative data, pathological upstaging rates, and robotic approach (RA) learning curve was performed. Results: This study evaluated 167 lobectomies in total, 118 by RA and 49 by VATS. Patient and tumor characteristics were similar. RA had significantly more lymph node harvested (14 versus 10; P = 0.004), more nodal stations sampled (5 versus 4; P \u3c 0.001), and more N1 nodes (8 versus 6; P = 0.010) and N2 nodes (6 versus 4; P = 0.017) resected. With RA, 22 patients were upstaged (18.6%) compared to 5 patients (10.2%) with VATS (P = 0.26). No differences were found in perioperative outcome. Operative time decreased significantly with a learning curve of 20 cases, along with a steady increase in lymph node yield. Conclusions: RA can be adopted safely by experienced VATS surgeons. Learning curve is 20 cases, with RA resulting in superior lymph node clearance compared to VATS. The potential improvement in upstaging and oncologic resection for NSCLC may justify the associated investments of robotics even for experienced VATS surgeons
Mathematical modelling of school teacher’s knowledge and beliefs about dyslexia
No full textTeacher’s role is very important for early identification and inclusion of dyslexic children in mainstream school. Lack of early identification and wrong perceptions of teachers regarding dyslexia may adversely affect the academic growth of dyslexic. The study primarily aimed at giving mathematical model of schoolteacher’s perception of dyslexia in Himachal Pradesh. Schoolteachers of Himachal Pradesh online filled Dyslexia Belief Index developed by Weddington and Wadlington (2005). Among 142 respondents, 45.1% teachers had moderate perception towards dyslexic students, 31% had low perception while 23.9% teachers had high perception towards dyslexic students. Teachers from Arts background, Gender (Male) and, having age between 36 and 40 and teaching experience of less than 5 years remained significant predictor for perception towards dyslexic students. Males were more likely to be at a higher on perception level towards dyslexic students (OR = 4.883, 95% CI 1.728–13.795). Teachers who are the head of the institute are more likely to have high perception towards dyslexic students (OR = 1.212, 95% CI .089–16.566) as compared to teachers who are PGT, TGT and primary teachers. 
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